THE 


ITYDEOPATHIC  ENCYCLOPEDIA. 


f^ 


X       111 


MUSCLES  OF  THE  FRONT  FIGURE. 

A  PLATISMA  MYOIDES— broad  muscle  of  the  neck. 

a  STERNO-HYOIDEUS — muscle  between  the  breast  and  tongue 
bones. 

h  MASTOIDE US— mastoid  muscle. 

B  DELTOIDES — the  muscle  covering  the  shoulder-joint. 

C  BICEPS  BRACHII— two-headed  muscle  of  the  arm. 

D  PRONATOR  RADII  TERES— pronating  muscle  of  the  arm. 

E  SUPINATOR  RADII  LONGUS— supinating  muscle  of  the  arm. 

F  FLEXOR  CARPI  RADIALIS— radial  flexor  of  the  wrist. 

G  PALMARIS  LONGUS— long  bending  muscle  of  the  hand. 

H  FLEXOR  CARPI  ULNARIS— ulnar  flexor  of  the  wrist. 

I  PECTORALIS  MAJOR— large  muscle  of  the  chest. 

K  OBLIQUUS  DESCENDENS— oblique  descending  muscle. 

L  L  RECTUS— straight  muscle. 

L  LINEA  SEMILUNARIS— semilunar  line. 

M  LINEA  ALBA— white  line. 

N  POUPART'S  LIGAMENT— Poupart's  ligament. 

O  0  SARTORIUS— the  "  tailor's  muscle." 

P  TENSOR  VAGINA  FEMORIS— stretcher  of  the  fascia  lata. 

U  PSOAS  MAGNUS— large  lumbar  muscle. 

V  VASTUS  EXTERNUS— great  external  muscle. 
W  RECTUS  FEMORIS— straight  femoral  muscle. 
X  VASTUS  INTERNUS— great  internal  muscle. 

Y  GASTROCNEMIUS— muscle  of  the  calf  of  the  leg. 
y  SOLEUS — a  broad  flat  muscle  of  the  leg. 

Z  TIBIALIS  ANTICUS— anterior  muscle  of  the  leg. 


MUSCLES  OF  THE  SIDE  FIGURE. 

A     DELTOIDES — muscle  covering  the  shoixlder  joint. 

B     BICEPS  BRACHII— two-headed  muscle  of  the  arm. 

C     BRACHIALIS  INTERNUS— internal  muscle  of  the  arm. 

D     SUPINATOR  RADII  LONGUS— long  supinator  of  the  radius. 

E     TRICEPS— three-headed  muscle. 

F     TRAPEZIUS — trapezium-shaped  muscle. 

G     LATISSIMUS  DORSI— lateral  muscle  of  the  back. 

H     SERRATUS  MAJOR  ANTICUS— large  serrated  anterior  muscle. 

I  OBLIQUUS  DESCENDENS  EXTERN  US— external  oblique  de- 
scending muscle. 

K     GLUTEUS  MAXIMUS— largest  thigh  muscle. 

L     GLUTEUS  MEDI US— middle-sized  thigh  muscle. 

M    RECTUS  FEMORIS— straight  muscle  of  the  thigh. 

N     VASTUS  INTERNUS— great  internal  muscle. 

O     VASTUS  EXTERNUS— great  external  muscle. 

P  TENDONS  OF  THE  SEMIMEMBRANOSUS  AND  SEMITEN- 
DINOSUS  MUSCLES,  forming  the  inner  hamstring. 

Q  TENDON  OF  THE  BICEPS  FEMORIS,  forming  the  outer 
hamstring. 

R    ILIACUS  INTERNUS— internal  iliac  muscle. 

S     GASTROCNEMIUS   EXTERNUS— external  muscle  of  the  calf. 

T     SOLEUS— a  broad  flat  muscle  of  the  leg. 

U     PERONEUS  TERTIUS— fibular  muscle  of  the  leg. 

V  i;XTENSOR  LONGUS  DIGITORUM  PEDIS— long  extensor 
muscle  of  the  toes. 

W    TIBIALIS  ANTICUS— anterior  muscle  of  the  leg. 


-'^ 


b' 


V  f" 


•  / 


Vll 


MUSCLES  OF  THE  BACK  FIGURE. 

A  ]\IASTOIDE  US— mastoid  muscle. 

B  TRAPEZIUS — trapezium-shaped  muscle. 

a  INFRA     SPIXATUS— the    muscle   beneath    the   spine   of   the 

.  scupula. 

h  TERES  MINOR— long  round  smaller  muscle. 

r  TERES  MAJOR — long  round  larger  muscle. 

C  LATISSIMUS  DORSI— lateral  muscle  of  the  back. 

D  DELTOIDES — muscle  covering  the  shoulder-joint. 

/  TRICEPS  BRACHL\LIS— three-headed  muscle  of  the  arm. 

g  ANCONEUS— muscle  of  the  elbow. 

h  EXTENSOR    CARPI    RADIALIS    LONG  US— long  radial   ex- 
tensor of  the  wrist. 

E  SACRO  LUIvIBALIS — muscle  of  the  sacrum  and  loiuii. 

F  LONGISSIMUS  DORSI— long  muscle  of  the  back. 

G  GLUTEUS  MEDIUS— middle-sized  muscle  of  the  thigh. 

H  GLUT.EUS  ]\IAXIMUS— largest  muscle  of  the  thigh. 

I  SEMITENDINOSUS— half-tendinous  muscle. 

K  SEMIMEMBRANOSUS— half-membranous  muscle. 

L  BICEPS  FEMORIS— two-headed  thigh  muscle. 

M  GASTROCNEMIUS  EXTERNUS— external  muscle  of  the  calf. 


V 


THE    FOliKAlUI    AM)    IIANP. 


ix 
MUSCLES  OF  THE  FORE-AllM  AND  HAND. 

A    PRONATOR  TERES— long  round  pronator  muscle. 

B     SUPINATOR  RADII  LONGUS— long  radial  supinator. 

C     FLEXOR  CARPI  RADIALIS— radial  flexor  of  the  wrist. 

D     PALMARIS  LONGUS— long  muscle  of  the  palm. 

E     PERFORATUS,  &   PERFORANS— perforated,  and  perforating 
muscles. 

G    ABDUCTOR  POLLICIS  MANUS— abductor  of  the  thumb. 

H     PAL^IARIS  BREYIS— short  muscle  of  the  palm. 

K      EXTENSOR  POLLICIS— extending  muscle  of  the  thumb. 

K     EXTENSOR  PRIMI  INTERNODII— extensor  of  the  first  finger. 

L     EXTENSOR  CARPI  RADIALIS  BREVIS— short  radial  exten- 
sor of  the  -wrist. 

M    EXTENSOR  CARPI  RADIALIS  LONGUS— long  radial  exteu 
sor  of  the  Avrist. 

N     EXTENSOR  DIG ITORUM— extensor  of  the  fingers. 

O     EXTENSOR  CARPI  ULNARIS— ulnar  extensor  of  the  wrist. 

P     ANCONEUS— muscle  of  the  elbow. 

(i     EXTENSOR    SECUNDI    INTERNODII— supinator  and  exten- 
sor of  the  thumb. 

R     EXTENSOR  MINIMI  DIGITI— extensor  of  the  little  finger. 

S     FLEXOR  CARPI  ULNARIS— ulnar  flexor  of  the  ^vrist. 


BONES  OF  THE  HAND. 

A  CARPUS — bones  of  the  wrist. 

B  METACARPUS— bones  of  the  hand. 

C  DIGITUS  PRIMUS— bones  of  the  thumb. 

D  PHALANGES— bones  of  the  finjrers. 


BONES  OF  THE  FOOT. 

A  OS  CALCIS— heel-bone. 

B  TARSUS— bones  of  the  instep. 

C  METATARSUS— bones  of  the  foot. 

D  PHALANGES— bones  of  the  toes. 


XI 


PURIFICATION  OF  THE  BLOOD. 

The  figure  is  an  ideal  view  of  the  circulation  in  the  lungs  and  sys- 
tem. From  the  right  ventricle  of  the  heart  (2),  the  dark,  impure 
blood  is  forced  into  the  pulmonary  artery  (3),  and  its  branches  (4,  5), 
carry  the  blood  to  the  left  and  right  lung.  In  the  capillary  vessels 
(6,  6)  of  the  lungs,  the  blood  becomes  pure,  or  of  a  red  color,  and  is 
returned  to  the  left  auricle  of  the  heart  (9)  by  the  veins  (7,  8). 
From  the  left  auricle  the  pure  blood  passes  into  the  left  ventricle 
(10).  By  a  forcible  contraction  of  the  left  ventricle  of  the  heart, 
the  blood  is  thrown  into  the  aorta  (11).  Its  branches  (12,  13,  13) 
carry  the  pure  blood  to  every  organ  or  part  of  the  body.  The 
divisions  and  subdivisions  of  the  aorta  terminate  in  capillary  ves- 
sels, represented  by  14,  14.  In  these  hair-like  vessels  the  blood 
become^  dark  colored,  and  is  returned  to  the  right  auricle  of  the 
heart  (1)  by  the  vena  cava  descendens  (15)  and  vena  cava  ascen- 
dens  (16).  The  tricuspid  valves  (17)  prevent  the  reflow  of  the 
blood  from  the  right  ventricle  to  the  right  auricle.  The  semilunar 
valves  (18)  prevent  the  blood  passing  from  the  pulmonary  artery  to 
the  riglit  ventricle.  The  mitral  valves  (19)  prevent  the  reflow  of 
blood  from  the  left  ventricle  to  the  left  auricle.  The  semilunar 
valves  (20)  prevent  the  reflow  of  blood  from  the  aorta  to  the  left 
ventricle. 

To  efi'oct  the  complete  purification  of  the  whole  mass  of  blood, 
in  an  adult  of  ordinary  size,  requires  a  pint  of  atmospheric  air  to 
be  taken  into  the  lungs  at  each  inspiration ;  and  as  the  usual  num- 
ber of  inspirations  is  about  eighteen  per  minute,  the  daily  supply 
amounts  to  three  thousand  two  hundred  and  forty  gallons,  or  one 
hundred  and  thirty-five  gallons  per  hour. 


TMK 


HYDROPATHIC  ENCYCLOPEDIA: 


A    SYSTEM    OF 


HYDROPATHY  AND  HYGIENE, 


I.   OUTLINE   OF  ANATOMY,  ILLUSTRATED, 
n.   PETi-SIOLOGY   OF  THE   HUMAN   BODY, 
m.    HYG1E^•IC   AGENCIES  AND   THE    PRESERVATION    OF 
HEALTH. 

IV.  DIETETIC  AND   HYDROPATHIC   COOKERY. 

V.  THEORY   AND   PRACTICE  OF  WATER-TREATMENT. 


I      VI.    SPECIAL  PATHOLOGY  AND   HYDRO-THERAPEUTICS 
INCLUDING    THE    NATURE,    CAUSES,   SYMPTOMS, 
AND   TREATMENT   OF  ALL  KNOWN   iUSEA.SES. 
Vn.   APPUCATION  TO   SURGICAL  DISEASES. 
Vm.   APPUCATION     OP    HYDROPATHY    TO     iUDWITERT 
AND   THE   NURSERY. 


DESIGNED   AS 


A  GUIDE  TO  K-AlLEI^nND   STUDENTS 


AND    A     TEXT-BOOK    FOR    PHYSICIANS. 

^'BY  K.  T.  TRALL,  M.D. 


OTitf)  Numerous  ISnflrabcU  illustrations. 


VOLUME     1. 


NEW    YORK: 

FOWJl^EK       AND    WELLS,    PUBLISB  VKS, 


Boston  :  i 

No.  142  Washington  St.  \ 


NO.     308    BROADWAY 

1857 


1       PHiLAPELnn  1 ; 
\  No.  231  Arcli  S^v»^ 


./\^* 


^ 


CntLTcd,  a:cording  to  act  ^f  Congress,  in  the  yeaj*  185 1,  oy 
FOWLERS  AND  WELLS, 

te  the  <:i*>Tk'«  Oflicc  of  the  Di^trat  Cjurt  of  the  United  States  for  the  Southern  Dtatr'ai 

of  New  York. 


» 1  V  i"^~ 


PREFACE 


In  the  infancy  of  a  system,  so  comprehensive  in  its  principles 
and  so  multitudinous  in  its  details  as  to  embrace  all  the  laws  of 
hygiene,  and  all  the  facti  of  anatomy,  physiology,  and  organic 
chemistry,  it  can  hardly  be  expected  that  its  literature  will  bo 
otherwise  than  crude  and  incoherent. 

Of  the  many  valuable  woi'ks  extant  on  Water-Cure,  no  one 
embodies  all  the  departments  of  science  relating  to  the  cure  of 
disease  and  the  preservation  of  health,  into  a  consistent  and  philo- 
sophical system ;  nor  do  all  of  them  together  treat  of,  or  even 
mention,  the  majority  of  subjects  or  diseases  inseparably  con- 
nected with,  and  forming  parts  of  a  complete  plan  of  hydro-thera- 
peutics. 

In  attempting  to  supply  this  desideratum,  the  author  has, 
through  the  kindness  and  liberality  of  the  publishers,  been  enabled 
to  avail  himself  of  nearly  all  that  has  been  published  in  this  coun- 
try and  Europe  directly  or  remotely  connected  with  Hydropathy, 
as  well  as  an  extensive  range  of  pjivate  correspondence,  and 
written  but  unpublished  experience  in  domestic  practice. 

The  great  number  of  topics  embraced  in  the  scope  of  the  ^^'ork, 
rendered  the  utmost  brevity  of  language  indispensable ;  hence,  in 
advancing  new  doctrinal  propositions,  and  in  controverting  posi 
tions  deemed  erroneous,  but  little  space  was  left  for  details  an 
explanations. 

For  imperfections  in  style  and  arrangement,  the  only  available 
apology  is,  the  many  cares  incident  to  the  medical  direction  of 
two  hydropathic  establishments  during  the  whole  time  occupied 
in  the  preparation  of  the  work. 

New  York.  15  Laight  Street,  185i». 


ANALYSIS    OF    THE    C0NTEN18. 


INTRODLCTION. 

UiSToxv  '  >•  •!'  II  '  INK— Tlit^  Karlicfit  AmioiU  rhysiciaus- The  Early  Grecian  Physi- 
cian*— itic  nnd  th«'  Kmpirical  Physit-iaus— Medical  Philosophers — Hippo- 
crnVf—  ■  rr-^ilnr  !  I'ysiciHii — The  AlexaiiUrijui  School — The  Keguiars  banished 
fr,  .•  I'ractitioncr — Th.' i'rtumaties  and  Eclectics — The  first 
J  .  Arabian  School — The  Monks  and  Alchemists — The  Chem- 
j,  .)!  Kuipirics — The  Regular  and  Irregular  Coutioversy — 
'1  —Revival  of  the  Hippucratean  Doctrine — 'I'he  Fermenta- 
ti,  .  rhysicians — The  Vitaiists — The  Solidists — The  Metapb.ys- 
Icjti  l'hy»u  lu;l^— i^u.  2i:..i.vi;- — lJ;illcr  —  The  Seiui-iinimists — CulUn  —  The  Brunonian 
System — Medicine  at  the  end  of  the  Eighteenth  Century — Medicine  in  the  United 
States 9-3S 

HuTOKY  OK  BATHtNO.— Ancient  Bathing — Bathing  in  the  Middle  Ages— Bathing  Habita 
of  ditt"i;rrnt  Nations — Medicated  Baths— Medicaf  Testimony  in  favor  of  the  Remedial 
Use  of  Water 36-52 

PART  I— ANATOMY. 

Chapter  I.  Of  thk  Bones:  Osteology. — r-tructure  ot  Bone — Development — Stages 
of  Ossification — The  Skeleton — Vertebral  Column — Bones  of  the  Uead — Sutures  of  the 
Skull— Orbits  ol  the  Eye — The  Teeth — Bones  of  the  Chest — The  Thorax — Upper  Ks.- 
Iremitica— Pel  vis — I.tjwer  Extremities — Sesamoid  Bones 53-78 

CuArTEB  II.  Of  thk  Ligamknts:  Syndesmology. — Vertebral  Joints — Neck-joint — 
LowiT  jaw — (,'osto-vrrt«bral — Costo-stcrnal — Sternal — Vcrtebropelvic — Pelvis— Sacro- 
rocrytji'Mti — Puhic — St'rno  clavicular — Shoulder — Elbow — Wrist — Carpal  —  Carpo-me- 
Ijicarpnl— MeUicarpophalangeal — Phahmgeul — Ifip —  Knee — Ankle — Tars;d — Tarsti-me- 
tatursnl — Mt  talarso-phalaii j;ud — Toe 78-3:2 

CUATTER  III.  Ok  THK  McscLKs  :  MYOLOGY. — Structure — Development — Cranial  Group 
— Orbitiil.  Ocular — Nasal — Superior  Labal — Inferior  Labid — Maxillary — Auricular- 
Si:-  •'  ■  '  '  •'  ■  '^-  '■  '  ■  rynireal — Linguinal — Pharyngeal — Palatal — Prevertebral — 
• '  -.—Of  the  Abdomen — Of  the  Trunk — Periuea! — Upp<  r  Ex- 
tj         .  .     92-1-26 

CliArTRR  IV.  l»K  THE  Pasci«:  ApoxEunoLOGV. — Cellulo-fibrous  Fascia — Aponeurotic 
FmcIr — Temporal — Cervical — Thoracic — Abdominal — Inguinal  Hernia — iliac  Fasci;-. — 
Pc'.ric— perineal— Upp'T  Extremity— Lower  Extremitj-- Femoral  Hernia 1J7-J31 

Cmapt  *«  V.  Or  THK  Arteries:  Axgeiology.— Structure— Distribution— Intercom- 
II    ■  -  ■    ii''p — Aorta — Innijniinata — Carotids — Temporal — Maxilhiry 

—  Is — Thyroid  Axis — Internal  Mammary — Axillary — Bracli- 

i- -c  Aorta— Abdominal  Aorta — Gastric-^Hepatic — Splenic — 

MetenUTlc  —  rpcrraanc  —  lliacs  —  Femoral  —  Popliteal  —  Tibials  —  Plan  tar— Pulmnna- 
ry i:U- Uj* 

t'tiAPTKR  VI  Ok  thk  Veins:  Angeiology.— Structure — Of  the  Head— Diploe— Brain 
— Sinu«r« — Of  thn  Neck  — L'pper  Extremities- Axillary,  Subclavian,  Lower  Extremi- 
tiod — Popliteal— Femora!— Ol  the  Trunk- Venae  Cavse — Portal  System — V.na  Portto 

—  Pulmonary 148-155 

Cmapti  R  VII.     Of    the   Lymphatics  :   Anoeiology. — Absorbent    System— Valve;— 

Lyiisphntic  Glands — Lnrt-  ids — Thornric  Duct 1 415-161 

CiiAPTKR  VIII.  Ok  th'-  '  '-  '  ^;  Ni-rnnLOGY. — Structure— Ganiilions  and  Nervous 
r.'.ntern — Nervecell*-  >i],-g — Brain- Cerebrum  —  (  "ivbelhu:)— Mndulla  Ob- 

lonpatiw -Spinal  C^rd—  ^  rv.-s— Spinal   Nerves — OrgaJiic  Nerves— Ganglionic 

»-"y«<""'  lai-ijw 


c  0  N  T  l:  X  T  s 


Chapter  IX.  Organs  of  the  External  Senses.—  ?rgnn  cf  Smell — Orgau  of  Sight — 
Organ  of  Hearing — Organ  of  'iaste — Organ  of  Touch lS9-:203 

Chapter  X.  Of  the  Viscera  :  Splanchnology. — Urart — Larynx — 'I'rachea — Thy- 
roid Gland — Lungs — Pleura — Abdominal  Regions — Peritoneum — Alimentary  Canal — 
Pharynx — CEsophagus — Stomach — Intestines— Liver — Gall-bladder — Pancreas — Spleen 
— Supra-renal  Capsules — Kidneys — Pelvic  Viscera — Mammary  Glands — General  Anat- 
omy of  the  Foetus _ 2U4-'J34 

PART  IL— PHYSIOLOGY 

Chapter  L  Of  the  Tissues. — General  Characters  of  the  Tissues— Development  of 
Cells — Areolar  llssue— Muscular — Nervous — Motory  System — Sentient  System — Re- 
flex System — Mental  System — Philosophy  of  Mind — Nervous  Influence — Rationale  of 
Muscular  Action — Mesmeric  Phenomena — Order  of  Structural  Development. .  235-2.50 

Chapter  II.  Of  the  Special  Senses. — Sensation — Sense  of  Touch— Sense  of  Taste — 
Sense  of  Smell— Sense  of  Hearing — Philosophy  of  Sound — Sense  of  Sight 250-25"} 

Chapter  III.  Of  Voice  and  Speech. — Voice — Speech — Vowels — Consonants — Diph- 
thongs—  Triphthongs  —  Tones  —  Pitch — Volume — Compass — Musical  Notes — Ventrilc 
quism 257-29 

yHAPTEn  IV.  Of  the  Individual  Functions. — Digestion — Circulation — Respiration 
— Abfiorption — Nutrition— Secretion — Excretia  — Caloritication — Endosmose  and  Ex- 
osmose  260-287 

riHAPTER  V.     Of  Temperaments. — Nervous — Sanguine— BiUous — Lymphatic  .  287-2'JU 

Chapter  VI.    Races  of  Men. — Caucasian — Mongolian — Ethiopic — American — Malay — 

Origin  of  Races — Theory  of  Population 290-294 

PART  III.— HYGIENE. 

Chapter  I.  Of  Air. — Vital  Property  of  Air — Quantity  Respired — Purity  of  Air — Change 
of  Air — Position  and  Habits  affecting  Respiration — Catching  Cold — Purifying  the  Air— 
vSleeping  Rooms — Stoves  and  Fireplaces — Lamps — Candles — Gas-burners — Public  C.in- 
veyances 295-304 

Chapter  II.  Of  Light. — Relation  to  Organization — Physiological  Influences — Thera- 
peutic Considerations — Sanatory  Inferences 304-307 

Chapter  III.  Of  Duink. — Nature's  Beverage — Is  Man  a  Drinking  Animal? — Quantity — 
Temperature — Artificial  Drinks — Natural  VVaters — Purification — Adulterations  307-320 

Chapter  IV.  Of  Food. — Chemical  Elemrnts — Proximate  Elements — Aliments,  or  Foods 
Proper — Animal  Food — Vegetable  Food — Cou(iinienis 320-363 

Chapter  V.  Of  Temperature. — Vicissitudes  of  Weather — Generation  of  Animal  Heat 
— Capacity  to  Endure  P^xternal  Heat — Artiticial  Heat — Hcalthl'ulness  of  Climate — Com- 
mon Colds — ?.Ieau  Tempen-.tures 36.3-3fi7 

Chapter  VI.  Of  Exercis:c. — Necessity  for  Exercise — Physiology  of  Exercise — Varie- 
ties— Exercises  of  Children — Times  for  Exercising : 3(^7-370 

Chapter.  VII.  Ok  Sleep.— Definition — Phenomena — Natural  Term  of  Sleep — After 
Meals — Position  during  Sleej) — licda  and   Bedding 370-374 

Chapter  VIII.  Of  Clothing. — Physiological  Nature  of  Clothing — Materials — Color — 
Particular  Garments — Bed  and  Body  Linen — General  Rules 374-377 

Chapter  IX.  Of  Bathing. — Reasons  for  Bathing — Methods — Time  and  Temperature 
ol  Baths — Precautions 377-378 

Chapter  X.  Of  the  Excretions. — Relation  to  Nutrition — Involuntary  i-vacuations — 
Voluntary  Evacuations 379-380 

Chapter  XI.  Of  the  Passions. — Mental  Hygiene — Passions  as  Afl'ecting  Health — 
Healthful  Exercise — Relation  to  Longevity — Relation  to  the  Secretions — Physiological 
Law  of  the  Passions 38  L-383 

Chapter  XII.  Of  Longevity.— Natural  Duration  of  Life — Examples  of  Longevity — 
Natural  Death — Advantages  of  Longevity — Special  Means — Occupations  as  Affecting 
Longevity 383-Ii96 

PART  IV.— DIETETICS. 

Chapter  I.  Dietetic  Character  of  Man.— Bible  Evidence — Anatomical  Evidence-- 
Physiological  Evidence — Medical  Evidence — Ckemical  Evidence — Experimental  Evi- 
dence...  397-417 


vi  CONTENTS. 

rHAPTitm  II.  HronoPATHic  CooKKRV. — Prnctical  Co:is:dcrati«in8 — Prcparariors  of  Ani- 
mal Food— l'r«|iariiUoiia  ot  Vi-gclnble  Food — iireads- — .Seeds — Mushes — Graels  and 
i?oup»— l'u.idinL'8 — l'a*try — Cak.-s— Hoots— Oretn  Vegetables  —  Fruits — Nuts— Condi- 
menu  417-141 

Chafti^m  111.  DiETABiKS. — Gcueral  Uules  lor  Invalids — Therapeutic  Divisions  of  Diet— 
I>irl  lor  Tuhlic  Inatitutions 441-400 

IWRT  v.— THEORY  AND  PRACTICE. 

MAi'TKB  I.  iHiLosorHV  OK  WatekCubk. — Relations  ot  Water  to  the  Healthy  Organ- 
i>ro— .Modus  Out-randi— Watt-r  and  Urugtieatiuent  Contiasted— Rationale  of  Drug-med- 
scatioti «>-~^ 

CMArrKR  11.  Watek-Cube  l'Bf>CKSSKS. — Wet-shect  Packing— Half-pack  —  Douche — 
KuM  .1:.:  ^\^•t  sheet — Hip,  or  Sitzbath — Half-balh — Plunge — Footbath  —  Head-bath — 
«)  •  ract-bhlh — Dry  Pack,  or  r^weatingbath — Vapor-bath — Wave-bath — River- 
b'  ith — Fountain,  or  .^prnj-bnth — Portable  f^hower  bath — Atfusion — Tow«'\ 
or  '"'  •  !res8  Path — Warm  and  Hut  Baths — Swimming-bath — Eye  and 
r  -Oral,  or  Mouth-bath — Arm-hath — Hand-bath — Finger-bath— 
L'  .  \ir-bath —  Fomentiitioua —  llandagts  —  Chest- wrapper — Abdom- 
hi  -Vfiiuoii — Temperature  of  Baths — Duraticm  of  Baths — General  Rules  for 
U\  iiathing — Water-drinking — Lavements  and  Injections 22-59 

Chaj-tku  ill.  Cbisks. — Docriue  of  Crisis — Forms  of  Crisis — Management  of  Crises — 
Kationale  of  Crisis 59-67 

Chapter  IV.  Ok  the  Pclsb. — Nature  of  the  Pulse — Varieties  of  Pulse — Indications  of 
the  I'uise 67-71 

PART  VI— PATHOLOGY  AND  THERAPEUTICS. 

CiiAPTBK  I.  Or  Fevers. — Classifiratlon  of  Fevers — General  Characters — Causes — The- 
ory— Type — Rationale — Crisis — Duration — General  Treatment  —  Ephemeral  —  Inflam- 
matory—  Yellow — Nervous — Putrid — .*^hip — Spotted — Cainji — Jail — llospital  —  Marsh — 
Typhuid  —  H«-niittent  —  Intermittent —  Symptomatic — .Small-pox — Chicken-pox — Cow- 
pox — Measlen — Scarlatina — Erysipelas — Miliary — Plague 72-107 

Chattkr  !!.  Vi^rEBAL  Inflammations. — Theory  of  Inflammation — Rationale — Varie- 
li<  -  — General  Treatment — Phrenitis — Quinsj- — Laryngitis  —  Croup — 
M'  irt,  or  I'leurisy — Carditis — Hepatitis — Splenitis — Gastritis — Enteritis 
—  i\...   ...... ,,.-teritia— Orchitis 108-1^2 

rMArTEB  III.   AuTiiniTis. — Podagra,  or  Gout — Rheumatism — Lumbago — Sciatica  122-1S8 
CiiAi»Tra  IV.    Indiokstion. — Dyspepsia — Liver  Complaint — Misdentition — Colic — Chol- 
era—  Diarrbea — Inleolinal  Concretions — Worms — Hemorrhoids,  or  Piles 12S-150 

Chaftkr  V.     Flixks.— Catarrh — Influenza — Dysentery 151-1.33 

Chaptrr  VI  Caciikx'ES. —  Censumption  —  Marasmus — Atrophy — Anbseniia — Tabes — 
l-.i,...,.  .-1   ..,._!  ,.  .t    y,c — Heimoptysis — Hajmatemesis — Haematuria — Scurry — Pleth- 

or  .M'lnn(,sia — Catacausis 154-180 

Cmat  !■  .  i<r  THE  Eye. — Ophthalmia — Nebulss — Ulcers — Pterysium— 
FUphyioma-  ipil  —  CaUiract  —  .Amaurosis — Strabismus — Psorophthahuia-^ 
THrh(n«!»—  —  Ertropium —  Hordeolum  —  Excrescences  —  Ptosis  —  Fistula 
I-'"  '» — Hemcralopia  —  Nyctalopia  —  Myopia — Presbyopia — Ecchy- 
Hi  :.inces — Burst  Eye 180- 1£7 

CiiAi  ri  n  >iii.  1'.-:  \.K.s  OF  THE  E.u».— Otitis— Otorrhoea—Deaftiess— Otalgia— For- 
eifrn  liixin  •  and  lii-r.ts 137-195 

Cmaptkh   IX.      ERvriiK.MATO(;s    I.nflam.matioxs. —  (Edematous— Erysipelatous — G«u- 

KTeBous—AnsUiraical—Chillilain— Fret— Nettle-rash— Aptha,  or  Thrush— Pemphiijus— 

^^'"'*» 195-203 

CiiAPTKa  X.  s.— Convulbions — Epilepsy— Hysterics  —  Tremor — 

Debnuni  It  —St.  Vitus'  Dance— Raphania—Rarbiers—Coueh— 

^y  s  — Bronchitis— Sternalgia—Pleuralgirt— 

''■.  II— Subsultus — .^tretchii.g— Hydrophobia 

?:•' ■ — K,  ,.j,*\    -(  i;unp  —  Muscular  Distortion  of  the  Spine — 

Mu»cular  .*'t  ly  Neck 204-239 

^"*^""  ^^.  ,  '7  f^'KNKRAL  ToBpiTiDE.— Asphyxia- Ecstasy— CatJ.kpsy— 
I^thnrKy—Apnpifxy— Palsy _ _  2;J9-^45 

*^*f^-Ifi« '^' o  ^''"'^f"^^'r^'5°*»S*'''^*"-"<^P«^c--'^Plenic-I'"°'-^eaHc--.MeVenU>ric-^ 
iDtcsUnal— Omental— Coirphcated _ *>18-''")3 


'J  0  N  T  E  N  T  S.  vii 


% 

Chapter  XIII.  Dropsical  Diseases. — Anasarca  -CEdema  —  Hydrocephalus  —  Spina- 
bifida — Ilydrothorax — Ascites — Hydrops  Ovarii — Hydrops  Tubalis — Hydrops  Uteris 
Hydrocele — Emphysema — Puerperal  Tumid  Leg — Tropical  Tumid  Leg 25:2-261 

CHAPTER  XIV.  Diseases  of  Mis-ossification. — Rickets — Cretinism — Mollities  Ossium 
— Fragilitas  Ossium — Osthexy — Exostosis 262-264 

Chapter  XV.  Diseasks  of  Sensation. — Headache — Neuralgia — Sleeplessness — Rest- 
lessness— Antipathy — Vertigo  —  Syncope  —  Morbid  Sight  —  Morbid  H  „-aring  —  Morbid 
r^mell— Morbid  Taste— Morbid  Touch 264-272 

Chapter  XVL  Mental  Diseases. — Insanity — Melancholy — Madness — Fury — Despond- 
ency— Hallucination — Sentimentalism  —  Hypochondriacism — llevery — Absent-minded- 
ness— Mental  Abstraction — Brovvn-sludy — Somnambulism  —  Sleep-talking  —  Fatuity — ■ 
Irrationality — Imbecility 273-280 

Chapter  XVII.  Diseases  of  the  Vocal  Avenues.— Catarrh — Ozaena — Polypus-  - 
Snoring — Wheezing — Speechlessness  —  Dissonant  Voice  —  Stammering  —  Misenuncia- 
tion 280-284 

Chapter  XVIII.  Diseases  of  the  Sexual  Function. — Mismenstruation — Amcnor- 
rhoea — Dj^smenorrhoea — Chloro.sis —  Leucorrhoea  —  SpermorrhcEa — Venereal  Dis(  ases 
— Satyriasis — Nymphomania — Di.splacements 285-296 

Chaptep.  XIX.  Diseases  of  the  Urinary  Organs. — Suppression  of  Urn.'- — Ischuria 
— Strangury — Diabetis — Eneun^sis — Urinary  Diarrhea — Vicarious  Urination — Gravel — 
btone.  -T 296-300 

Chapter  XX.  Diseases  of  the  SKiN.^-Roseola — Gum  Rash — Lichenous  Rash — Pru- 
ricinous  Rvish — Millet  Rash — Wvter-blebs — Herpes — Rhypia — Eczema — Veal  Skin — 
Mole — Freckles — Sunburn — Orange  Skin — Piebald  Skin — Albino  Skin — Cyanosis — Lou- 
sines.? — Insect  Bites — W()rms — Dandruft' — Leprosy — Psoriasis — Icthyiasis — Impetigo — 
Porrigo — Ecthyma — ScaUies,  or  Lch — Morbid  Sweat — Morbid  Hair 301-31 1 

Chapter  XXI.  Poisons. — Acids — Alkalies — Neutral  Salts — Mercurial — Arsenical — An- 
timonial — Lead — Coppe)- — Bismuth — Tin — Silver — Gold — Iron — Zinc — Manganese — Io- 
dine— Phosphorous — Sulphur — Chrome — Bromine — Alum — Platina — Barytes — Metallic 
Salts  and  Oxides — Narcotics — Acrids — Mushrooms — Poisonous  Fish — Serpents  and  In- 
sects   311-324 

PART  VIL— SURGERY. 

CiiAPTEH  I.  Surgical  Appliances. — Instruments  —  Compress  —  Ligature  —  Sponge — 
Adhesive  Plaster — Tents  and  Pledi.:ets — !)ry-cupping — Bandages — Splints — Caustics- 
Torsion — The  Tourniquet — Congelation  —  Fomentations  —  Emetics — Anaesthesia — Hae- 
mastasis — Transfusion 325-331 

Chapter  II.    Wounds. — Distinctions — General  Consequences — Treatment 332-334 

Chapter  III.  Injuries. — Concussion — Compression  —  Bruises  —  Strains  —  Burns  and 
Scalds — Part-icvjlar  Wuuuds  and  Iisjuries 334-339 

Chapter  IV.  Tumors. —  Whelk — Sycosis — Warts — Corns — Bunion — Onyxis  —  Gangli- 
ons— llanula — Epulis — Bronchocele — Whitlow — Schirrus  and  Cancer — Fungus  Haema- 
todes  —  Bone  cancer — Carbui:ole  —  Lupus — Aneurism — Varix — White  Swelling — Hy. 
drops  Articuli  —  Varicocele  —  IlEsmatocele  —  Sarcocele  —  Hernia  Humoralis  —  Cystic 
Sarcoma — Polj'pi — Enlarged  Pro.-tate  Gland 340-355 

Chapter  V.  Ulcep-s. — Furunculus — Parulis — Fever  Sores — Caries  and  Necrosis — Fis- 
tula in  Ano — Fistula  in  Periniio — Strictures  and  Fissures — Salivary  Fistula — Fistulas 
Lauhrymalis 356-364 

Chapter  VI.  Abscesses. — Empyema — Maxillary  Abscess — Mammary  Abscess — Onyx 
— Lumbar,  or  Psoas  Abscess — Hip-disease — Prostatic  Abscess 365-368 

Chapter  VII.  Herni.^,  or  Ruptures.  —  Varieties  of  Hernia  —  Technology  —  P.ath- 
(ilo>?ical  Distinctions  —  Special  Causes  —  Diagnosis  —  General  Treatment — Radical 
('.urn 369-377 

Chapter  VHI.  Deformities. — Hare-lip — Tiod-tongue — Enlarged  Tonsils  and  Uvula — 
Squinting — Superfluous  Fingers  and  Toes — Web  lingers — Wry  Nock — Spina  Bifida — 
Spinal  Curvatures — ^^lercurializcd  Tongue — Pseudarlhrosis  —  Club-foot —  Contracted 
Sinews 377-384 

Chapter  IX.  Dislocations. — Technology — Dislocation  of  the  Jaw — Clavicle — Shoul- 
der—  Llbow — Wrist — Carpal  and  Metacarpal — Fingers — Hip  —  Knee — Ankle — Foot — 
Toes  385-407 

Chapter  X.  Fractures. — Technology — Fractures  of  the  Cranium — Nose — Lower-jaw 
— Scapula — Clavicle — Sternum — Ribs— Spine — Pelvis — Humerus — Elbow — Fore- arm- 
Wrist— Hand— F'agers— Thigh— Patella— Lrg—  \nkle— Foot 407-423 


Tm  CONTENTS. 

CHArTKH  XI.  Taiwicvlar  Opkhations. — Trephining — paracentesis  Capitis — Paracen- 
ti.'s!^  Oru'i— F!^•.u!:^  !.Mi hry malis — T'litropium  and  Ix-tn-piuni — AnchyJoblcp'naion  and 
t;\:i  iinii  Lnffopiithalmos — Bl<  iilmridoplastice  and  Khinorrbape — 
1,1  ,  itoiny — Kfratoplagtice — Cituplatti'-c — Chelio  and  Genio  plas- 
t;.  tion,  AbborptioTi,  or  Solutitm — IVcthdravving — Pumping^  the 
t^t  -Inoculation — Qisophagotomy — {-'hoking  —  Laryngtoiuy — Tra- 
ch'  >  Abdominis — I'araccntesis  Vesicaj — Imperforate  Anus — Imper- 
fori*:--  Licthru — LiUiuulripBy  and  Lithotomy — Amputation — Ligating  and  Compressing^ 
Arwrua 423-437 

PART  VIII.— MIDWIFERY. 

CiiAPTF.R  I.  HiSTOKV  OK  MiDWiFKRY. — AncicHt  Midwifery — Modern  Midwife: y — F.; 
malu  Authors  wnd  Practitioners — Man  luidwilcry — Who  should  be  Midwives? .  A'.id-4i'.j 

CiiAPTEB  II.  Kepkodcction. — Theories  of  Reproduction — Transmission  of  Organiz  i- 
tion — '11x0  Mart  lageable  Age — physiological  Law  of  Marriage 443—147 

CilAPrKR  in.  I'livsioLOGY  uF  THE  FffiTV s. — Foptal  Development — Fcetal  Circulation — 
'I'Uri  Thymus  (iland — The  Placenta — The  Umbilical  Cord — The  Liquor  Amnii.  447-4.jJ 

CiiApTBB  IV.  Obstetrical  Anatomy. — IJonos  of  the  Ptlvis — Cavity  of  the  Pelvis— 
Di'tmcters  of  the  I'elvi.': — Deformities  of  the  Pelvis 45"J-45J 

CiiAPTKH  V.  I'REO.NA.NCY. — >'igns  of  rrfgiiiincy — Dm||tion  of  Pregnancy — Extra-uter 
ino  Prognnncy — Supertoetation — Pathology  of  the  Foetus — Hygienic  Management  dur- 
ing l'r«'gnnncy — Accidents  of  Prcgmmcy 455-460 

Chapter  VI.  Pahtuhition. — Rationale  of  Labor — The  Pains  of  Childbirth — Medicating 
Labor  Pains — Natural  Labor — Diagnosis  of  Presentations — Stages  of  Labor — Position 
(luring  Labor  —  Mkinagcnient  during  Labor  —  The  Albr-birth — After-management — 
Convalescence  of  Lying  in  Women — Accidi^nts  during  the  Lying-in  Period...  461-475 

chapter  VII.  Infant  Nursing. — Dress  of  Infants — Bathing — Food — Drink — Sleep — 
Exerciec — Kxcretions — Teething — Drugging — Infantile  Diseases 475-482 

Chapter  Vlll.  Complicated  Labors. — Tedious,  or  Protracted  Labors — Preternatural 
Pi  ■  ■  _■  ■  •  ••:  VI  ..:-.,- — Face  Presentations — Breech  Presentations — 
F  Mons  of  the  Superior  Extremities — Compound 
I':  — Prolapsed  Cord- — Retained  Placenta — Hem- 
«)rriiage — c'unvuisiuus — i^ufrperai  Mania — Letcerations 463-49"} 

ArpKNDix — Thcoiy  of  Conception f9?-4&l 


flYDROPi\THI(;     ENCYCLOPEDIA, 


INTRODUCTION. 

Before  t^e  prevailing  medical  practice  can  be  revoluUonized,  and  a 
system  introduced  at  variance  with  established  usages — in  direct  antag- 
onism with  the  general  habits,  customs,  education,  and  prejudices  of 
the  people ;  in  utter  contempt  of  the  teachings  and  practices  of  great 
and  venerable  names,  and  opposed  to  the  pride,  interest,  reputation, 
and  even  conscientious  convictions  of  a  learned,  honorable,  and  influen- 
tial profession — the  intelligent  portion  of  the  comnmnity  will  demand 
reasons  the  most  profound  and  evidences  the  most  conclusive,  while  the 
illiterate  will  require  an  accumulation  of  facts  and  details  absolutely 
overwhelming. 

The  philosophy  of  life  and  health,  the  laws  of  the  human  organism, 
and  its  relations  to  suiTOunding  nature,  have  been,  in  my  judgment,  al- 
ready sufficiently  demonsti'ated  to  satisfy  the  intellectual  mind  of  the 
former  class,  and  their  application  lo  the  preservation  of  health  and 
cure  of  disease  amply  demonsti'ated  by  actual  experiment  for  the  ex- 
ercise of  the  faith  of  the  latter  ckss.  All  that  seems  necessary  now, 
in  order  to  achieve  that  great  reform  in  human  society,  which  shall 
restore  to  the  individuals  who  compose  it  "  sound  minds  in  sound  bo- 
dies," and  that  exalted  state  of  happiness  which  human  nature  is  sus- 
ceptible of,  even  in  this  world,  is,  to  commend  these  great  truths  to  the 
thoughts  and  feelings  of  human  beings  in  such  a  manner  that  they 
shall  be  exemplified  in  their  lives. 

A  short  sketch  of  the  origin  and  progress  of  what  is  called  medical 
science  will  exhibit  the  baseless  fabric  we  are  laboring  to  demolish ;  and 
a  brief  review  of  the  history  of  bathing,  as  it  has  been  employed  rem- 
edially  in  all  ages  of  the  world,  will  prove  that  the  Water-Cure,  though 
in  its  infancy  as  a  system  of  the  healing  art,  has  had,  in  all  its  essentia 
particulars,  the  snnction  of  the  most  learned  men  of  all  professions  in 


10  INTRODUCTION. 


all  ages.     These  topics,  therefore,  preseat  themselves  as  forming  a 
prrtiiient  introduction  to  this  work. 

iMaiiy  of  thf  hlsto*"  ••»1  datu  rehitive  to  these  subjects  are  collected 
from  liostock's  History  of  Medicine,  and  Bell's  work  ou  Baths  and  the 
Water  R«'^imen.  In  the  application  and  genemlization  of  these  data, 
and  in  relation  to  the  principles  to  which  they  refer,  I  have,  how^ever. 
ditfored  often  and  widely  from  these  authors 

niSTOEY    OF    IMEDICINE. 

Writers  generally  agree  that  medicine  first  became  a  profession 
anions  the  Eiiyjuians.  Its  origin,  however,  is  involved  in  fabulous  and 
impenetrable  obscurit}'.  In  Egjpt  and  in  most  of  the  earlier  nations 
the  priests  were  the  practitioners  of  the  healing  art ;  and  unfortunate 
was  it  for  the  human  race  when  medicine  was  "elevated  to  the  dignity 
of  a  distinct  profession."  To  me  the  priest  appeai-s  to  be  the  proper 
person  to  teach  the  body  as  well  as  the  soul  "  the  straight  and  narrow 
way."  The  functions  of  mind  and  body  ai-e  so  intimately  related,  all 
the  powers  of  the  one  and  organs  of  the  other  constantly  acting  and 
reacting  on  each  other,  that  I  cannot  imagine  how  it  is  possible  for  the 
spiritual  or  physiological  teacher  to  do  full  justice  to  man  in  either  re- 
lation of  his  existence  without  understandins;  the  laws  of  both.  JsTar, 
I  would  have  the  same  person  exercise  the  function  of  priest,  doctor, 
lawyer,  and  schoolmaster ;  and  that  individual  who  can  present  to  his 
f»*llow-rreatures  the  most  harmonious  whole  of  a  human  being — who 
ran  best  teach  in  theory,  and  most  faithfully  exemplify  in  practice,  tlie 
laws  of  being  in  his  moral,  physiological,  legal,  and  social  relations, 
should  belong  to  the  learned  profession  and  be  a  leader  among  men. 

Tin:  Karlikst  A.nciknt  Physicians. — The  Egyptian  priests  prac- 
Ui"'\  the  healing  art  by  means  of  magical  incantations,  which,  of 
•  nurse,  produced  their  good  or  bad  impressions  through  the  medium 
of  the  imagination,  the  elTicacy  of  their  prescriptions  bearing  a  pretty 
exact  ratio  to  the  superstition  and  credulity  of  their  patients.  The 
medical  practice  of  the  Assyrian  priests  consisted  mainly  of  magical 
aits,  while  the  actual  learning  they  possessed  was  carefully  concealed 
in  a  mystical  technicality.  Among  the  early  Jews  the  priests,  who 
were  tlw  physicians  also,  treated  the  leprosy  and  other  di^^eases  with 
various  ceremoni<^  to  affect  the  imagination,  at  the  same  time  enforc- 
ing.judiriou?  regulations  to  avoid  the  sources  of  contagion,  and  promote 
personal  cleanliness 

Tmk  Kauly  Grkcia.n  PnvsriAN?  —In  G .eece  the  genius  of  Hip- 


HISTORY    OF    MEDICINE.  11 

pocrates  first  caused  medicine  to  be  regarded  as  a  science,  though 
Chiron,  who  hved  about  1300  e.g.,  is  accredited  for  having  introduced 
the  healing  art  to  his  countrymen,  ^sculapius,  a  pupil  of  Chiron,  is 
considered  the  first  person  who  made  medicine  an  exclusive  study  and 
practice.  His  sons,  Machaon  and  Podalirius,  are  celebrated  in  Ho- 
mer's Iliad  for  then-  medical  skill,  though,  as  they  were  employed 
principally  as  surgeons  in  the  Greek  armies,  then*  medication  was 
doubtless  mostly  confined  to  cmde  yet  simple  methods  of  dressing 
wounds  and  recent  injuries,  which  were  exceedingly  common  in  that 
warlike  age.  The  descendants  of  iEsculapius,  called  Asclepiadoe,  were 
the  priests  of  the  temples  ;  and  the  temples  were  the  hospitals  to  which 
the  sick  were  brought,  where  the  priests  performed  numerous  imposing 
ceremonies  to  inspire  confidence,  and  gave  various  directions  conducive 
to  temperance,  cleanliness,  and  simplicity  of  diet.  The  temples  were 
located  in  the  most  salubrious  places,  and  in  them  frequent  ablutions 
were  recommended  for  the  sick ;  these  w^ere,  no  doubt,  the  real  cura- 
tive agencies. 

W«  have  no  knowledge  that  iEsculapius,  or  his  immediate  successors, 
ever  conceived  the  idea  of  curing  diseases  by  drugs  administered  inter- 
nally. Ablutions,  bandages,  fomentations,  ointments,  mechanical  sup- 
port, and  the  application  of  balsamic  and  astringent  herbs,  with  the 
occasional  use  of  wine  or  other  stimulating  substances,  constituted  their 
whole  and  their  ample  materia  medica ;  and  these  were  aE  employed 
externally. 

The  Dogmatic  j^^d  the  Empirical  Physicians. — For  several 
centuries  succeeding  the  age  of  iEsculapius  and  his  sons,  we  have  no 
records  that  medicine  made  the  least  progi-ess.  Numerous  temples 
w^ere  erected  in  honor  of  iEsculapius,  ^\ilo  was  deified  as  the  god  of 
medicine ;  and  in  these  temples  a  practice  obtained  among  the  patients 
of  recording  on  a  tablet,  for  the  benefit  of  others,  a  statement  of  their 
diseases  and  the  means  by  which  they  were  relieved,  thus  converting 
the  temples  into  schools  of  medicine.  But  then  there  w^ere  men  of 
superior  sagacity  and  inordinate  selfishness,  who  desired  to  turn  the 
common  knowledge  to  individual  cidvantage.  The  temples  of  Uos  and 
Gnidos  became  rival  establishments.  One  assumed  to  be  philosophical, 
by  uniting  reason  w^ith  experience,  while  the  other  professed  to  be 
goverr^d  solely  by  facts  and  observations.  Thus  arose  two  medical 
Beets — tiie  Dogmatists  and  the  Empirics,  who  long  divided  the  medical 
world,  and  whose  influence  is  not  yet  extinct,  for  we  find  at  tnis  day 
many  physicians  who  follow  wherever  theory  leads,  regardless  of  facts 
or  consequences ;    and  another  set  of  practitioners  who  are  merely 


12  INTRODUCTION. 


routine   imitators,  without  a   particle    of  pretension   to   any   rational 

HN  >tf!ll. 

Mkdk  AL  1'milosopukrs.— i*ytlmj,^oi-as,  in  the  sixth  century  before 
Christ,  \\f\s  tlie  pioru-t-r  of  n  class  of  scholars  of  general  information  and 
philosophinil  mind,  who  gave  much  attention  to  the  mvestigation  of  the 
Btructures,  functions,  and  diseases  of  the  human  body.  He  established 
a  school  at  Crotona,  to  which  students  resorted  from  most  parts  of 
Greece  and  Italy.  Mor«  than  twenty  years  of  his  life  were  spent  in 
Kg>'pt,  Chaldea,  and  Eastern  Asia,  and  he  prosecuted  the  study  of 
com|)arutive  aujitomy  I)y  dissecting  animals.  His  pupils  were  not  ex- 
clusively devoted  to  medical  studies,  but  were  among  the  men  most 
celebrated  for  general  erudition  in  that  and  in  the  succeeding  age. 
Aniong  the  most  illustrious  of  his  followers  were  Democritus  and  Hera- 
clitu.s,  the  f( inner  being  regarded  as  the  first  person  who  attempted  the 
dissection  of  a  human  subject.  Acrou  is  mentioned  by  Pliny  as  among 
the  first  who  undertook  to  apply  philosophical  reasoning  to  medicine. 
Herodicus  is  considered  the  inventor  of  gjarinastic  exercises,  which  the 
Greeks  regarded  as  an  important  branch  of  the  healing  art. 

Hiri'ocRATKS. — One  of  the  most  sagacious,  observing,  and  indus- 
trious men  that  ever  lived  was  the  "Coan  Sage,"  who  has  been  enti- 
tled the  "  Father  of  Medicine."  Hippocrates  was  a  pupil  of  Herodicus, 
brought  uj)  among  the  Asclepiadac,  in  the  temple  of  Cos.  He  traveled 
much  in  foreign  countries,  devoting  himself  to  the  study  and  practice 
of  medicine  with  untiring  energy,  and  his  works  became  text-books  for 
many  ages;  even  to  this  day  his  leading  docti'ines  are  extensively  rec- 
ognized. His  practice  has  been  called  a  rational  empiricism ;  in  other 
wonl?.  a  careful  observation  of  facts,  and  a  reasoning  process  based 
ujx)!!  their  ron-equences.  His  first  philosophical  proposition  regarded 
fire  as  the  primitive  source  of  all  matter,  the  four  elements  being  a 
result  of  the  collision  and  combination  of  its  ever-moving  particles;  and 
his  li'ading  physu)!ogical  proposition  was,  the  existence  of  a  general 
presiding  principle  of  vitality  for  the  whole  body,  and  a  special  vital 
power  in  each  organ.  If  we  substitute  the  modern  term,  electricity,  for 
his  "fire,"  and  the  modern  phrases,  organic  sensibility,  and  special 
centre  of  organic  perception,  for  what  he  calls  "nature"  and  "power," 
we  shall  very  nearly  harmonize  his  ideas  with  those  entertained  by 
pomo  of  the  ablest  livii  '  -logists.  His  docti-ine  that  the  fluids 
Were  the  primar>'  seat  .  o  was  never  disputed,  save  by  some 

email  factions  of  medical  nu-n,  u!itil  about  the  commencement  of  the 
•ightejMith  ce^iturv     und  oven  r)ow  it  has  at  least  as  many  advocates  b» 


HISTORY    OF    MEDICINE.  13 

opponents.  In  his  system  the  combinations  of  the  four  elements  of  fire, 
air,  earth,  and  water,  with  their  four  qualities  of  hot,  cold,  moist,  and  diy, 
gave  rise  to  the  four  humors  of  the  body,  blood,  phlegm,  bile,  and  black- 
bile,  which  originally  tended  to  produce  the  four  temperaments,  and 
which  in  their  turn  contributed  to  the  excess  or  defect  of»each  of  the 
humors.  These  speculations,  crude  and  fanciful  as  they  may  be,  at  least 
indicate  a  powerful  tendency  in  the  mind  to  analyze  and  systematize. 

The  doctrine  of  crises  originated  with  Hippocrates.  He  noticed 
that  fevers  evinced  a  tendency  to  terminate  on  particular  days,  which 
he  called  critical ;  and  he  observed  that  there  is  a  tendency  in  all  dis- 
eases to  a  cure  by  some  eruption  or  evacuation.  His  practice  was 
consistently  founded  on  the  indications  presented  by  these  phenomena. 
Modern  physicians  have  been  most  unfortunate  in  overlooking  or  disre- 
garding these  fundamental  truths,  which  happily  are  now  being  re- 
established by  the  water-treatment.  His  materia  medica  was  derived 
wholly  from  the  vegetable  kingdom,  the  horrid  chemicals,  metallic  salts^ 
and  oxides,  acids,  and  spirituous  compounds,  which  have  since  "  demon- 
strated the  eflQciency  of  our  arms,"  in.  killing  pain  and  patients,  being 
then  unknown.  Purgatives,  sudorifics,  diuretics,  and  injections  were 
his  principal  internal  lemedies,  while  externally  he  employed  bleeding, 
issues,  ointments,  plasters,  and  liniments.  The  following  extract  from 
Bostock  shows  a  remarkable  congruity  between  the  leading  practical 
idea  of  Hippocrates,  and  the  doctrine  universally  acted  upon  by 
hydropathic  practitioners ; 

"The  gi'eat  principle  which  dh'ected  all  his  operations  was  the 
supposed  operation  of  'nature,'  in  superintending  and  regulating  all  the 
actions  of  the  system.  The  chief  business  of  the  physician  is  to  watch 
these  operations,  to  promote  or  suppress  them  according  to  circum- 
stances, and  perhaps,'  in  some  rare  cases,  to  attempt  to  counteract  them. 
The  tendency  of  this  mode  of  practice  would  be  to  produce  extreme 
caution,  or  rather  inertness,  on  the  part  of  the  practitioner,  and  we 
accordingly  find  that  Hippocrates  seldoin  attempted  to  cut  short  any 
morbid  action,  or  to  remove  it  by  any  decisive  or  vigorous  treatment. 
Considering  the  state  of  knowledge  on  all  subjects  when  he  lived,  it 
must  be  admitted  thatihis  plan  of  proceeding  was  much  more  salutary 
than  the  opposite  extreme,  and  that  it  had  likewise  the  good  effect  of 
enabling  the  practitioner  to  make  himself  better  acquainted  with  the 
phenomena  of  the  disease,  and,  by  observing  the  unaided  efforts  of 
nature,  to  form  his  indications  with  more  correctness,  and  to  determine 
to  Avhat  object  he  ought  more  particularly  to  direct  his  attention." 

It  must  be  admitted  that  the  bleedings,  active  purgatives,  the  sweat- 
ings and  diuretics  of  the  Hippoeratean  practice  were  inert  comr^r^d 


U  INTRODUCTION 


with  the  more  profuse  bleedings  of  the  moderns,  and  their  hundreds 
of  mineral  poisons;  but  the  constantly  accumulating  number  of  chronic 
diseases,  and  the  greater  fatality  of  acute,  certainly  favor  the  idea 
that  our  modern  .Esculapians,  though  much  more  iwwcrful  doctoi-s,  ai-e 
much  Uss  successful  ones. 

Thk  First  "Irregular"  Physician.— Subsequent  to  the  age  of 
Hipixicrates,  medicine  remained  stationary  for  several  centuries.  His 
sons,  Thcssidus  and  Draco,  his  son-in-law  Polybus,  Diodes  of  Carystus, 
and  Praxagoras  of  Cos,  ai-e  the  only  names  distinguished  among  his 
immediate  successors  One  of  their  coutemporaiies  was  a  Dr.  Chiysip- 
pus,  who  opjwsed  bleeding  and  the  employment  of  active  purgatives ; 
he  was,  however,  regarded  as  a  sort  of  "uTegulai',"  who  did  not  pay 
due  deference  to  the  authority  of  gi'eat  names. 

Plato  and  Aristotle,  like  most  of  the  ancient  Greek  philosophers, 
were  conversant  witli  the  medical  doctrines  of  their  day,  though  not 
practicing  physicians.  The  latter  published  the  fii-st  works  on  anatomy 
and  physiology,  and  all  his  \vi"itiugs,  though  full  of  refined  vagaries,  held 
a  strong  influence  over  the  public  mind  for  many  centuries  after  his 
death. 

The  Alexandrian  School. — The  Ptolemies  founded  a  medicai 
ecliool  at  iVlexandria  about  300  b.c.  The  most  fam&us  of  its  professors 
were  Erasistratus  and  Heroj)hUus,  who  dissected  bodies  of  criminals 
obtained  of  government.  Erasisti'atus,  having  been  a  pupil  of  Chrysip- 
pu.*",  adopted  his  opinions  against  bleeding  and  violent  remedies,  profess- 
ing to  trust  nature  more  and  art  less.  Herophilus  paid  particular 
nttention  to  the  action  of  the  heart,  and  w\is  the  first  to  give  any  thing 
like  an  accurate  description  of  the  various  kinds  of  pulse. 

Soon  after  the  institution  of  the  Alexandrian  school  a  division  of 
medical  men  occurred,  by  which  the  practice  of  physicians  proper,  or 
dietetics,  and  druggist;?,  and  surgeons,  became  distinct  vocations ;  and 
uot  lung  after  this  event  the  gi'eat  schism  occurred  which  divided 
modiral  men  into  two  sects,  the  Dogmatists  and  Empirics,  already 
mentioned.  All  the  medical  men  of  the  day,  and  for  several  succeed- 
ing ages,  were  attached  to  one  or  tlie  other  of  these  rival  parties. 

The  Regulars  Banished  from  Rome. — After  the  decline  of 
Grecian  lit*'niture.  medicine,  as  a  distinct  pursuit,  made  no  progi-ess 
for  a  long  time.  During  the  warlike  days  of  Rome,  she  was,  for  six 
hundred  years,  without  a  physician  who  made  the  healing  art  a  pro- 
fcssior.     The  superstitious  and  :erenionios  of  the  Greeks  were  ti'ans- 


HISTORY    OF    MEDICINE.  16 

Dorted  to  Rome,  and  plagues  and  other  epidemics  were  attempted  to 
be  stayed  by  such  rites  as  would  propitiate  the  offended  deities.  Pliny 
states  that  about  two  hundred  years  before  the  Christian  era,  the  first 
regular  physician,  by  the  name  of  Arcagathus,  established  himself  as  a 
practitioner  at  Rome.  He  was  received  at  first  by  the  people  with 
respect  and  even  reverence,  but  so  severe  was  his  practice,  and  so  un- 
successful its  results,  that  disgust  succeeded  admiration,  and  caused  the 
citizens  to  prohibit  the  practice  by  law,  and  banish  its  professors  from 
the  land. 

About  a  century  after,  Asclepiades,  of  Bithynia,  a  pupil  of  Epicuras, 
went  to  Rome  as  a  teacher  of  rhetoric.  Being  unsuccessful,  he  turned 
his  attention  to  medicine,  by  which  he  acquired  gi'eat  popularity.  His 
practice  was  very  mild  and  cautious,  and  as  he  denounced  with  vehe- 
mence the  harsh  measures  of  some  of  his  predecessors,  he  was  then 
regarded  by  his  contemporaries,  and  is  now  by  medical  historians,  as  a 
sort  of  irregular,  or  quack.  He  was  the  first  to  arrange  diseases  into 
the  classes  of  acute  and  chronic.  His  pupil,  Themison,  of  Laodicea, 
founded  a  third  medical  sect,  called  the  Methodic,  who  adopted  a  kind 
of  eclectic  system,  combining  parts  of  the  systems  of  the  Dogmatists 
and  Empirics.  Like  his  master,  his  philosophical  notions  were  mainly 
derived  from  Epicurus.  Diseases  he  referred  to  states  of  contraction 
and  relaxation,  and  remedies  were  divided  into  two  classes,  asti'ingents 
and  relaxants.  The  Methodic  theory  regards  the  solids  as  the  primary 
seat  of  disease,  thus  opposing  directly  the  Hippocratic  doctrine,  or 
humoral  pathology. 

The  First  Heroic  Practitioner. — The  next  individual  of  note 
whose  discoveries  or  vagaries  have  had  an  important  bearing  on  medical 
practice  was  Thessalus,  who  lived  half  a  century  later  than  Themison. 
By  pompous  pretensions,  swelling  self-sufficiency,  and  abundant  cun- 
ning, he  acquired  gi'eat  reputation  and  wealth ;  he  treated  all  his  pre- 
decessors and  contemporaries  with  the  utmost  contempt,  and  even  took 
to  himself  the  modest  title  of  the  Conqueror  of  Physicians.  He  intro- 
duced a  new  method  of  medical  treatment,  called  metasynocrisis,  which, 
unhappily  for  mankind,  "has  been  too  much  followed  by  the  medical 
world.  It  consisted  in  producing  an  entire  change  in  the  state  of  the  body, 
instead  of  merely  regulating,  correcting,  and  removing  morbid  actions  and 
symptoms  after  the  Hippocratic  plan.  It  may  possibly  startle  the  non- 
medical reader  to  be  informed  that  a  principle  so  manifestly  absurd, 
and  promulgated  by  its  author  dy  fabricator  for  no  other  purpose  than 
to  get  gold  and  fame,  was  generally  adopted  by  subsequent  medical 
writers,  and  is  '^\v  tlie  principal  ccnaer-stone  of  orthodox  medical 


16  INT  n  o  u  i:  '■:  1 1  o  N , 


practice.  Until  the  acUoiit  of  Thc^salus,  the  phj'sicians  were  content 
to  study  the  iiulicitioiis  of  nature,  aid  and  assist  her  efforts,  and  remove 
obstacles  in  her  way.  Since  his  time  faith  in  the  integi-ity  of  nature 
has  steadily  declined,  and  reliance  on  the  power  of  art  as  steadily  ad- 
vanced, until  we  behold  a  body  of  learned  professors  of  the  healing 
art  sending  the  most  deadly  and  desti'uctive  agents  to  ravage  within 
the  domain  of  vitality,  liecdless  of,  or  faithless  to,  the  great  tmth  that 
nature,  and  nature  alone,  is  the  true  physician. 

Soranus  and  C.  A^relianus  are  the  next  Roman  physicians  of  celeb- 
rity. They  were  strict  Methodics,  and  theii  wTitings  did  much  to 
dvance  the  particuhr  notions  which  they  had  imbibed ;  then*  remedial 
measures  were,  however,  ver}-  mild,  and  licnce  generally  successful. 
But  it  is  wortliy  of  especial  remark,  as  evidence  of  the  powerful  influ- 
ence of  a  preconceived  tiieory  over  the  exercise  of  judgment,  that 
modern  writers,  who  have  generally  adopted  the  heroic  notions  of 
Thessalus,  condemn  the  practice  of  these  Methodics  for  its  want  of 
vigor  and  promjJtness.  Its  success  was  no  argument  in  its  fiivcr  so  long 
ns  it  >\'anted  power !  Abstinence,  the  batli,  frictions,  and  external  ap- 
plications were  tlieir  leading  remedial  measures.  Topical  bleeding  was 
also  employed,  though  general  blood-letting  was  rai'ely  resorted  to ; 
narcotics  and  oleaginous  applications  were  frequently  used,  and  gi-eat 
attention  paid  to  pure  air ;  sometimes  a  moist  air  was  enjoined. 

The  Pneumatics  and  Eclectics. — During  the  first  two  centuries 
of  the  Christian  era  the  Methodic  sect  prevailed,  yet  the  peculiar 
speculations  of  differcr.t  individurds  were  gi-idually  inti'oduced,  causing 
at  length  the  formation  of  several  subdivisions,  or  new  sects,  of  medical 
practitionei-8,  the  most  prominent  of  which  were  the  Pneumatics  and 
the  Eclectics,  or  Epit>ynthetics.  Pneumatology  and  eclecticism  are  not 
therefore  quite  as  modern  notions  as  man}-  have  supposed. 

The  PneumiUics  evidently  had  a  glimpse  of  the  trae  idea  of  vitalitj^ 
yet  were  incapable  of  expressing  it  rationally.  They  taught  that  the 
human  boily  was  composed  of  solids,  fluids,  and  spirits.  Their  ideas 
of  tlie  sj)iritual  agency  in  the  production  and  cure  of  disease  were 
etrikingly  analogous  to  the  modern  doctrine  of  the  nervous  influence. 
The  moat  eminent  ^vl•itor  of  this  sect  was  Aretreus.  His  practice  was 
more  active  and  less  expectant  than  that  of  the  Methodics. 

The  most  celebnited  of  the  Eclectics  was  Archigenes,  of  Appamea. 
who  practiced  at  Rome  in  the  time  of  Trajan.     His  A\Titings  are  ex- 
tremely obscure  and  chimerical,  yet  he  acquu-ed  gi-eat  popularity  and 
influence  ;  perhaps  he  is  as  much  indebted  to  the  uninteUigible  chai'ac 
ter  of  his  works  as  to  any  other  circumstance  for  his  faiCB. 


HISTORY    CF    MEDICINE.  17 

Celsus  is  the  first  native  Koman  physician  of  whom  we  ha\e  any 
account.  He  wrote  several  books  on  medicine,  which  show  tliat  sm*- 
gery  and  pharmacy  had  made  considerable  progi*ess.  It  is  difficult  to 
class  him  with  either  of  the  sects  of  his  day ;  in  practice  he  pursued 
mainly  the  method  of  the  Asclepiadcs.  His  origin,  or  the  age  in  which 
lie  lived,  are  not  precisely  known,  though  it  is  conjectured  that  he  lived 
in  the  reigns  of  Augustus  and  Tiberius. 

The  First  Pharmacopceia. — In  the  reigns  of  Claudius  and  Nero  a 
class  of  ^vl•iters  became  famous  by  their  pharmaceutical  preparations. 
The  most  notorious  among  them  were  Scribonius  Largus,  who  made  h 
book  of  nostrums  and  indiscriminate  formulae,  and  Andromachus,  who 
compounded  a  medicamentum  of  sixty-one  ingredients.  It  was  called 
the  theriaca,  and  its  most  essential  constituent,  from  which  its  name 
was  derived,  was  the  dried  flesh  of  ^^pers  !  This  preparation  has 
since  been  recommended,  by  regulcU*  physicians,  for  almost  every 
known  disease,  and  was  even  retained  in  the  pharmacopceias  of  the 
schools  until  the  beginning  of  the  present  century.  lu  fact,  the  cod- 
liver  oil  of  this  day  has  not  been  a  greater  hobby  with  modern  physi- 
cians, than  with  the  ancients  was  the  viperous  compound  of  Androma- 
chus, who,  for  his  marvelous  learning  and  skill  in  mixing  together  the 
most  incongi'uous  articles  in  the  most  nonsensical  manner,  was  honored 
with  the  title  of  Archiator,  or  Principal  Physician — a  title  bestowed  by 
the  Roman  emperors,  and  continued  for  several  centuries. 

Pliny,  though  not  practically  a  medical  man,  was,  nevertheless,  fa- 
miliar with  all  that  was  taught  on  the  subject  in  his  time.  He  repre- 
sents the  prevailing  practice  as  essentially  empirical,  consisting  of  va- 
rious vegetable  and  animal  mixtures,  administered  with  scarcely  any 
inquiry  whatever  into  theu'  mode  of  operation. 

Dioscorides  Avas  a  distinguished  author  at  the  same  period.  An 
elaborate  treatise  which  he  %vrote  on  materia  medica  was  the  standard 
production  for  many  ages  subsequently.  It  contains  descriptions  of  all 
articles  then  employed  in*medicine,  with  an  account  of  their  supposed 
virtues,  much  more  curious,  however,  than  useful. 

Galen. — The  name  and  history  of  Galen  are  more  familiar  to 
modern  practitioners  of  the  healmg  ai*t  than  are  any  other  ancient 
physicians.  Thoroughly  educated  in  all  the  schools  of  philosophy,  he 
selected  from  them  all,  except  the  Epicurean,  which  he  totally  rejected. 
He  was  a  native  of  Pergamus,  b  it,  after  ti-aveling  extensively,  at  the 
request  of  the  Emperor  Aurelius  settled  in  Rome.  His  works  num- 
ber nearly  two  hundred  treatises  on  alL  subjects  directly  or  remotely 


18  I N  T  R  D  D  U  C  T 1 0  N. 


connected  with  medicine.  In  the  formation  of  opinions  he  was  entirely- 
independent,  paying  veiy  little  respect  to  authority ;  and  so  gi-eat  was 
the  reputation  he  acquired  for  learning,  skill,  and  wisdom,  that  his 
opinions  were  regarded  by  many  as  oracles.  In  theory  he  was  with 
ho  Dogmatists,  and  in  practice  he  professed  to  venerate  and  act  upon 
the  principles  of  Hippocrates. 

In  Galen's  time  the  Roman  empire  began  to  decline ;  and  the  gene- 
ral decay  of  science  and  literature  in  the  middle  ages  succeeding,  has 
left  little  to  record  in  the  shape  of  innovation.  Sprenzel  has  pithily 
characterized  the  medical  writei-s  of  the  third  and  fourth  centuries  as 
"  frigid  compilers,  or  blind  empirics,  or  feeble  imitators  of  the  physician 
of  Pergamus."  Oribasius,  who  lived  in  the  fourth  centuiy,  Aetius  in 
the  fifth,  and  Alexander  Trallianus  and  Paulus  ^Egina  in  the  sixth, 
wrote  books  which  professed  but  little  more  than  to  be  compilations  of, 
and  commentaries  on,  the  works  of  Galen 

The  Arabian  School. — With  the  death  of  Paulus,  about  the  mid- 
dle of  the  seventh  century,  terminated  the  Greek  school  of  medicine. 
The  Arabians,  who  conquered  a  large  portion  of  the  semi-civilized 
world,  destroyed  the  immense  Alexandrian  library,  yet  the  Arabian  phy- 
sicians had  adopted  the  opinions  of  Galen,  and  followed  his  practice  im- 
plicitly. But  a  new  school  soon  arose  among  them,  ownng  to  the  inven- 
tion of  chemistr5%  and  its  being  made  subservient  to  medicine.  One  of 
the  most  celebrated  Ai-abian  jihysicians  was  Rhazes,  bora  at  L-ak,  in 
Persia,  in  the  ninth  century.  His  writings,  though  mostly  comments 
on  Galen  and  the  Greek  physicians,  contain  an  original  and  elaborate 
treatise  on  the  theory  and  treatment  of  small-pox  and  measles.  In  his 
writings  on  surgery  and  pharmacy  are  found  indications  of  the  em- 
ployment of  chemical  remedies,  which  formed  so  important  and  so  dis- 
astrous an  era  in  medicjil  history  soon  after. 

After  Rhazes  flourished  Ali  Abbas,  a  physician  and  writer,  who  ob- 
tained the  tirio  of  magician ;  and  about  a  century  later  appeared  on  the 
stage  Avicenna,  who  acquired  a  reputation  among  his  countiymen  not 
inferior  to  that  of  Galen.  He  was  born  at  Bokhara,  a.d.  980,  and  was 
carefully  educated  in  the  schools  of  Bagdat,  His  published  works  were 
nun>erous,  and  his  "  Canon  Modicinae,"  a  kind  of  encyclopoedia  of  ex- 
isting medirnl  sciences,  was  the  text-book  in  nzost  of  the  Arabian,  and 
even  European,  schools  for  several  centuries. 

Mesne  the  elder,  Mesue  the  younger,  and  Albucasis  were  among 
the  last  Arabians  of  distinction  who  ^^T0te  much  on  medical  subjects. 
Avenzoar,  and  his  pupil  Averroes,  natives  of  Spain,  wrote  voluminously 


HISTORY    OF    MEDICINE.  19 

in  the  Arabic  language,  and  enjoyed  great  celebrity,  but  their  works 
have  added  nothing  substantial  to  those  of  their  predecessors. 

With  Averroes  terminated  the  Arabic  or  Saracenic  school  of  medi- 
cine, the  great  reputation  of  which  is  mainly  owing  to  the  circumstance 
that,  from  the  eighth  to  the  twelfth  centuries,  Avhen  all  Europe  was 
sunk  in  deep  bai'barism,  the  principal  remains  of  a  taste  for  literature 
and  science  existed  among  the  Moors  and  Arabs.  Medical  historians 
give  the  Arabians  credit  for  having  added  many  vegetable  products, 
and  a  few  metallic  salts  and  oxides,  to  the  catalogue  of  remedies.  The 
spii'it  of  the  age,  then,  among  those  eminent  m  the  profession — not  un- 
like the  spirit  of  the  present  day — was  that  of  emulation  in  wi'iting  the 
greatest  number  of  books,  and  finding  out  new  substances  which  could 
be  taken  into  the  stomach  and  applied  externally,  and  called  medicines. 
The  intelligent  reader  will  not  fail  to  perceive  that  thus  far,  in  medical 
histoiy,  the  merit  of  successfiil  practice,  amid  all  the  conflicting  notions 
that  have  by  turns  prevailed,  is  fairly  attributable  to  hj^gienic  regula- 
tions, particularly  as  regards  diet  and  bathing ;  while  the  necromancy 
and  the  drugging  may  be  regarded  as  having  been  accidentally  useful 
or  injm'ious,  according  to  ch'cumstances.  This  principle,  which  is  the 
ti'ue  key  to  the  intei-pretation  of  medical  testimony,  will  become  more 
and  more  apparent  as  we  proceed. 

The  Monks  and  Alchemists. — From  the  twelfth  to  the  fifteenth 
centuries  the  practice  of  medicine,  in  those  countiies  best  known  to 
us,  was  principally  in  the  hands  of  the  monks,  whose  healing  resources 
were  mainly  drawn  from  magical  arts  and  asti'ological  superstitions. 
The  mystery  of  this  system  enabled  the  practitioners  to  acquire  an  un- 
bounded influence  over  the  ignorant  masses.  Chemistry,  or,  rather, 
alchemy,  was  then  prosecuted  with  much  ardor,  with  the  view  of 
discovering  a  method  of  transmuting  the  baser  metals  into  gold,  and  of 
preparing  a  universal  medicine — conceits  which  seem  to  have  been  very 
generally  entertained  by  theHearned  of  that  period;  and  the  pursuit  of 
them  led  to  many  experiments  and  the  introduction  of  many  chemical 
preparations  into  the  materia  medica,  and,  indeed,  laid  the  foundation 
of  the  mineral  drag  system  of  the  present  day.  Most  of  the  alche- 
mists and  medical  pretenders  were  knaves  of  the  lowest  character,  or 
dupes  of  the  most  marvelous  credulity,  and  a  few  were,  according  to 
Bostock,  "  compounds  of  knavery  and  folly." 

The  only  medical  schools  of  any  note  were  the  Neapolitan,  of 
Monte-Cassino  and  of  Salerno.  The  latter,  which  was  the  first  to 
grant  diplomas,  maintained  some  reputation  until  eclipsed  by  those  of 
Bologna  and  Paris,  in  the  thirteenth  century.    About  this  time  anatomy 


aO  INTRODUCTION. 


was  ftttentively  studied  by  dissections.  The  first  English  physician 
ot"  note  was  Aiiglicaiius,  who  published  a  work  in  the  early  part  of  the 
fourteenth  century,  entitled,  "Medicinae  Compendium,"  made  up  of 
ivifiing  disquisitions  on  insignificant  topics. 

The  European  feudal  system  now  began  to  be  sliaken  by  the  crtn 
eudes;  Couslantiuople  was  captured  by  Mahomet  the  Second,  about 
the  middle  of  the  fifteenth  centur}' ;  about  thirty  yeara  after  the  min 
of  the  Byzantine  empire  the  Reformation  occun-ed ;  and  about  the 
eame  period  the  art  of  printing  was  invented;  all  of  which  events 
tended  to  give  a  powerful  impulse  to  the  world  of  mind,  and  re-awaken 
investigation  in  all  the  departments  of  science,  literature,  and  the  aits. 
Still,  the  gi-eat  body  of  mediciil  ^^Titers,  for  want  of  philosophical  prem 
ises  by  which  to  direct  scientific  researches,  and  in  utter  destitution  of 
all  ascertained  principles  to  which  they  could  refer  the  facts  developed 
by  anatomical,  pathological,  and  chemical  knowledge,  busied  themselves 
in  collecting,  arranging,  republishing,  expounding,  and  commenting  on 
the  multitudinous  works  of  Hippocrates  and  Galen.  Their  labors  only 
tended  to  multiply  books  ah*eady  too  numerous,  and  mystify  ideas  al- 
ready too  confused. 

The  alchemic  art  was  at  length  ti'ansferred  from  Arabia  into  the  Eu- 
ropean countries,  where  it  was  pursued  with  as  much  assiduity  as  by 
the  Arabs  themselves.  Medical  chairs  were  established  in  various 
universities  in  Europe  during  the  thirteenth  century ;  medical  lectures 
were  given  in  the  universities  of  Vienna  and  Paris,  and  schools  were 
established  in  Padua,  Pavia,  Milan,  Rome,  and  Naples.  Linacre,  who 
was  educated  at  Oxford,  spent  some  time  in  Italy  and  at  the  court  of 
Florence,  and  on  returning  to  England  succeeded  in  establishing  medi- 
cal professorships  at  Oxford  and  Cambridge,  and  laid  the  foundation  of 
the  London  College  of  Physicians. 

Thi:  Chemical  Physicians. — The  next  important  event  in  medical 
history  was  the  formation  of  the  chemical  sect.  Chemistiy,  after  hav- 
ing been  employed  in  various  pharmaceutical  processes,  was  applied  to 
pliysiolog)'.  iKitholngy,  and  therapeutics ;  hence  the  origin  of  chemical 
doctors.  The  chemical  physicians  advanced  their  theories,  which  were 
us  wild  and  extravagant  as  any  preceding,  ones,  with  great  boldness  and 
nssurancp,  and  for  a  long  time  the  Galenists  and  Chemists  were  the 
rivjd  sects  of  the  medical  world.  But  the  Galenists  had  an  ever-pres- 
ent champion  in  the  very  name  of  Galen,  who  may  well  be  called  the 
Prince  of  Medical  Philosophers.  He  was  a  philosopher — a  natural, 
philo'jopher;  for  he  studied  nature  closely,  deeply,  profoundly,  and  de- 
d»ced  his  principal  indications  of  cure  from  an  accurate  observation  of 


HISTORY    OF    MEDICINE.  21 

her  laws.  But  his  system  was  destined  to  be  oveitlirown  by  an  ad- 
venturous vagi'ant,  who,  in  all  the  mental,  moral,  and  physical  elements 
and  proportions  of  a  complete  and  thorough  quack,  never  had  his 
equal  on  earth. 

The  Prince  of  Empirics. — And  now  appeared  upon  the  stage  of 
action  an  individual — Paracelsus  by  name^ — whom  the  whole  medical 
world  denounces  as  a  base,  impudent,  and  unprincipled  charlatan,  yet 
to  whom  the  same  medical  world  is  more  indebted  for  the  present 
/stem  of  allopathic  drugging  than  to  all  other  physicians  who  have 
dver  lived.  It  is  to  him  that  we  owe  the  intfoduction  of  the  antimonial 
and  mercurial  practice  which  constitutes  the  gi'eat  strength  of  the 
popular  materia  medica,  and,  I  may  add,  its  terribly  devastating  power 
on  human  constitutions. 

Aureolus  Phillippus  Paracelsus  Theophrastus  Bombast  de  Hoheu- 
heim,  as  he  delighted  to  style  himself,  was  born  at  Enseidlen,  in  Switzer- 
land, in  1493.  His  father,  who  was  a  physician,  took  great  pains  in 
his  education,  and  he  became  a  proficient  in  physic  and  surgery;  but 
becoming  charmed  witli  the  study  of  alchemy,  his  iiiiher  committed 
him  to  the  instructions  of  Trithemius,  abbot  of  Spanheim,  who  was 
renowned  for  knowledge  in  the  secrets  of  alchemic  art. 

Paracelsus,  by  bold  pretensions,  and  a  few  lucky  adventm'es  in  the 
field  of  medigal  practice,  became  celebrated  among  the  learned  of  his 
day,  and  was  made  a  medical  professor  in  Basil,  in  1527,  where  he  re- 
ceived for  a  short  time  a  large  salaiy.  In  the  "pride,  pomp,  and  cir- 
cumstance" of  this  honored  position,  he  burned,  with  great  solemnity, 
the  works  of  Galen  and  Avicenna,  declaring  to  the  astonished  and 
probably  admiring  multitude  that,  as  he  had  found  the  philosopher's 
stone,  mankind  had  no  further  use  for  the  medical  works  of  others. 

It  is  recorded  of  Paracelsus  that  he  performed  some  gi-eat  cures.  It 
is  certain  that  some  of  his  gi'eat  cures  were  the  exact  prototypes  of 
many  gi-eat  cures  performed  daily  among  us  at  the  present  time,  and 
not  very  much  to  the  advantage  of  the  patients.  For  example,  he  cured 
the  celebrated  printer  of  Basil,  Jerohemus,  of  a  pain  in  the  heel,  after 
"  every,  thing  else  had  been  tried  in  vain."  There  is,  however,  a 
qualification  of  the  story.  The  ti'eatment  moved  the  pain  from  the 
heel  to  the  toes,  which  became  entirely  stiffened,  and  although  the 
patient  had  no  more  pain,  he  soon  died  of  apoplexy ! 

How  far  a  certain  accident  had  to  do  with  his  singularly  eiTatic  and 
profligate  life,  is  worthy  of  a  passing  thought.  In  early  childhood  he 
was  made  a  eunuch  from  an  unfortunate  mutilation  by  a  sow,  and  as  he 
grew  up  he  became  a  perfect  ha^er  of  womankind,  while  a  love  of 


INTkODUCTlON. 


mere  notoriety  seemed  to  have  become  the  passion  by  which  he  was 
ruled. 

ilis  principal  doctrine,  that  the  human  body  is  composed  of  the  three 
elements  of  salt,  sulphur,  and  mercury,  was  stolen  fi'om  the  writings 
of  Viileuline,  and  his  principal  remedies  in  all  diseases  were  mercury, 
antimony,  and  opium.  If  tiie  reader  fad  to  discover  any  relation  be- 
tween such  theory  and  such  practice,*  he  is  in  no  worse  predicament 
than  he  will  find  himself,  in  most  cases,  if  he  attempt  to  trace  the  con- 
nection between  most  of  the  medic*J  theories  and  practices  in  tiiis  more 
enligiiteued  day. 

Tlie  medicjU  life  of  Paracelsus  may  be  stated  in  few  words.  He 
surreptitiously  appropriated  another  man's  lavention  as  his  own,  prac- 
ticed the  vilest  aiLs  of  cliarlataury,  assumed  the  most  pompous  titles, 
proclaimed  that  he  had  discovered  a  universal  panacea,  the  long-sought 
elixir  riife,  by  which  life  could  be  prolonged  to  an  indefinite  period, 
lived  a  dissipated  vagabond,  and  died  prematurely  at  the  age  of  forty- 
eight. 

Thk  Regular  and  Irregular  Controversy. — Although  Pai'a- 
celsus  introduced  a  new  era  in  medical  practice,  and  had,  like  most 
otlier  noted  cliaractei"s  of  lofty-sounding  pretensions  and  brazen-faced 
unpudence,  abundance  of  followers,  still  many  of  the  *' old-school" 
physicians  held  out  against  the  innovations  of  his  disciples.  Thus 
originated  a  contest  between  the  Galenists  and  Chemists,  which  -satis 
prolonged  through  tlie  sixteenth  century.  The  Galenists  were  the 
regulars,  and  the  Chemists  were  the  emph'ics,  of  that  period  The 
former  dealt  out  prodigiously  multitudinous  compounds,  and  tlie  latter 
made  a  bold  stand  with  fewer  but  much  more  potent  agents,  while 
each  sect  accused  the  other  of  killing  their  patients,  I  fear  with  too 
nmch  truth.  The  Paracelsian  doctors  ultimately  triumphed,  and,  as  a 
singularly  striking  exemplification  of  the  strange  inconsistency  between 
the  fancies  and  facts  of  misnjuned  medical  science,  it  may  be  told  that 
the  medical  world  has  long  since  repudiated  every  vestige  of  the  arts, 
pretensions,  and  doctrines  of  Paracelsus  and  his  apostles,  yet  retained, 
imitated,  and  greatly  extended  their  practice ;  for,  notwithstanding 
raotlern  chemists  have  added  several  hundreds  of  other  chemical 
preparations  to  the  materia  medica  of  the  great  Quicksilver  Quack, 
liiere  ih  hardly  a  disease  in  the  catalogue  of  human  ailments  in  which 
the  employment  of  mercurj-,  antimony,  and  opium  is  not  recommended 
by  tlie  standard  authors  and  living  teachers  of  the  Jrug  system. 

The   Anatomical   Puvsic?/ .1.— While   the  discussions  between 


HISTORY    OF    MEDICINE.  2» 

the  contending  parties  just  noticed  were  gi'adually  extending  the  influ- 
ence of  the  empirical  practitioners,  and  circumscribing  that  of  their 
adversaries,  the  science  of  anatomy  began  to  be  more  accurately  culti- 
rated,  which  circumstance  gave  rise  to  a  sect  of  physicians  called  the 
Anatomists.  Vesalius,  about  the  middle  of  the  sixteenth  century, 
})rosecuted  this  department  of  knowledge  with  unwearied  assiduity. 
He  was  followed  by  Eustachius  and  Fallopius,  who  acquired  gi'eat 
reputation  for  anatomical  skill.  The  anatomical  physicians,  however, 
did  not  introduce  any  thing  original  in  relation  to  the  theory  or  the 
practice  of  medicine.  They  were  divided  concerning  the  opinions  of 
Galen,  and  may  be  subdivided  into  his  defenders  and  his  opposers ;  be- 
tween these  sub-sects  long  and  acrimonious  discussions  occurred,  not 
concerning  what  was  true  or  what  was  false,  but  whether  the  notions 
of  Galen  were  right  or  ^vTong. 

Revival  of  the  Hippocratean  Doctrine. — During  the  seven- 
teenth century  the  docti'ines  of  Hippocrates  again  became  the  prevail- 
ing medical  philosophy.  Anatomy  made  rapid  progress  ;  Harvey  dis- 
covered the  circulation  of  the  blood ;  Asselli,  Rudbeck,  and  Baitholine 
traced  out  the  absorbent  system ;  and  Malpighi,  Hooke,  and  others, 
explained  the  structure  and  functions  of  the  lungs.  Boyle  disengaged 
chemistry  from  the  mystery  by  which  it  was  smTounded,  and  explained 
its  true  province  to  be,  not  the  manufacture  of  solid  gold,  nor  liquid 
nostrums,  nor  gaseous  theories,  but  "an  investigation  into  the  change 
of  properties  which  bodies  experience  in  their  actions  upon  each  other." 

Still  the  chemical  physicians  kept  up  the  popularity  of  their  practice 
by  mixing  with  it  not  a  little  of  the  magical  ceremonies  and  asti'ological 
pretensions  so  rife  a  few  centuries  before.  Some  of  them  acquired 
extraordinary  popularity,  and  many  of  them,  paiticularly  in  England; 
become  apparently  sincere  fanatics  to  their  own  system.  Among  these 
were  Fludd,  who  manifested  implicit  faith  in  astrology;  Kenelm  Digby 
a  man  of  rank  and  refined  education,  who  published  an  account  of  th 
mystical  virtues  of  the  "sympathetic  powder;"  and  Valentine  Greatrix, 
who  cured  all  diseases  by  the  imposition  of  the  hand.  "  These  circum- 
stances," says  Bostock,  "are  interesting,  not  merely  as  forming  a  part 
of  the  history  of  medicine,  but  as  displaying  a  singular  feature  in  the 
history  of  tlie  human  mind ;  demonstrating  the  difficulty  which  exists 
:n  eradicating  from  it  errors  and  follies,  even  the  most  gross  and  palpa- 
i)le,  when  they  have  once  become  deeply  rooted." 

Although  the  discoveries  alluded  to  in  anatomy  had  tm'ned  the  atten 
lion  of  medical  men  more  to  vital  actions,  as  aflbrding  a  better  explicatiou 
of  the  phenomena  of  disease  fhan  chemical  changes,  and  had  generally 


24  INTUOL  JCTION. 


restored  the  humoral  pathology  of  Hippocrates,  the  practice  of  medi-    j 
cine  did  uot  undergo  a  corresponding  change.     The  Anatomists  were    \ 
ttuxious  of  course  to  have  their  pharmacopoeia  include  "  all  the  modern 
niprovements,"  hence  they  pursued  a  mixed  or  compound  practice,  by    j 
Hiding  the  mercury,  antimony,  and  opium  of  Paracelsus,  and  other    | 
drugs  of  more  recent  production,  to  the  bleeding,  purging,  sweating,     : 
etc.,  of  the  eai-lier  i>hysician3.     In  fact,  they  incorporated  nearly  all 
that  was    known  of  a  poisonous  or  desti'uctive   natm'e  among  their 
lUcrapcuticid  agents,  and  omitted  nearly  nil  that  was  really  worth  pre-     [ 
ecrving — attention  to  diet,  regimen,  bathing,  cleanliness,  etc. 

i 

Thk  Fkrmextatiomsts. — Another  sect  of  physicians  now  arosQ  | 
or,  rather,  a  branch  of  the  Chemists,  who  attempted  to  blend  the  I 
cnide  chemistry  of  the  day,  and  the  cruder  physiology,  mto  a  com-  ' 
pound  philosophical  system.  The  leading  doch'ine  adopted  by  this  ' 
sect  was,  that  certain  fermentations  in  the  blood,  and  other  fluids,  were  ] 
tlie  causes  of  the  different  states  of  health  and  disease ;  certain  hu-  j 
mors  were  acid ;  others  alkaline ;  and,  as  one  or  the  other  predomi- 
nated, a  con-esponding  specific  disease  was  the  result.  Thus  fever  | 
was  an  acidulous  disease,  requiring  alkaline  remedies,  etc.  This  notion  \ 
was  eloquently  advocated  by  Sylvius,  who  filled  the  medical  chair  at  j 
Leyden,  and  became  the  fashionable  doctrine  in  France  and  Germany  ; 
tor  a  considerable  time.  Willis,  of  England,  was  also  an  able  defender  : 
of  the  chemical  doctrines ;  he  published  a  work  in  1759  on  fermenta-  j 
tion  and  fever,  wherein  he  attempted  to  prove  that  every  organ  in  the  ' 
body  had  its  own  peculiar  fermentation,  a  morbid  state  of  which  con-  j 
slituted  disease.  '■ 

Sydenham,  who  has  been  called  the  English  Hippocrates,  agi'eed  \ 

with  Willis  in  the  theory  of  chemical  fermentation,  but  adopted  the  j 

Hippocratic  doctrine,  that  the  primary  changes  in  disease  take  place  in  ; 

tlie  fluids  instead  of  the  solids.     He  also  agi-eed  with  Hippocrates  that  , 

disease  was  an  eflfort  of  nature  to  get  rid  of  noxious  matters,  and,  like  j 

his  great  prototj-pe,  adapted  his  remedial  agencies  mainly  to  the  regu-  1 

lation  of  the  actions  of  the  system.     Though  his  practice  has  been  i 

called  feeble  and  inert,  it  would  be  difficult  to  name  an  equally  success-  ' 

ftd  i)hy9ician  among  the  bolder  practitioners  who  have  wielded  more  • 

potent  drugs  since  his  day.  i 

Notwitlisfnnding  numerous  discoveries  had  been  made,  and  many  j 
facts  accumulated  up  to  tiiis  date  in  chemistry,  anatomy,  and  physi- 
ol()g\',  it  m  at  least  questionable  whether  any  more  rational  views  were 
eiitertain«'d  of  the  true  nature  of  disease  than  were  advanced  by  Hip- 
pocrates nciirlv  three  thousand  years  before  ;  and  it  is  positively  certain  j 


HISTORY    OF    MEDICINE.  26 


hat  none  among  the  most  eminent  of  the  new  schools  or  sects  of  more 
modern  date,  have  been  more  successful  in  cui'ing;  diseases  than  were 
Hippocrates,  Galen,  and  Sydenham. 

The  Mathematical  Physicians. — Mathematical  science  Imving 
made  considerable  progress  during  the  latter  part  of  the  sixteenth 
centuiy,  the  medical  theorizers  of  the  day  seized  upon  its  facts  to 
effect  another  docti'inal  revolution  ;  hence  arose  a  sect  whose  members 
composed  the  Mathematical  school.  Borelli,  a  profound  mathematician, 
undertook  to  explain  certain  functions  of  the  body  on  mechanical 
[)rinciples ;  and  his  pupil,  Bellini,  maintained  that  all  the  actions  of  the 
cody  were  under  the  influence  of  gravity  and  impulse,  and  that  all  the 
vital  functions  could  be  elucidated  by  an  application  of  the  principles  of 
hydraulics  and  hydrostatics.  The  new  hypothesis  soon  ranked  among 
its  converts  many  of  the  most  learned  men  of  the  age,  and  the  Mathe- 
matical physicians  became  formidable  rivals  to  the  Chemical.  The 
phenomena  of  disease  were  accounted  for  by,  or,  rather,  referred  to, 
the  mechanical  terms  of  derivation,  lentor,  obstruction,  friction,  resolu- 
tion, etc. ;  but,  as  has  been  the  case  in  most  instances  from  the  creation 
of  the  world  to  a.d.  1851,  the  practice  had  little  or  no  relation  to  the 
theory.  Diseases  were  treated  by  the  Mathematical  physicians  with 
the  remedies  of  the  Chemists  and  Galenists.  Indeed,  the  practical 
pai-t  of  medicine  was  regarded  then,  as  it  had  been  long  before,  and 
has  been  long  since,  of  secondary  importance  to  the  theory.  The 
minds  of  medical  men  were  mainly  devoted  to  theoretical  speculations, 
and  vastly  more  talent  was  wasted  in  endeavoring  to  establish  and  pro- 
mulgate favorite  dogmas,  of  no  earthly  use,  except  to  render  the  au- 
thors of  them  famous,  than  was  expended  in  investigating  ti'uth  or 
curing  diseases. 

The  ViTALiSTS. — The  next  medical  sect  in  order  was  the  Vitalists. 
It  originated  with  Van  Helmont,  and  finally  triumphed  over  both  the 
Chemical  and  Mathematical  sects.  Van  Helmont  at  first  belonged  to 
the  Chemical  school ;  but  to  its  doctrines  he  added  the  idea  of  a  specific 
agent  residing  in,  or  attached  to,  the  system,  which  controls  its  own 
spontaneous  actions,  and  also  the  actions  of  remedial  age^its.  This 
conception  was  doubtless  the  ideal  germ  of  the  vital  principle  of  later 
physiologists,  and  the  vis  mecUcatrix  natures  of  the  present  day ;  nor  is 
it  radically  different  from  the  idea  of  the  efforts  of  nature  as  enter- 
tained by  Hippocrates. 

Van  Helmont  proposed  nothing  new  in  the  way  of  curing  diseases, 
contenting  himself  with  mere  matters  of  opinion ;  and  the  commiini- 


16  INTRODUCTION 


cntion  of  his  doctrines  did  not  allay  the  wordy  wai-fare  still  waged  be- 
tween the  Chemists  and  iMathematicians,  until  it  was  revived  and  re- 
fined by  the  genius  and  energy  of  the  next  successful  adventurer  in 
the  field  of  niediad  theory. 

This  was  Stahl,  who  was  born  at  Anspach,  in  IGuO.  He  undoubt- 
edly saw  the  sad  deficiencies  and  gross  errors  in  the  prevailing  theories. 
and,  perceiving  that  neither  chemical  nor  mechanical  reasoning,  nor 
both,  could  ever  explain  the  phenomena  of  life,  he  refeiTed  vitfd  ac- 
tions to  the  operation  of  a  principle  he  called  anima.  From  a  close 
obsen-ation  of  the  intluence  which  tlie  mind  exercises  over  the  body, 
he  came  to  the  conclusion  that  all  the  vital  functions  w^ere  produced 
and  sustained  by  the  influence  of  an  animating  and  superintending 
spiritual  principle.  This  principle  prevents  or  repairs  injuries,  coun- 
teracts or  removes  morbific  causes,  and,  in  fact,  appears  to  be  the  ag- 
jfregate  of  what  modern  physiologists  speak  of  as  the  crganic  instincts. 

But,  as  an  exception  to  the  general  rule,  the  theory  of  Stahl  did  in- 
tluence  his  practice  very  considerably,  for,  instead  of  the  rash  and 
dangerous  potencies  and  process-es  then  in  vogue,  his  view^s,  in  the  lan- 
guage of  an  eloquent  historian,  "tended  to  repress  the  energy  of  the 
practitioner  still  more  than  the  pathological  doctrines  of  Hippocrates. 
They  did,  indeed,  cause  him  to  trust  more  to  his  presiding  deity — the 
great  physician.  Nature — and  less  to  artificial  drugs  and  destnactives. 
Happy  would  it  have  been  for  the  human  race  if  a  more  inert  practice 
lind  continued  to  this  day,  to  "  repress  the  energy  of  the  practitioner," 
tor  sad  experience,  and  the  constantly  accumulating  catalogue  of  human 
ills  and  chronic  n)aladies,  unheard  of  in  former  days,  sufficiently  dem- 
onstrate that  success  in  curing  disease  holds  a  much  nearer  relation 
to  the  inertness  than  to  the  energj'  of  the  practitioner,  as  far  as  active 
poisons  are  concerned. 

The  doctrines  of  Stahl,  and  the  extraordinary  metaphysical  acuteness 
with  which  they  were  supported,  had  ah  extensive  influence  on  medi- 
cal o})inions ;  but  about  that  period  there  were  so  many  rival  medical 
schools  evolving  new  theories,  each  advancing  their  claims  to  notice  with 
p-eat  7.eal  and  ability,  that  it  was  impossible  for  any  one  hypothesis  to 
be  ctMiiTally  rcccivod. 

Thk  Soliihsts. — Hoffman,  the  conlempoi-ary  of  Stahl,  was  also  his 
colleague  in  the  University  of  Halle,  as  well  as  his  rival,  and  an  equal 
aspirant  for  name  and  tlnne.  He  wTote  voluminously,  and  the  princi- 
pal theoretical  notion  which  he  originated  was  a  modification  of  the 
Stnhlian  doctrine  of  vitality.  Instead  of  refeiTing  the  operations  of  the 
•nimal  oconon.y  to  an  anima,  ho  imputed  them  to  a  nervous  injiiience. 


HISTORY    OF    MEDICINE  27 

This  was  almost  a  distinction  without  a  difference,  but  it  served  his. 
purpose.  The  details  of  his  practice  were  essentially  those  of  the 
Chemica.  and  Mathematical  physicians,  possessing  no  new  feature 
whatever.  His  pathology'  united  the  notions  of  the  Humoralists  and 
Solidists,  and  he  advanced  the  doctrine  of  tone  and  atony ^  or  spasm 
and  relaxation  of  the  moving  fibres — a  doctrine  which  long  influenced 
the  writings  of  his  successors,  and  which  was,  no  doubt,  derived  from 
the  ancient  notion  of  constriction  and  relaxation.  His  writings  are  sa4d 
to  abound  in  inconsistencies  and  contradictions. 

In  ]G71  Glisson  published  a  treatise,  in  which  he  advocated  the  doc- 
ti'ine  of  muscular  in-itability,  explaining  it  as  a  specific  property  attached 
to  the  living  fibre,  in  opposition  to  the  humoral  pathology  of  Hippo- 
crates, which  until  this  time  had  generally  prevailed.  Toward  the 
close  of  the  seventeenth  cenitury,  Bagliva,  an  eminent  medical  scholar, 
systematically  opposed  the  Hippocratic  pathology,  placing  all  the  causes 
of  disease  in  an  altered  condition  of  the  solids.  These  two  writers 
laid  the  foundation  for  the  overthrow  of  the  humoral  pathology  and 
the  introduction  of  solidism,  which  has  been  very  generally  received 
by  the  medical  profession  to  the  present  time.  It  is  now,  however, 
decidedly  on  the  decline. 

But  this  revolution  in  theory  had  no  perceptible  effect  on  the  prac- 
tice. Whichever  hypothesis  the  physician  adopted  was  the  samo  to 
the  patient.     The  prescriptions  were  alike  in  either  event. 

The  Metaphysical  Physicians. — Soon  after  the  revival  of  letters, 
the  greatest  scholars  among  medical  men  were  incessantly  laboring  to 
apply  the  inductive  philosophy  inti-oduced  by  Bacon,  and  found  so  suc- 
cessful in  advancing  other  departments  of  philosophy,  to  the  study  of 
medicine  as  a  science.  How  signally  they  failed,  let  the  record  of  in 
numerable  theories  which  have  come  and  gone,  like  the  changes  of  the 
moon,  testify.  This  failm-e  was  not  owing  to  a  want  of  learning,  or 
ambition,  or  industry,  or  integrity  of  pui-pose.  It  is  atti-ibutable  purely 
to  the  want  of  the  true  starting-point.  The  learned  world  was  full  of 
book-made  philosophies,  brain-racked  theories,  and  closet-engendered 
metaphysics.  The  minds  of  medical  authors  were  all  more  or  less 
warped  and  beclouded  Avith  the  speculations  of  their  predecessors  and 
teachers.  There  was  no  one  of  sufficient  originality'  of  intellect  and 
independence  of  mind  to  '^ast  off  the  ti-emendous  incubus  of  venerated 
authority,  and  go  directly  to  the  truth  itself  for  the  evidence  of  ti'uth — 
to  ask  nature  to  interpret  her  own  laws.  Destitute  of  all  demonstrable 
premises  upon  which  to  predicate  their  investigations,  and  from  which 
to  extend  their  inquiries,  each  one  seems  to  have  conceived  a  hypo- 


/8  INTROiJUCTION. 


iliesis,  or  detected  an  error,  and  then  studied  and  wrote  to  mamtain 
the  one  or  refute  the  otJier.  The  dh'cction  of  men's  minds  was  too 
my:jlically  niftapliysical  for  the  prosecution  of  ti'ue  philosophical  re- 
search. How  few  men  have  ever  lived  who  had  mental  capacity  even 
lo  think  of  a  fiiijt  principle  ! 

BoERHAAVK. — No  One  ranks  higher  in  the  annals  of  modern  medi- 
cal history  than  Boerhaavc,  who  was  contemporaneous  with  Stahl  and 
[loJTinan.  He  was  a  professor  at  Leyden,  and  in  practical  judgment 
lias  been  justly  regarded  as  superior  even  to  Galen.  But  in  groping 
among  the  dm'k  chimeras  of  his  predecessors  he  was  unable  to  find  any 
thing  more  eudm-ing  than  mere  conjectm'e  and  gi-atuitous  assumption 
upon  which  to  establish  a  new  system.  He  attempted,  however,  to 
form  and  fashion  out  of  the  discc  .'dant  materials  before  him  a  theory 
and  practice  which  should  combine  the  excellences  of  all  systems,  and 
be  truly  eclectic.  But  any  system,  embodying  such  conflicting  opinions 
OS  were  found  in  the  speculations  of  the  different  schools,  must  neces- 
sarily contain  the  seeds  of  early  dissolution ;  and  accordingly  we  find 
that  the  system  of  Boerhaave  did  not  long  survive  him.  His  nephew, 
Kauw  Boerhaave,  his  successor,  Gaubius,  and  Gorter,  a  professor  of 
Harderwyc,  wrote  extensively  on  medical  subjects,  but  to  little  account, 
save  to  restore  the  vital  agency  in  explaining  the  phenomena  of  disease, 
which  Boerhaave  had  nearly  discarded. 

Van  Swietcn,  professor  in  the  medical  school  at  Vienna,  was  a  fol- 
lower of  Boerhaave,  and  the  ablest  supporter  of  his  views.  He  wrote 
extensive  commentaries  on  the  multitudinous  aphorisms  of  his  prede- 
cessor, but  they  were  of  little  practical  value. 

Hallkk. — This  distinguished  scliolar,  who  has  been  called  the  father 
of  modern  physiology,  was  a  pupil  of  Boerhaave.  He  possessed  a  mind 
singularly  oi'iginal  and  comprehensive,  and  afler  long  and  patient  re- 
search into  the  nature  of  the  functional  powers  of  the  human  body, 
made  a  substantial  improvement  in  physiological  science.  Disregarding 
nil  the  authority  of  learned  names  and  mere  theories,  he  established 
the  doctrine  of  the  iiritahility  and  sensibility  of  the  muscular  and  nei  j- 
ous  systems.  His  Elements  of  Physiology  "introduced  a  new  era  int® 
medical  science."  His  peculiar  views  were  warmly  controverted  by 
many  distinguished  \\Titer9,  and  as  warmly  supported  by  others. 

T'lE  Semi-Ammists. — Wliile  Haller's  doctrines  were  sti-engthened 
and  confirmed  by  numerous  experiments  instituted  by  Z'mmerman, 
Coldani,  Fontnnn,  Tissrt.  Zinn,  and  Verschuir,  they  were  powerfully 


HISTORY    OF    MEDICINE.  29 

opposed  by  Wliytt  and  Porterfield,  of  Scotland,  whose  reasonings, 
however,  though  able  and  acrimonious,  have  been  characterized  as 
much  more  metaphysical  than  physiological.  Whytt  succeeded  in 
founding  a  sect  called  the  Semi- A  limists,  whose  principal  distinctive 
tenet  was  a  vital  or  sentient  principle  compounded  of  the  docti'ines  oi 
Stahl  and  Haller,  evidently  intended  ts  a  middle  theory  between  the 
two. 

Sauvages,  professor  at  Montpelier  in  1734,  was  one  of  the  main  sup- 
porters of  the  Semi-Animist  sect.  He  was  the  first  to  arrange  diseases 
into  classes,  orders,  genera,  and  species,  constituting  a  methodical 
nosology.  Still  we  have  no  evidence  that  these  conti'oversies,  modifi- 
cations, revolutions,  or  improvements  materially  affected  the  prevailing 
method  of  ti'eating  diseases  at  the  bedside. 

CuLLEN. — William  CuUen,  who  was  the  successor  of  Whytt  in  the 
University  of  Edinburgh,  achieved  as  brilliant  a  reputation  as  Haller, 
and  effected  as  great  a  revolution  in  medical  practice  as  Haller  did  in 
physiology.  In  discriminating  the  phenomena  of  disease,  Culien  was 
unrivaled;  and  he  was  the  first  medical  innovator  for  ages  whose  theory 
and  practice  were  consistent  with  and  sh-ictly  related  to  each  other. 
His  "First  Lines  of  the  Practice  of  Physic"  were  in  fact  text-books 
in  our  medical  schools  less  than  a  quarter  of  a  centuiy  ago.  His  works 
on  nosology  and  materia  medica  have  never  been  excelled  in  rigid 
powers  of  analysis  and  accuracy  of  observation,  and  his  opinions  are 
often  quoted  as  high  authority  by  medical  journals  of  the  present  day. 
But  his  carefully  elaborated  theories  were  wanting  in  the  one  thing 
needful  for  an  enduring  system — an  ascertained  first  principle,  and 
hence  were  destined  to  pass  away  like  the  baseless  fabrics  of  a  thousand 
other  theoretical  visions  whiuh  preceded  and  succeeded  him.  No  one 
now  pretends  to  acknowledge  or  defend  his  theories,  though  many 
physicians,  perhaps  a  majority,  follow  essentially  his  practice,  thus 
exhibiting  another  of  those  glaring  absurdities  which  stamp  with  incon- 
sistency ahiiost  every  page  of  medical  history. 

The  Cullenian  system  of  ti'eating  diseases  may  be  resolved  into  a 
single  indication,  that  of  counteracting  the  symptoms.  Thus  in  a  fever 
he  would  reduce  by  bleeding,  niti'e,  and  other  antiphlogistics,  in  the  hot 
stage ;  stimulate  with  bark,  wine,  tonics,  etc.,  in  the  cold  stage ;  and 
obviate  spasm,  putrescency,  etc.,  with  narcotics,  alkalies,  acids,  etc.,  in 
the  intermediate  or  sweating  stage.  Nothing  can  be  more  absurd  than 
such  a  practice  in  a  fever  which  passes  tlu'ough  all  these  stages  once  a 
day,  or  every  other  day  for  several  weeks,  for  it  keeps  one  hand  con- 
tiaually  working  against  the  other      It  amounts  tc  nothing  but  treating 


80  INrilODUCTION. 


toniporai-y  and  ever-changing  symptoms  on  a  plan  of  antipathy  or  an- 
tagonism, without  any  rt'gard  to  the  permanent  state  of  the  constitution, 
or  natural  course  and  termination  of  the  disease.  Yet,  as  already  inti- 
mated, it  is  tlie  prevailing  allopathic  practice. 

It  should  bo  mentioned  that  Culleii  recognized  the  self-preserving 
and  self-rngulating  jninciple  of  vitality;  but  he  improved  on  the  notions 
of  Stahl,  Van  Helmont,  and  Hoffman,  in  explaining  it  as  an  inherent 
property  of  organization,  which  he  called  the  vis  medicatrix  nature,  or 
remedial  power  of  nature,  rather  than  a  superadded  sentient  principle. 

TiiK  BiiLNOMAN  System. — The  Cullenian  school  found  a  rival  in 
the  bold  vagaries  of  what  has  been  called  the  Brunonian  theory,  in  an 
eai'ly  period  of  its  existence.  A  Dr.  Brown,  of  Edinbui-gh,  who  had 
been  a  personal  and  professional  friend  of  Culleu,  became,  from  some 
cause — ])robably  spleen,  jealousy,  or  disappointment — his  bitter  antago- 
nist, and  a  vehejnent  opposer  of  his  doctrines.  To  effect  his  purposes 
of  ambition  and  opposition  he  advanced  a  new  medical  doctrine.  He 
did  not  trouble  himself  about  authorities,  facts,  experiences,  or  reasons, 
but  simply  assumed  his  principles,  announced  his  doctrines,  laid  down 
his  pnictice,  supported  the  whole  with  lofty  pretensions,  and  found 
many  followers  among  men  of  learning  and  science,  and  in  many  med- 
ical schools  whose  professors  adopted  his  doctrines. 

Brown  maintained  that  life  was  a  forced  state,  analogous  to  the  flame 
of  a  candle ;  that  any  thing  which  affects  the  living  body  acts  as  an 
excitant  or  stimulant  upon  a  specific  projDerty  it  possesses,  which  he 
termed  excitability.  Thus  defective  excitement  or  stimulation  produces 
accumulation  of  excitability,  oi  indirect  debility,  while  excessive  stimu- 
lus produces  exhausted  excitability,  or  du-ect  debility;  and  that  all 
diseases  are  referable  to  one  or  the  other  of  these  states,  requiring 
Btimuh.ting  or  reducing  measures,  as  the  excitability  is  exhausted  or 
accumulated.  The  practice  that  naturally  results  from  such  a  theory 
or  phantasy  is  bleeding  in  one  class  of  diseases,  aud  brandy  in  the 
other;  and,  in  truth,  the  world  is  much  indebted  to  the  genius  or  the 
impudence  of  John  Brown  for  the  extensive  use  of  alcohol  and  alcoholic 
mixtures  in  modern  medical  prescriptions. 

The  poetical  and  refined  Darwin  deserves  a  passing  notice  here,  as 
a  fruitless  theorist  and  elaborate  speculator.  His  "Zoonomia"  is  cer- 
tainly a  monument  of  genius,  but  destitute  of  any  sound  philosophical 
principles,  and  his  medical  notions  are  now  universally  regarded  as 
purely  fanciful. 

Medicine  at  the  End  of  the  Eighteenth  Century. — At  the 


HlSTOlir    OF    MEDICINE.  31 


conclusion  of  the  eighteenth  century,  L.e  physicians  on  the  continent 
of  Europe  generally  pursued  the  eclectic  plan  of  Boerhaave.  Among 
the  French,  Lieutaud,  who  published  in  1749  a  gi'eat  work  called  "Sy- 
nopsis Universse  Praxeos  Medica?,"  was  the  most  celebrated.  In  Ger- 
many, De  Haen  published  a  work  equal  to  Lieutaud's,  called  "  Ratio 
Medendi,"  but  he  bitterly  opposed  all  the  new  notions  of  that  period,  and 
waiTed  against  Haller's  docti'ines,  and  against  the  practice  of  inocula- 
tion. The  most  celebrated  medical  schools  in  Europe  were  those  of 
Paris,  Vienna,  and  Leyden.  The  medical  schools  of  Italy  also  enjoyed 
a  high  reputation.  Bonet  and  Mangel  there  introduced  the  shady  of 
pathological  anatomy,  which  was  followed  up  by  Valsalva  and  Morgagni, 
who  made  extensive  post-moitem  examinations,  and  recorded  the  ana- 
tomical appearances  of  the  stractm-es.  One  source  of  error,  however, 
pervaded  all  their  observations,  as  it  does  post-mortem  investigations  at 
this  day.  It  is  this.  Structural  appearances  after  death  denote  the 
effects  of  disease ;  and  these  morbid  changes  were  and  are  often  mis- 
taken for  or  confounded  with  the  causes  of  disease. 

Burserius  was  the  only  theorist  of  any  note  that  Italy  produced  at 
this  time,  but  his  works  are  only  admired  for  the  elegance  of  the  lan- 
guage in  which  they  are  written.  The  Italians  adopted  the  Brunonian 
system;  but  the  fatality  attending  its  practical  application  caused  its  utter 
abandonment,  and  a  return  to  the  equally  u'rational  theory  but  somewhat 
less  fatfd  practice  of  the  Cullenian  school.  The  Egyptian  physicians 
were  more  disposed  to  prosecilte  anatomical  and  physiological  re- 
searches than  to  form  systems  of  any  kind. 

With  the  progress  of  chemistry  during  the  eighteenth  century,  many 
of  tlie  feebler  articles  and  more  complicated  compounds  of  the  pharma- 
copoeias were  substituted  by  more  simple  yet  more  powerful  metallic 
and  mineral  preparations  and  vegetable  exti-a-cts — powerful  in  the  sense 
of  the  sti'ength  or  force  of  the  impression,  not  in  reference  to  the 
quality,  or  kind,  or  utility  of  that  impression ;  and  if  this  was  an  im- 
provement in  pharmacy,  as  medical  historians  usually  inform  us,  there 
was  assuredly  some  progress  made  in  the  dealing,  if  not  the  healing 
prt.  It  was  an  improvement  by  which  apothecaries  have  profited  to 
Lhe  extent  of  many  millions  of  doHai's. 

Medicine  in  the  Present  Century. — The  historian  who  care- 
fully and  without  prejudice  surveys  the  present  state  of  the  medical 
profession  will  observe  one  of  the  strangest  anomalies  which  the  humar 
mind  can  contemplate.  He  will  observe  a  leai-ned  profession,  adorned 
with  as  bright  a  galaxy  of  names — scholai-s,  philosophers,  and  phiian- 
thropists — as  any  p]-ofe£v>ion  in  any  age  of  the  Vv'orld  could  ever  boast. 


32  INTRODUCTION. 


devoting  themselves,  with  a  zeal  and  industry  worthy  of  all  praise,  to 
the  study  and  pi-actice  of  medicine,  yet  having  no  confidence  at  all  in 
their  own  system,  and,  stninger  still,  wondering  and  complaining  that 
the  great  masses  of  the  people  have  no  confidence  in  it ! 

Bostock  has  admitted  that  "our  actual  information  does  not  increase, 
in  any  degree,  in  proportion  to  our  experience."  The  solution  of  this 
rcmaikablo  problem  will  be  found  as  we  pioceed. 

Never  was  any  department  of  human  knowledge  prosecuted  with 
greater  assiduity  and  energy  than  have  been  all  the  sciences  collateral 
to  the  practice  of  physic,  during  the  last  fifty  years.  Anatomy,  chem- 
istry, and  operative  surgery  have,  indeed,  made  wondei-ful  and  sub- 
stantial i)rogress.  Pathology  has  been  gi'eatly  advanced.  Physiology 
has  been  diligently  studied,  but  unfortunately  with  little  success.  Time, 
facts  in  physiology  have  multiplied  exceedingly,  and  hyr^theses  into 
which  they  have  been  woven  have  added  greatly  to  the  numerical 
strength  of  medical  libraries ;  but  as  far-  as  demonsJrating  the  laws  of 
life,  or  increasing  our  means  for  the  cure  of  disease,  I  may  safely 
assert  what  Bostock  admits,  viz.,  "  So  far  as  the  practice  of  medicine 
is  concerned,  the  benefit  is  rather  in  anticipation  than  in  existence." 

In  anatomy,  surgery,  and  materia  medica.  Great  Britain  and  Amer- 
ica have  jjroduced  many  illusti'ious  names,  among  whom  may  be  men- 
tioned Hunter,  Munro,  Bell,  Cooper,  and  Pereira,  of  the  old,  and 
Wistar,  Horner,  Physick,  Mott,  Eberle,  and  Dunglison,  of  the  new, 
world.  In  physiolog;y,  anahiical  chemistiy,  and  anatomy  the  Ger- 
mans have  taken  the  lead ;  and  pre-eminent  among  those  who  have 
acquired  distinction  are  Camper,  Blumenbach,  Soemmering,  Meckel, 
Tiedeman,  Sprengel,  liosenmuller,  Mtiller,  and  Liebig.  In  pathology 
and  phnrmacy  the  French  have  outsti'ipped  all  other  nations,  and  the 
labors  of  Pinel,  Andral,  Breschet,  Broussais,  Corvisart,  Cniveilliler, 
JDujiuytren,  and  Laennec  have  obtained  a  world-wide  celebrity;  while 
in  physiology  the  French  school  has  given  us  the  works  of  Bichat, 
Cuvier,  Richerand,  Majendie,  and  others.  Italy  is  far  behind  the 
other  countries  named,  yet  it  has  produced  a  few  eminent  medical 
scholars,  among  whom  are  Scarpa,  Mascagni,  Ronaldo,  and  Tommasini. 

But  while  this  tribute  is  due  to  the  talents  and  acquirements  of  the 
medical  [)hilosophers  of  this  nge,  it  must  be  remembered  that  all  their 
vast  aiTay  of  learning,  and  all  their  multitudinous  writings,  have  done 
nothing  toward  placing  th**  healing  art  on  a  true  philosophical  founda- 
tion. They  have  rather  tended  to  render  the  confusion  of  ancient 
iogmas  woj-so  confi)un<led  by  modern  speculations. 

If  a  gangrenous  limb  is  to  be  amjmtated,  a  tumor  removed,  a  cancer 


HISTORY    OF    MEDICINE.  88 

excised,  or  a  toe  disjointed,  Professors  Mott,  Pai'ker,  Dudley,  Rogers, 
Detiiiold,  etc.,  etc.,  can  perform  the  operation  with  all  the  skill  and 
judgment  the  case  admits  of.  Operative  surgery  has  well  nigh  reached 
perfection.  If  it  is  desirable  to  know  in  what  proportion  of  cases  in 
choleras,  typhoid  fevers,  dysenteries,  etc.,  there  was  nausea,  or  vomit- 
ing, or  headache,  or  pain  in  the  back,  or  chills,  or  rigors,  or  pain  in  the 
limbs,  among  the  premouitoiy  symptoms,  or  what  precise  shades  of 
color  and  consistence  the  various  sti'uctures  manifested  after  death,  we 
have  in  the  present  state  of  pathological  science  neai'ly  all  the  informa- 
tion we  sliall  ever  know  wiiat  to  do  with.  If  we  would  inquire  what 
particular  phenomena  of  symptoms  follow  the  administration  of  any 
given  mineral  preparation  or  vegetable  drug,'tiie  materia  medieas  of  the 
day,  though  extremely  conti'adictory  with  each  other,  give  us  aE  the 
details  that  can  possibly  be  of  any  service.  And  if  we  would  under- 
stand exactly  what  proportion  of  ultimate  or  proximate  elements  enter 
into  the  composition  of  any  solid  or  fluid,  of  matter  organic  or  inor- 
ganic, animate  or  inanimate,  the  present  state  of  chemical  science  gives 
us  as  accurate  a  knowledge  as  can  be  of  any  advantage,  so  far  as  the 
practice  of  medicine  is  concerned. 

The  reader  may  nov/  naturally  ask.  Why  has  not  success  in  treating 
diseases  kept  pace  with  the  extraordinary  progi-ess  of  knowledge  in  the 
collateral  medical  sciences  ?  The  answer  is  ready.  A  philosophical, 
and  hence  successful,  practice  of  the  healing  art  must  be  based  upon 
the  laws  of  life,  the  economy  of  vitality.  The  only  foundation,  there- 
fore, of  a  true  medical  practice  is  correct  physiological  principles ;  and 
here  is  precisely  where  the  whole  orthodox  medical  system  of  the 
present  day  fails — utterly  and  totally  fails.  It  has  no  physiological  sci- 
ence upon  which  to  practice  truly  the  healing  ait.  In  the  language  of 
one  of  the  gi'eatest  of  modern  physiologists,  Majendie,  "  there  is  scarcely 
a  sound  physiological  principle  extant." 

When  I  intimate  that  there  is  no  physiology  in  the  world,  I  mean, 
of  course,  the  medical  world.  Out  of  the  regular  profession  this 
science  has  been  more  prospered.  Unti'ammeled  by  the  theories  of 
the  schools,  individuals,  not  of  the  order  of  medical  men,  have,  as  I 
shall  hereafter  show,  demonstrated  the  ti'ue  science  of  life,  and  laid 
the  ti-ue  foundation  for  a  medical  practice,  whose  most  powerful  rem- 
edies, so  far  from  being  the  most  potent  poisons  known  on  the  surface 
or  dug  from  the  bowels  of  the  earth,  are  the  very  cogencies  by  which 
the  ^vhole  vegetable  and  animal  creations  are  developed  and  sustained. 

Medicine  in  the  United  States. — In  no  part  of  the  world  are 
Jiedlc.al  scliools  more   numerous,  medica    writers  more  prolific,  and 


U  INTRODUCTION. 

mediciil  periodicals  more  abundant,  than  in  the  United  States.  And  no 
age  ot'the  world  presents  a  medley  ol'  medical  scribblers  in  the  regular 
profession  more  biased  and  bigoted  in  their  notions,  more  visionary  in 
thoir  speculations,  more  puerile  in  theii  theories,  and  more  inconsist- 
ent in  their  practices,  than  is  furnished  by  tlic  history  of  the  present 
Etnte  of  the  mediail  profession  in  this  country.  This  is  not  because 
medical  men  in  this  countiy  are  not  as  talented  as  those  of  any  other 
(ountry,  nor  becimse  medical  men,  as  a  class,  are  not  as  intelligent, 
honest,  and  philanthropic  as  men  of  any  other  class.  It  is  simply  be- 
cause there  is  no  medical  science  in  existence.  The  practice  of  the 
popular  system  is  purely  empirical.  From  establishing  new  systems 
and  building  new  theories,  the  attention  of  medical  men  now  seems 
mainly  directed  to  the  discoveiy  of  new  remedies  and  the  concentra- 
tion of  old  ones.  The  critic  who  will  take  pains  to  examine  the  stand- 
Hrd  works  of  the  most  popular  authoi*s  on  theory  and  practice — Good, 
Watson,  Wood,  Thacher,  Eberle,  Elliotson,  Dunglison,  Dickson,  and 
others — will  find,  on  almost  every  page,  the  most  contradictoiy  theories 
supported  by  equal  authority,  and  the  most  opposite  practices  recom- 
mended on  equal  testimony.  Well  might  the  celebrated  Dr.  Rush,  of 
Philadelphia,  after  a  life-long  experience  in  witnessing  the  eft'ects  of 
dnigs  upon  the  human  constitution,  declare  to  his  medical  brethren, 
"  Wc  have  done  little  more  than  to  multiply  diseases  and  increase  their 
fatality-." 

The  diligent  student  of  medical  history  cannot  fail  to  discover  that 
the  ancient  and  more  ignorant  practitioners  were  more  successful  in  cur 
ing  diseases  than  are  the  modern  and  wiser  physicians.  The  reme 
dial  agents  of  the  ancients  were  comparatively  inert  and  comparatively 
harmless,  and,  while  they  inspired  their  patients  with  a  due  degi'ee  of 
confidence  and  hope,  by  the  charms  and  ceremonials  of  magic  and 
mystery,  they  really  relied  on  judicious  hygienic  regulations  to  "aid 
and  assist  nature"  in  eliecting  the  cure.  Modern  intelligence  repudi- 
ates the  ai1s  and  incantations  of  a  less  civilized  age  ;  and  in  then*  stead 
has  substituted  the  stronger  potencies  of  modern  invention,  while  the 
habits  of  living  and  thinking,  with  medical  as  well  as  with  other  men, 
knve  become  so  unnatural  and  artificiid  that,  in  managing  diseases,  vol- 
nrtarj-  habits  and  liy<iienic  agencies  are  almost  w^holly  overlooked. 

The  genenil  plan  pursued  at  the  bedside  of  the  patient,  by  regular 
physicians  of  this  countiy,  and,  I  believe,  of  all  countries,  is  intended 
to  be  eclectic.  While  they  disown  all  the  theories  that  have  ruled  the 
world  by  turns,  they  endeavor  to  preserve  and  incorporate  in  then-  pre- 
8rr«ptions  all  the  remedial  moans  wliif.h  those  rejaijted  theories  have 


HISTORY    OF    MEDICINE.  B5 

brought  into  favor.  The  only  point  of  skill  is  to  discriminate  the  exact 
disease,  state,  stage,  condition,  temperament,  age,  or  other  circum- 
stance, which  renders  this,  that,  or  tne  .^iier,  or  all  together,  the  most 
advisable  in  the  experimental  prescription.  The  only  acknowledged 
guide  now  is  experience.  But  unfortunately  the  guide  points  all  ways 
at  the  same  time.  There  is  no  common  agi-eement  in  the  testimony 
of  medical  men  respecting  the  indications  of  the  most  common  diseases, 
nor  the  properties  or  operative  effects  of  the  most  common  articles  of 
the  materia  medica. 

To  illusti-ate :  Bleeding  has  been  extensively  em.ployed  in  typhus 
fevers  for  tlii'ee  hundred  years,  yet  physicians  are  divided  in  opinion 
whether  it  is  good  or  bad  practice.  Opium  has  bp«n  in  use  over  two 
thousand  years ;  but  medical  men  cannot  agree  whether  it  operates 
primarily  as  a  sedative  and  secondarily  as  a  stimulant,  or  exactly  the 
contrary,  primarily  as  a  stimulant  and  secondarily  as  a  sedative.  Mer- 
cury has  been  employed  more  or  less  for  about  three  hundred  years, 
and  extensively  during  the  last  fifty  years ;  and  some  authors  consider 
it  a  tonic,  others  a  stimulant,  others  a  deobstruent,  or  alterative,  others 
a  sedative,  and  yet  others  an  antiphlogistic.  Brandy  has  been  freely  ad- 
ministered in  the  city  of  New  York  and  elsewhere  in  the  treatment  of 
the  cholera  during  two  epidemics ;  the  result  of  the  experience  is,  about 
half  of  the  physicians  commend  it  highly,  and  the  other  half  condemn 
it  utterly.  Within  the  last  fifty  years  no  less  than  four  different 
methods  of  ti*eating  ordinary  fevers  have  prevailed :  the  bark  and  wine 
practice,  the  cold  afiusion  practice,  the  bleeding  and  saline  practice, 
and  the  mercurial  and  opium  practice.  In  about  the  same  period, 
some  scores  of  specifics  for  some  of  the  most  foi'midable  diseases  have 
been  discovered,  tried,  proved,  and  then  ^aid  aside,  to  be  followed  by 
others  which  experienced  a  similar  rise  and  fill  of  reputation.  Digitalis, 
the  effluvia  of  cow-stables,  and  a  preparation  of  nitric  acid  and  opium, 
have  been  among  the  vaunted  cures  for  consumption.  Twenty  yeara 
ago  iodine  was  found  to  be  a  specific  for  scroilila;  but  no  one  now 
thinks  of  it  save  as  an  occasional  auxiliaiy ;  and  two  years  ago  cod- 
.iver  oil  was  literally  flooding  the  country  under  the  auspices  of  the 
aSopathic  medical  journals,  and  the  right  wing  of  the  great  medical 
army,  the  apothecaries,  as  a  remedy  for  consumption  and  scrofula ;  but 
tts  brief  day  is  already  drawing  to  a  close. 

These  facts  are  enough  to  show  the  uttei*  fallacy  of  medical  experi 
once,  and  the  unsatisfactory  nature  of  medical  testimony,  unless  based 
upon  some  intelligible  principle  to  which  we  can  refer  the  phenomena 
they  present.   I  cannot  more  appropriately  conclude  these  remai'ks  than 
by  the  following  rxtract  from  Bostock's  history:  "lu  modern  timea 


86  INTPwODUCTION 

and  more  remarkably  in  Great  Britain,  no  one  tliinks  of  proposing  a 
new  mode  of  jiractice  Avithout  supjwrting  it  by  the  results  of  practical 
experience.  The  disease  exists,  the  remedy  is  prescribed,  and  the 
disease  is  removed ;  "we  liave  no  reason  to  doubt  the  veracity  or  the 
ability  of  the  namitor ;  his  favorable  report  induces  his  contemporaries 
to  [)ursue  the  same  metms  of  cure ;  the  same  favorable  result  is  obtained, 
and  it  api)ears  impossible  for  an;  fact  to  be  supported  by  more  decisive 
testimony-  Yet  in  tlie  space  of  a  few  short  years  the  boasted  remedy 
has  lost  its  virtue ;  the  disease  no  longer  yields  to  its  power,  while  its 
place  is  supplied  by  some  new  remedy, which,  like  its  predecessor, 
inns  through  the  same  career  of  expectation,  success,  and  disappoint- 
ment." 

HISTORY    OF    BATHING. 

A  com]>lete  record  of  the  bathing  customs  of  all  nations,  and  of  the 
remedial  uses  to  which  water  has  been  applied  by  medical  men,  w'ould 
furnish  us  with  many  more  examples  of  what  has  been  done  amiss, 
than  of  what  is  worthy  of  imitation.  Somehow  or  other  at  some  time 
or  other,  the  idea  came  to  possess  the  minds  of  practitioners  of  the 
healing  art,  and  through  them  the  minds  of  the  people  generally,  that 
impure  waters  were  more  healthful  for  sick  persons  than  pure.  Con- 
sistently with  this  ridiculously  absurd  vagary,  those  springs  of  Avater  which 
contain  Ih.e  gi'catest  amount  and  variety  of  impurities,  are  the  most  cele- 
brated as  resorts  for  health-seeking  invalids.  And  this  silly  conceit  re- 
ganling  the  remedial  intluence  of  drugged  w^aters  has  extended  to  their 
external  as  well  as  internal  employment;  hence  all  manner  of  artificially 
medicated,  mineralized,  saline,  alkaline,  acid,  oleaginous,  spirituous, 
gasified,  and  compound  haths  and  fumigations  have  found  advocates  in 
the  raiiks  of  the  medical  profession.  It  seems  to  be  inconceivable  to 
the  book-biased  minds  of  most  regular  physicians  that  pure  water  can 
dissolve  and  Wiish  away  the  impurities  of  the  body  better  than  impure 
water.  In  their  view  some  foreign  agent,  something  extraneous,  some- 
thing powerful  must  be  taken  or  applied  to  desti'oy  the  morbid  entit}% 
or  counter-irritate  the  diseiised  condition,  or  "force  a  healthy  action." 
When  it  is  considered  that  the  solvent  property  of  water  is  exactly 
pro|)()rtioned  to  its  freedom  from  all  extraneous  ingi-edients  held  in 
solution,  the  strange  hallucination  that  prefere  sulphur,  iodine,  iron, 
saline,  and  other  unclean  springs,  to  the  pure  element  as  it  distils  from 
the  clouds  of  Ijeaven,  for  medicnl  purposes,  will  have  to  be  put  down  to 
the  account  of  those  things  on  this  ea.vth  which  are  wholly  unaccountable. 

Ancitnt  Bathiv-j. — Almost  a*  far  back  as  we  r an  trace  liistoricaJ 


MISTOEY    OF    BATfllNa  37 

data,  Ave  fin  I  furounJ:  of  various  domestic  baths.  The  earliest  Bible 
account  of  Ivitiiinc!;  speaks  6f  the  daughter  of  Pharaoh  and  her  attend- 
ants going  down  !o  \\ui  Nile.  Homer  speaks  of  the  bathing  habits 
of  many  of  his  heroe?.  Hercules  was  indebted  to  Minerva  and  Vulcan 
for  the  refreshing  influence  of  warm  baths.  Althenseus  informs  us  that 
it  v/as  the  custom  of  antiquity  for  women  and  virgins  to  assist  strangers 
in  their  ablutions.  Among  Oriental  nations  the  means  for  bathing  were 
provided  as  an  act  of  hospitality  for  travelers. 

Both  the  Old  and  New  Testaments  frequently  mention  bathing  as  a 
sanatary  and  healing  process,  and  as  a  religious  rite.  With  all  the 
ancient  nations  frequent  ablutions  or  immersions  were  typical  of  moral 
purity.  Moses,  Jacob,  Aaron,  Job,  as  well  as  the  more  ancient  patri- 
archs, enjoined  and  practiced  bathing  as  a  means  of  both  bodily  and 
spiritual  purification.  Jews,  Christians,  Mahometans,  and  Pagans  have 
all  agreed  in  one  tenet,  the  baptism  of  personal  cleanliness.  Elisha  the 
prophet  directed  Namaan  the  leper  to  bathe  seven  times  in  the  Jordan. 
Our  Saviour  commanded  the  blind  man  fro  wash  in  the  pool  of  Siloam. 
Many  of  the  sick  were  sent  to  the  healing  waters  of  Bethesda.  The 
Gree]<  and  Egyptian  priests  washed  themselves  in  cold  water  several 
"imes  a  day. 

Bathing  in  the  Middle  Ages. — But  in  process  of  time,  as  the 
customs  of  societies  and  nations  became  more  complicated  and  sensual, 
bathing  degenerated  almost  into  a  means  of  mere  sixury  and  sensuous 
indulgence.  Though  the  Egyptians  first  reduced  bathing  to  a  systema- 
tized part  of  the  medical  practice  of  their  day,  and  for  ordinary  purposes 
recommended  cold  ablutions  in  preference  to  warm  baths,  as  the  habits 
of  the  people  became  luxurious  and  enervating,  the  cold  ablution  for 
health  was  substituted  by  the  w^arm  immersion  for  pleasure. 

The  Greeks  adopted  the  bathing  customs  of  the  Egyptians,  and  at- 
tached public  baths  to  their  gymnasia;  and  a  bathing  room  for  guests 
was  a  common  apartment  in  their  private  houses.  Socrates,  Aristotle, 
and  Plato  speak  of  baths  as  in  common  use.  tlippocrates,  the  "flither 
of  medicine,"  recommended  them  for  many  hygienic  and  therapeutic 
purposes. 

The  Spartans  were  in  the  habit  of  plunging  their  new-born  infants 
*ntd  cold  springs.  The  members  of  their  adult  population  wove  cer- 
tainly fiiir  specimens  of  /igorous  health  and  powerful  frames.  But 
m.edical  theorizers  have  explained  this  fact  in  another  way.  They 
assert  that  the  practice  killed  all  the  tender  children,  the  robust  only 
being  able  to  survive  it ;  so  that  all  who  lived  through  it  and  grew  up 
to  manhood  were  robi  st  and  healthy  in  spite  of  the  bathing.  But  tho 
4 


83  INTRODUCTION. 


usrierlioii  is  wholly  gratuitous,  and,  notwithstanding  it  is  the  prevailing  ■ 
opinion  of  the  medical  faculty,  there  is  not  a  p.-u'licle  of  evidence  to  , 
sustain  it.  I  have  seen  too  many  children  in  New  York  city  who  have  | 
been  bathed  in  cold  water  IVoni  birth,  every  one  \vithout  exception  j 
becoming  remarkabl-y  robust  and  healthy  compared  with  non-bathed  ' 
or  warm-water-wushed  ones,  to  give  the  least  credence  to  a  statement  j 
which  seems  to  have  been  made  on  mer«  theoiy,  without  any  investi-  | 
gation  at  all. 

The  ancient  Germans  were  much  addicted  to  cold  batliing.     The  ; 
Gauls,  the  powerful  progenitors  of  the  British  race,  had  sacred  fount-  \ 
ains,  which  were  resorted  to  for  the  purpose  of  bathing  and  healing  I 
diseases;  and  in  England  many  cold  springs  have  been  celebrated  for 
their  curative  virtues.  | 

In  the  days  of  Roman  pride  and  luxuriance  public  and  private  baths  I 
were  consti-ucted  on  a  magnificent  scale ;  and  the  agriculturists,  sol- 
diei"S,  and  laborers  would  frequently  batlie  in  the  Tiber.  After  the  j 
aqueducts  were  built,  by  which  an  abundant  supply  of  water  was  in-  j 
troduced  to  Home,  warm  batlis  became  general ;  and,  instead  of  being  ! 
employed  for  cleanliness  and  health,  they  were  soon  regarded  as  a  j 
mere  source  of  luxury,  and  thus  became  a  means  of  physiological  j 
degeneration  and  efleminacy.  Public  buildings,  called  thermae,  for  i 
warm  bathing,  increased  rapidly,  and  in  the  days  of  Nero,  who  erected  { 
a  most  sumptuous  one,  the}*  numbered  eight  hundred  or  more.  With  j 
the  baths  were  connected  grounds  for  sporting  and  athletic  exercises,  "i 
and  extensive  libraries.  The  baths  of  Caracalla  had  sixteen  hundred  j 
marble  seaf,  2apable  of  seating  three  thousand  persons,  and  w^ere  or-  | 
namented  with  two  hundred  pillars.  But  surpassing  aU  others  in  size  | 
and  splendor  were  those  of  Diocletian.  It  is  related  that  in  theii*  con-  , 
ptiTJction  he  employed  forty  thousand  Christian  soldiers,  whom  he  i 
caused  to  be  massacred  as  soon  as  the  w^ork  w^as  completed.  Such  are  ; 
the  consequences  of  perverting  the  practice  of  bathing  for  the  sake  of 
that  "  cleanliness  which  is  next  to  godliness,"  and  tliat  health  of  body  ''• 
which  contributes  so  powerfully  to  a  sound  mind,  to  a  mere  lustfiil  en-  \ 
joyment.  The  warm  bath  degenerated  into  the  hot,  and  feasting  and  i 
gluttony  bccnmo  parts  of  the  purpose  for  which  a  Roman  bathing  I 
establishment  was  frequented.  i 

The  Greeks,  too,  constructed  immense  bathing  establishments,  and  ! 
furnished  them  ^^•ith  all  the  appliances  of  health  and  luxury,  as  cold,  | 
warm,  hot.  and  vai)()r  Iwitlis ;  but  unfortunately,  as  in  most  cases  where  ; 
good  and  evil  are  placed  before  the  judgment  and  sensuality  of  human 
nature,  the  latter  proved  victorious.  Lounging  in  warm  -svater,  and  j 
anointing  the  body  with  an  immense  profiision  of  oils,  soaps,  and  per    ' 


HISTORY    OF    BATHING.  89 

fumes,  became  favorite  amusements,  followed,  of  course,  by  indolence 
and   enervation. 

When  Alexandria  was  conquered  by  the  Moslems  it  contained  four 
thousand  baths,  constructed  on  the  Roman  plan ;  and  when  the  Span- 
iai'ds  conquered  Granada  the  bathing  habits  of  the  Moors,  and  also 
their  language  and  dress,  were  proliibited,  as  a  means  of  their  con- 
version. 

In  most  of  the  large  Fjuropean  towns,  in  the  "barbarous  ages," 
public  baths  were  erected,  where  the  people  bathed  each  Saturday 
evening.  The  early  Christians  of  Gaul  had  baths  constructed  in  their 
convents.  Pope  Adrian  I.  recommended  the  parochial  clergy  to  visit 
the  baths,  in  giand  procession,  every  Thursday.  The  institutions  of 
chivalry  required  the  knight  to  be  subjected  to  a  complete  ablution  be- 
fore receiving  his  armor.  The  Order  of  the  Bath,  still  retained  in 
England,  originated  from  the  circumstance  that  the  candidate  was 
knighted  while  immersed  to  the  chin  in  a  highly  decorated  bath. 

Bathing  Habits  of  Different  Nations. — The  people  of  Swit- 
zerland are  said  by  Marcand  to  bathe  more  generally  than  those  of  any 
other  countiy.  The  baths  at  Baden  have  been  as  celebrated  for  their 
abuses  as  for  their  uses,  having  been  resorted  to  during  the  sitting  of 
the  Council  of  Constance,  more  for  luxury  and  debauchery  than  for 
health.     Such  is  not  the  case,  however,  at  present. 

In  Italy  the  numerous  warm  and  mineral  springs  are  much  resorted 
to,  especially  in  the  northern  pait,  where  immersion  and  douche  bath- 
ing are  common.  To  most  of  their  celebrated  springs  the  poor  are 
allowed  free  access ;  and  attached  to  some  of  them  are  hospitals  for 
invalid  soldiers. 

The  Germans  have  long  been  accustomed  to  warm  bathing.  Char- 
lemagne had  a  bath  consti'ucted,  capable  of  accommodating  one  hun- 
dred persons  at  a  time,  and  it  was  his  custom  to  sit  in  council  in  a  large 
warm  bath  of  the  waters  of  Aix.  During  the  prevalence  of  leprosy, 
in  the  middle  ages,  bathing  w^as  enjoined  as  a  religious  duty ;  and  as 
diseased  persons  commenced  frequenting  the  public  watering-places, 
the  people  generally  resorted  more  to  the  rivers.  At  present  bathing 
at  the  regular  establishments  is  quite  systematized,  yet  the  people  are 
more  generally  negligent  in  regard  to  the  practice  than  formerly. 

In  Russia  vapor  baths  have  long  been  and  are  stiU  celebrated.  In 
their  establishments  the  vapor  is  obtained  by  pouring  water  on  heatea 
stones,  and  the  temperature  is  raised  to  122°,  and  even  133'^.  The 
vapor  bath  is  follow^ed  by  tepid,  and  then  cold  ablutions,  and  sometimes 
a  lake  or  river  plunge-   or  a  roliing-in-the-snow  bath.     Rubbing  the 


40  INTRODUCTION. 


body  aiKl    lutheriug  it  with   sonp   arc   usually  pai'ts  of  the  Russian 
procesjs. 

The  FiiilandLM-s  resort  often  tc  the  dry  and  moist  sweating  baths,  the 
vapor  for  the  dry  being  122'^,  and  for  the  moist  140^^  to  IGT^-.  The 
latter  process  is  painfully  suftbcative  and  exti-emely  debihtating.  Most 
of  the  peasantry  have  bath-houses,  used  by  men  and  w^omen  promis- 
cuously. They  are  constantly  in  the  habit  of  passing  from  the  atmo- 
sphere of  their  bathing-rooms,  which  ai-e  heated  to  167=*,  to  the  open 
air  out-doors,  where  the  thermometei  is  down  to  24^  below  zero,  ti'an- 
sitions,  which,  astonishing  as  they  appear,  do  not  seem  to  produce  any 
nnmediate  inconvenience. 

Throughout  Sweden,  Norway,  and  Lapland  baths  ai-e  very  com- 
mon. 

The  Oriental  nations  have  the  most  numerous  and  splendid  bathing 
establishments  of  the  present  day. 

The  public  baths  of  Turkey  are  spacious  edifices  of  hewn  stone. 
The  temperature  of  the  rooms  is  about  100°,  where  the  bather  soon 
gei."  into  a  perspiration  by  the  heated  air,  and  is  rubbed,  kneaded, 
Btretcned,  lathered,  and  perfumed,  and  finally  w^ashed  with  tepid  or 
cold  water  to  his  liking.  Smoking  and  coffee  succeed  the  operation. 
The  long-continued  wai'm  and  hot  bathing  gives  to  their  females  a  pe- 
culiarly pale,  peach-like  softness  of  skin,  indicative  of  lassitude  and  de- 
bilitj'  rather  than  health  and  strength.  In  fact,  luxury,  mere  animal 
gratification,  seems  to  be  the  only  purpose  thought  of  in  most  of  the 
bathing  establishments  of  the  East. 

The  Persians  rival  the  Turks  in  magnificer.ee,  if  not  in  convenience. 
But  the  manner  of  bathing  differs  materially  from  the  Turkish.  The 
toilet  is  the  leading  idea  of  a  Persian  bath.  Instead  of  rubbing,  sham- 
pooing, etc.,  the  attendant,  or  operator,  is  mainly  occupied  in  staining 
the  beard  and  hair  black,  the  feet  and  hands  yellow,  and  the  nails  of  the 
fingers  and  toes  of  a  deep  red. 

In  Egypt  and  India  bathing  is  practiced  in  a  manner  very  similar  to 
that  of  the  Turks.  In  Cairo  there  are  about  seventy  public  baths.  In 
addition  to  the  manipuLitions  of  a  Turkish  bath,  the  attendant  of  the 
Egyptian  bather  rubs  the  soles  of  the  feet  with  a  kind  of  rasp,  made 
of  baked  clay.  It  is  customary  for  betrothed  females  to  go  in  gi-and 
procession  to  the  bath  a  day  or  two  before  marriage,  accompanied  by 
intimate  friends  and  relatives.  The  three  stages  of  the  bathing  process 
consist  of  sweating,  rubbing,  and  washing.  Aromatic  unctions  are  gei?~ 
erally  employed,  and  the  Persian  fashion  of  dyeing  the  nails  with  a 
preparation  of  henna  is  very  much  in  vogue. 

The  East  India  baths  are  conducted  similarly  to  those  of  the  Egyp 


HISTORY    CF    BATHING.  41 

tian.     The  women  of  quiility  spend  much  time  in  them,  and  seem  to 
realize  in  their  use  only  a  source  of  sensuous  pleasure. 

The  Mahometans  are  requh-ed  to  bathe  three  times  a  day.  Among 
them  a  depilatory  pomatum,  to  remove  the  hair,  is  often  applied ;  it  is 
1  oraposed  of  sulphuret  of  arsenic  and  quick-lime  mixed  with  fat. 

The  Bramins  ai'e  under  the  same  religious  injunction  to  bathe  as  the 
pjfuliometans. 

'I'Jie  Hindoos  of  all  classes  perform  their  devotional  pilgrimages  to 
{ii«  (xanges  and  the  Jumna,  to  bathe  in  their  sin-absolving  waters. 

Among  the  North  American  Indians  bathing,  especially  in  rivers,  has 
j.Kvays  been  a  general  practice.  Some  tribes  in  the  vicinity  of  the 
Kocky  Mountains  use  the  sudatory  or  hot  sweating  bath,  followed  by 
the  cold  plunge.  Some  of  the  extreme  northern  tribes  make  a  squai*e 
mud  box  on  the  edge  of  the  river,  in  which  they  sit  and  enjo3^  a  vapor 
bath,  with  steam  raised  by  means  of  hot  stones  and  jugs  of  water. 
This  is  rather  a  fashionable  recreation  among  tliem,  and  is  often  prac- 
ticed in  parties  for  social  amusement.  On  the  frontiers  a  bath  is  con- 
structed of  wicker-v»'ork,  the  tip  of  which  is  covered  with  skins. 
William  Penn  saw  an  Indian  chief,  in  the  "colony  of  Pennsylvania," 
eiitirely  cured  of  an  attack  of  fever,  by  a  thorough  steaming,  followed 
by  several  plunges  in  the  river,  for  which  purpose  a  hole  was  cut 
through  the  ice. 

The  Peruvians  have  numerous  public  bnths,  both  from  hot  springs 
and  from  their  hundreds  of  miles  of  aqueducts. 

The  Abysinians  are  represented  by  the  h-aveler,  Bmce,  as  in  the 
habit  of  ti'eating  the  violent  fevers  of  that  country  with  cold  water  ex- 
lernally  and  internally. 

The  Mexicans  originally  bathed  in  a  sort  of  oven,  into  w^hich  the 
I  athe.r  crept  when  sufficiently  heated,  and,  by  pouring  water  on  the 
liot  stones,  raised  a  vapor  and  produced  copious  sweating.  Kentish 
riffirms  that  lliis  bath  is  resorted  to  as  a  remedy  for  stings  of  insects  and 
bites  oi  poisojutus  reptiles;  it  is  employed  also  by  women  after  child- 
birth. 

Tlie  ^"'ren(■,l^  were,  long  ago  generally  accustomed  to  batliing.  Vapor 
nv.d  other  batlis  were  numerous  in  Paris  at  an  early  period  of  its  his 
lory.  Irately  the  vapor  baths,  which  are  frequent  along  the  banks  of 
the  Seine,  are  eni[)Ioyed  as  preparations  for  the  w\Ti-m-vrater  bath. 
That  they  are  visited,  however,  more  for  entertainment  than  from  any 
sense  of  hygienic  virtue  is  evident  from  the  fact,  that  they  have  been 
occasionally  closed  for  a  time  by  the  public  authorities,  and  were  once 
prohibited  during  the  prevalence  of  a  contagious  disease.  In  Paris 
there  are  at   | 'resent   ni-my  warm^  cold,  and  vapor  bathing  establish 


42  I  N  T  R  0  D  U  C  T I  0  X. 


meats,  some  of  which  are  very  properly  connected  with  the  hospitals. 
v-zold  bathi  unJ  swiiuuiiug  schoc/L-.  fur  each  sex  separately,  abound  on 
the  banks  of  the  Seine. 

In  Enj-liind  bathing  iustitutiuus  arose  and  declined  with  those  of 
Koine.  Soon  after  the  conquest  of  England  by  the  Xorraans  the  lep- 
rosy made  its  appearance,  when  bathing  habits  revived  again,  and  in 
treating  the  disease  the  rold  bath  was  generally  resorted  to.  About 
the  middle  of  the  sixteenth  century  the  bathing  practices  of  the  peo- 
ple again  degenerated  to  mere  luxury ;  and,  up  to  the  present  time,  its 
warm,  hot,  mineral,  and  sulphurous  springs  have  been  quite  a  fashion- 
able resort  for  that  class  of  fashionable  invalids  w^hose  complaints  are 
closely  connected  with  ftishionable  indolence.  Now,  however,  cold 
bathing  is  increasing  in  favor,  and  promises  to  become  general.  Dr. 
Bell  thinks  it  has  ali-eady  been  carried  to  an  esti-erae  for  medical  pur- 
poses ! 

The  people  of  the  United  States  have  never  yet  been  overmuch 
given  to  bathing  in  any  manner.  The  more  wealthy  in  our  cities  re- 
sort to  the  bathing-houses  occasionally,  and  in  the  warm  season  many 
of  the  city  and  countiy  people  amuse  themselves  by  swimming  in  our 
rivers,  lakes,  ponds,  and  at  various  places  on  the  sea  shore.  Some 
pei"?ons  content  themselves  with  washing  the  whole  body  once  a  week ; 
others  once  a  yeai*;  and  a  few^  are  satisfied  without  washing  at  alL 
Every  well-wisher  of  the  human  race  wili  hope  they  will  remain  as 
they  are  in  this  respect,  rather  than  imitate  the  sensualizing  bathing 
customs  of  the  old  world.  But  attention  to  the  general  subject  of 
batJiing  is  fast  awakening  among  us,  and  there  is  everj^  reason  to  believe 
the  great  masses  will  ere  long  become  sufficiently  intelligent  to  adopt 
daily  bathing  as  a  physiological,  hygienic,  moral,  social,  and  eminently 
Christian  duty  and  privilege.  Our  largest  cities.  New  York,  Piiila- 
delphia,  and  Boston,  have  within  a  few  years  supplied  themselves  w4th 
an  abundant  supply  of  good  soft  water;  many  other  cities  and  villages 
are  about  following  the  example,  and  the  people  in  our  country  places 
are  fa-^t  turning  their  attention  to  the  benefits  of  having  pure  water  for 
both  bathing  and  drinking  purposes.  Bath-rooms,  in  the  cities  above 
named,  are  beginning  to  be  regarded  as  indispensable  apaitments  of 
public  buildings  and  private  dwellings.  The  numerous  hydropathic 
establishments  springing  up  in  all  parts  of  the  country  are  perliaps  the 
most  efficient  insti'umentalities  in  indoctrinating  individuals  and  families 
into  the  theory  of  personal  cleanliness  ;  and  with  all  the  agencies 
named  we  may  regard  the  jirospect  for  this  nation  to  become  "re- 
deemed, regenerated,  disenthriiled,"  from  obstructed  pores  and  fouJ 
eecretioDs,  as  very  promis'ng. 


HISTORY    OF    BATHING.  43> 

MtoiCATED  Baths. — A  brief  notice  in  this  place  of  the  various 
metliods  of  impure  bathiug,  invented  by  superstitious  ignoramuses  and 
learned  ^Esculapians,  may  serve  a  better  purpose  than  mere  amuse- 
ment for  the  reader. 

A  medicated  bath,  in  the  popular  medical  sense,  is  water  or  hot  air 
charged  with  some  drug  or  extraneous  ingi*edient.  In  ancient  times 
medicinal  baths  of  oil,  oil  and  w^ater,  milk,  milk  and  wine,  and  eveu  of 
blood,  were  emplo^^ed.  More  recently,  baths  made  of  the  steepings 
of  the  husks  and  other  refuse  matters  of  grapes,  and  of  olives,  after  the 
expression  of  their  juice  and  oil,  have  been  employed ;  and  still  later 
gelatine,  dissolved  in  water,  has  been  recommended  by  physicians,  prob- 
ably as  a  nutritious  bath ! 

Mud  baths  or  earth  baths  have  been  employed  in  Germany,  France, 
Italy,  and  other  places.  The  process  of  a  mud  bath  is  technically  called 
illutation.  A  kind  of  artificial  illutament — presuming  mud  to  be  the 
natural  one — for  anointing  the  body,  was  rsade  of  oil  and  the  perspira- 
ble matter  scraped  off  the  skins  of  the  Greek  athletse.  Doubtless  it 
possessed  as  much  virtue  as  any  of  the  "all-healing  ointments"  of  the 
present  day. 

Warm  dung  baths  are  not  unknown  among  medical  prescriptions  on 
the  continent  of  Europe. 

Bees-eggs  baths,  made  of  wax,  honey,  and  the  excrement  ci  oees, 
have  been  among  the  acknowledged  outAvard  medicaments,  and  proba 
bly  have  worked  their  due  proportion  of  wonderful  cures. 

The  Sand  bath,  called  arenation,  is  known  to  many  Eastern  civilized 
and  semi-civilized  nations.  The  body  is  covered  up  with  the  warm 
sand  and  exuvial  matters  on  the  sea  shore,  so  as  to  produce  active 
sweating.  Other  substances,  as  earth  and  sulphur,  salt  and  grain,  have 
been  used  for  arenation. 

Insolation  baths  have  enjoyed  a  high  reputation.  The  body  is 
Avi'apped  up  in  the  hide  of  an  animal,  or  in  leather,  and  then  exposed 
to  the  heat  of  the  sun  until  sweating  takes  place.  Occasionally  the 
body  is  turned  so  as  to  expose  ail  sides  to  the  sun  about  equally,  not 
very  unlike  the  operation  of  roasting  a  goose  on  a  spit  before  the  fire. 
The  process  is  followed  by  washing  in  alum  or  sulphur  water.  Some- 
times the  patient  is  laid  on  a  bed  of  wormwood,  chamomile,  sage, 
peniiyroj-al,  or  other  herbs. 

Epithems,  poultices,  and  fomentations,  which  are  really  local  baths, 
have  been  employed  extensively  both  in  ancient  and  modern  times. 
Bags  of  heated  sand,  ashes,  salt,  oats,  barley,  etc.,  have  each  been 
supposed  to  possess  peculiar  virtues;  while  caiTots,  hard  soap,  basswood 
roots,  flaxseed,  Indian  meal,  bread  and  milk,  yolk  of  eggs,  scraped 


ii  intr:»duction. 


potatoes,  with  a  great  variety  of  barks,  roots,  aud  herbs  have  in  thou- 
sands of  instances  filled  the  spectator  with  amazement  by  producing  : 
eftects  very  like  those  of  a  common  rag  dipped  in  common  water. 

Sulphur  funiiisations  were  among  the  ancient  baths ;    and  several  j 

modern  authors  liave  written  learned  treatises  on  their  employment  i 

for  the  itch.     It  is  not  many  years  since  the  administration  of  the  Civil  : 

Hospitals  of  Paris  appointed  a  commission  of  learned  men  to  examine  ' 

into  the  merits  of  the  sulphm*  fumigating  treatment  in  this  disease.     It  I 

may  excite  the  risibles  of  those  who  have  seen  the  itch  effectually  I 

cured  by  a  single  soap-suds  bath,  to  be  told  that  among  the  many  sat-  j 

isfactorv  conclusions  to  which  the  iui-y  of  investigation  arrived  was  the  I 

fict  that,  "on  an  average,  thirteen  fumigations  and  a  period  of  seven  | 
daj's  were  sufficient  to  cure  the  disease." 

Vinegar  fuynigations  have  been  employed  since  the  days  of  Hippo-  1 

crates.    Resinous,  aromatic,  and  emollient  herbs  have  been  employed  in  ' 
fomentations  for  3000  years,  and  are  in  repute  still. 

General  fumigations  to  the  whole  body,  with  a  variety  of  mineral  ; 

preparations,  are  now  recognized  processes  of  the  allopatliic  materia  i 

medica.     The  articles  in  most  common  use  are  the  mercurials — calo-  j 

mcl,  corrosive  sublimate,  and  cinnibar — the  protoxide  of  zinc,  and  deut-  ! 
oxide  of  arsenic. 

Suljyhuretled  hydrogen  gas,  or  hydro-sulphuric  acid,  is  also  employed  ' 
in  the  same  way. 

Nitro-muriatic  acid,  for  foot  and  other  local  baths,  is  a  common  pre- 
scription. 

Pulmonary  insufflation,  cajled  by  some  atrimatrics,  has  been  lauded  ' 
as  a  curative  process  in  consumption  and  other  diseases  of  the  lungs. 
It  consists  mainly  in  inhaling  some  kind  of  foul  air,  made  filthy  by  ani- 
mal excrementitious  matters,  or  by  burning  or  smoking  certain  sub-  i 
stances,  so  as  to  fill  the  room  and  the  patient's  lungs  with  their  ftimes, 
as  turpentine,  tar,  gum,  resin,  stj'rax,  vinegar,  sugar,  old  leather,  old  ' 
rags,  etc.  i 

The  terminal  point  of  the  ridiculous  in  this  line  of  practice  was  ; 

reached  when  Dr.  Beddoes  published  his  book,  recommending  patients  \ 

to  sleep  in  cow  stables,  and  inhale  the  fi-esh  stench  of  that  delectable  ' 
locality,  or,  to  speak  learnedly,  the  "factitious  gases,"  which  are  the 

common  air  mixed  with  exhalations  from  the  skin,  lungs,  kidneys,  and  '. 

intestines  of  the  animals.     But  Dr.  Beddoes  stands  not  alone  in  the  I 
glory  of  finding  out  cures  for  consumption.      Almost  all  conceivable 

kinds  of  impure  and  disease-producing  airs,  as  well  as  impure  and  dis-  ; 

ease-producing  waterg,  have  had  the  sanction  of  the  medical  profession  ' 

as  remedies  /  i 


iIISTORY    OF    BATHING. 


Professor  Rcid  gives  us  a  list  of  thirty-four  "factitious  atmospheres," 
to  be  employed  for  medicinal  purposes.  The  catalogue  is  worth  record- 
ing, if  for  no  other  purpose,  to  aid  some  future  vu-tuoso  in  making  up  a 
museum  of  obsolete  medical  curiosities:  1.  Dry  ah-;  2.  Dry  and  hot 
air;  3.  Dry  and  cold  an-;  4.  Rapid  and  hot  air;  5.  E.apid  and  cold  air; 
6.  Moist  ail-;  7.  Moist  and  warm;  8.  Moist  and  cold;  9.  Rapid,  moist, 
and  warm;  10.  Rapid,  moist,  anr*  ,ald ;  11.  Steamed  aii-;  12.  Highly 
oxygenated,  by  an  admixture  of  oxygen ;  13.  Less  oxj^genating,  by 
diluting  air  with  nitrogen ;  14.  Deoxidating,  by  adding  agents  to  abstract 
a  part  of  the  oxygen;  15.  Niti'ous  oxide — intoxicating  gas;  16.  Niti'ous 
acid;  17.  Nitric  acid;  18.  Chlorinated;  19.  Sulphurous;  20.  Car- 
bonic; 21.  Ammoniacal;  22.  Prussic;  23.  Acetic;  24.  Arsenical;  25. 
Mercurial;  26.  Alcoholic;  27.  Ethereal;  28.  Benzoic;  29.  Camphor- 
ic;  30.  Lavender;  31.  Orange;  32.  Cinnamon;  33.  Creosotic ;  34. 
Hydro-sulphate  of  ammonia. 

Iodine  has  lately  found  a  place  in  medical  books  as  a  fumigator,  or 
Etrimatric  agent. 

Iodine  with  alcohol  was  introduced  by  Sh'  Charles  Scudamore,  who 
also  employed  the  tinctures  of  opium,  conium,  ipecac,  deadly  nightshade, 
digitalis,  Prussic  acid,  and  chlorine. 

The  hydriodate  ofjjotassa,  wliich  is  so  frequently  the  efficiently  evil 
agent  in  the  sai'sapai-illas  of  the  shops  and  the  newspapers,  is  consider- 
ably employed  atrimati-ically. 

Chlorine  inhalation  has  had  its  day  of  fame  in  curing  consumptions, 
the  only  drawback  to  which  is  the  fact  that  the  patients  died. 

Tobacco  has  had  its  merits  confessed  by  the  facult}'.  The  smoke 
of  tobacco  cigars  and  camphor  cigarettes  has  been  recently  recom- 
mended for  aifections  of  the  throat,  chest,  and  lungs,  by  the  professors 
of  our  New  York  medical  schools. 

Peruvian  hark,  oak  hark,  myrrh,  preparations  of  iron,  suhnitrate  of 
hismuth,  hepar  sulphuris,  ivhite  vitriol,  blue  vitriol,  alum,  sugar  of  lead, 
and  lunar  caustic,  all  reduced  to  impalpable  powder,  and  applied  by 
inhalation,  are  among  the  methods  at  the  present  time  commended  to 
us  by  living  medical  teachers,  for  the  treatment  of  diseases  of  the  air 
passages. 

Gas  baths  are  rather  a  modern  notion.  Chlorine  gas  baths  have 
been  exhibited  for  diseases  of  the  liver,  and  carbonic  acid  gas  baths  are 
recommended  for  "every  thing  in  general." 

Soap  baths  are  mentioned  in  medical  books.  They  ai'e  certainly 
useful  to  those  who  do  not  wash  frequently,  and  among  medicated 
baths  ought  to  rank  as  number  one. 

Medicinal  water  baths,  made  of  the  watenB  of  our  fashionab^  adul- 


4e  INTRODUCTION. 


terated  springs,  are  employed  more  or  less,  and  many  imitations  of    | 

tliem  are  manufactured  at  home.    They  are  merely  water  impregnated    | 

^vith  various  mineral,  earthy,  alkaline,  and  saUne   ingredients.      Any    | 

person,  by  throwing  a  handful  of  dirt,  a  shovelful  of  coal  or  wood  ashes, 

a  siwonful  of  salt,  and  a  piece  of  chalk  into  a  barrel  of  pure  Croton   \ 

water,  can  make  as  good  a  medicated  bath,  or  as  healthful  a  medicated    ; 

drink,  as  can  be  found  at  Saratoga,  Avon,  or  Cheltenham.  , 

The  anesthetic  agents,  ether  and  chloroform,  which  are    properly   | 

ntrimatrics,  are  now  well  known,  and,  except  for  surgical  purposes,  are   I 

'  I 

destined  to  have  a  short-lived  popularity.  i 

Finally,  we  have  the  grease  bath.     This  is  the  very  latest  external  j 

application  which  has  emanated  from  the  allopathic  school.     It  consists  ! 

in  rubbing   the  whole  surface  oi   the  body  frequently  with  various  : 

unguents,  as  fat  bacon,  hog's  lard,  suet,  tallow,  etc.,  etc.     It  originated 

with  Dr.  Schneeman,  physician  to  the  King  of  Hanover,  and  in  treating  ' 

eruptive  fevers,  and  many  other  diseases,  is  highly  recommended  by  j 

Dr.  Taylor,  of  England,  and  a  Dr.  Lindsly,  of  Washington  City.     As  a  | 

species  of  factitious  unction  it  deserves  to  rank  with   the   factitious  ' 

atmosphere  practice  of  Dr.  Beddoes.  ! 

Medical  TESxnioNy  ix  Favor  of  the  Remedial  Use  of  Wa 
TER. — From  the  days  of  Hippocrates  to  Priessnitz,  the  most  eminent  \ 
physicians  of  all  countries  have  spoken  almost  as  extravagantly  in  praise  j 
of  the  medicinal  employment  of  water  as  do  the  hydropaths — the  hy- 
dro-maniacs, as  they  are  sometimes  called,  of  the  present  time.     Yet 
directly  in  the  face  of  this  testimony  its  employment  as  a  remedial 
agent  had  steadily  declined,  until  recently  revived  by  the  wonders  told 
of  Graefenberg.  1 

Hippocrates  wrote  much  in  favor  of  the  good  effects  to  be  derived 
from  water  both  in  health  and  disease.  He  declared  that  the  bath,  in  : 
cases  of  pneumonia,  soothes  ^he  pain  in  the  side,  chest,  and  back,  con-  i 
cocts  the  sputa,  promotes  expectoration,  improves  the  respiration,  and  ' 
allfiys  lassitude.  He  advised  pouring  cold  water  on  inflamed  and 
swelled  joints,  in  gout  and  rheumatism,  and  in  spasms,  luxations,  and  ' 
fractures.  i 

Galen  placed  water  in  the  highest  rank  of  his  materia  medica.     He 
regarded  the  bath,  followed  by  exercise  and  friction,  as  one  of  the  chief 
parts  of  a  system  of  perfect  cure.     He  has  left  the  following  record :  ; 
"  Cold  water  quickens  the  actions  of  the  bowels,  provided  there  be  no 
constrictions  from  spasms,  when  warm  water  is  to  be  used.      Cold  \ 
drink   stops   hemorrhages,  and    sometimes   brings   back   heat.      Cold  i 
drinks  are  good  in  continued  and  ardent  fevers.     They  discharge  the  j 


HISTORY    OF    BATHING-.  47 

peccant  and  redundant  humors  by  stool,  or  by  vomiting,  or  by  sweat." 
In  biliousness,  spasms,  headache,  fever  of  the  stomach,  hiccup,  cholera 
morbus,  obstinate  ophthalmia,  plethora,  he  recommended  tepid  and 
w^arm  water-drinking,  with  the  ti-ansition  bathing — hot  followed  by 
tepid  or  cold. 

Celsus,  in  treating  affections  of  the  head,  directs  a  warm  sweating 
bath,  foHow^ed  by  the  tepid  and  cold  bath,  with  an  additional  quantity  of 
cold  water  to  the  head.  He  recommends  water  in  fuUness  of  the 
stomach,  headache,  weak  vision,  d«>afness,  tremors,  sinking,  pains  in  the 
joints,  diarrhea,  piles,  and  in  hysterical  and  hypochondriacal  affection ; 
and  praises  the  bath  in  low  fevers,  digestive  disorders,  and  diseased 
kidneys.  He  also  advises  cold  immersion  in  skin  diseases  and  in  hy- 
drophobia. 

Asclejpiades,  of  Bithynia,  though  regarded  as  an  empiric  by  the 
orthodox  doctors  of  his  day,  advocated  cold  water  internally  and  ex- 
ternally in  hiccup,  sour  eructations,  and  nocturnal  emissions. 

Oribasius  testified  to  the  value  of  water-ti'eatment  in  a  manner  sim- 
ilar to  that  of  Galen. 

JEtius  directed  baths  in  protracted  fevers,  convulsions,  retention  of 
urine,  lassitude,  and  nervous  pains,  although  he  added  to  the  water  one 
fifth  part  of  heated  oil. 

Rhazes  advocated  bathing  in  nearly  all  diseases.  His  water-treat- 
ment of  small-pox  was  far  more  successful  than  any  drug  practice  has 
proven  since. 

Avicenna  was  also  a  strenuous  advocate  for  the  watery  regimen  in  a 
multitude  of  diseases,  especially  asthma,  colics,  and  dropsy.  He  rec- 
ommended infants  to  be  bathed  daily  in  tepid  water.  It  is  a  sad  pity 
that  Avicenna,  the  Arabian  Galen,  has  not  more  imitators  in  this  respect 
among  modern  physicians. 

Hoffjnan  pronounced  water  a  universal  remedy.  His  language  is  * 
"  We  assert  that  water  is  a  remedy  suited  to  all  persons,  at  all  times ; 
that  there  is  no  better  preservative  from  distempers ;  that  it  is  assur- 
edly serviceable  both  in  acute  and  chronic  diseases ;  and,  lastly,  that  its 
use  answers  to  all  indications,  both  of  preservation  and  cure." 

Boerhaave  has  wi'itten :  No  remedy  can  more  effectually  secure 
health  and  prevent  disease  than  pure  water. 

Haller,  as  a  testimonial  of  its  value,  drank  nothing  hut  water ;  and 
the  same  is  recorded  of  Demosthenes,  Milton,  and  Locke. 

Floyer  certifies :  Water  resists  putrefaction  and  cools  burning  heat 
and  thirst,  and  helps  digestion.  He  recommended  cold  bathing  in  a 
variety  of  diseases. 


48  INTRODUCriON. 


Baynard  supposed  good  water  to  possess  healing  and  balsamic  prop- 
erties.     He  \\x\s  a  strong  advocate  for  bathing  as  a  remedy. 

Gregory  regarded  water  as  a  tonic  to  the  digestive  organs. 

The  celobnited  Clieyne  exclaimed :  Without  all  peradventure,  water 
was  the  primitive  original  beverage,  and  is  the  only  simple  fluid  fitted 
for  diluting,  moistening,  and  cooling. 

JMacijuart  in  an  especial  manner  recommended  men  of  science  and 
5ettei"8  to  make  water  their  fovorite  drink,  assuring  them  that  their 
ideas  would  be  more  precise,  their  judgment  sounder,  and  their  senses 
more  delicate. 

Londe,  and  Levy,  French  authors  on  hygiene,  speak  emphatically  in 
favor  of  the  utility  of  water  in  preserving  health. 

»•<//■  John  Koss,  Miller,  and  other  Northern  navigators,  have  testified 
that  exclusive  water-drinkers  endure  the  rigors  and  withstand  the  dis- 
eases of  the  frigid  zone  better  than  any  other  pereons. 

Dr.  Jackson,  and  Mr.  Marshall,  of  the  British  array,  and  Drs. 
Mosely,  and  James  Johnson,  of  London,  assure  us  that  the  dangers  of 
living  in  tropical  climates  ai-e  the  least  for  the  pure  water-drinkers,  and 
that  these  are  fai-  less  liable  to  the  diseases  of  acchmation. 

Haly  Abbas,  and  Mesnes,  Arabian  writers,  prescribed  bathing  in 
most  diseases,  and  theh'  directions  for  conducting  the  processes  wero 
generally  singularly  judicious. 

AlsaJiar alius,  Ai'abian,  recommends  bathing  to  moisten  the  body, 
open  the  pores,  dispel  uatuiencc,  remove  repletion,  procure  sleep,  re- 
lieve pain,  fluxes  of  the  bowels,  and  lassitude,  restore  lean  bodies  to 
plumpness,  soften  conti-acted  limbs,  etc. 

Lanzani,  Italian,  commended  large  doses  of  cold  water  internally 
as  the  best  remedy  for  fever,  and  WTOte  two  elaborate  books  to, explain 
the  gi'ounds  of  his  practice. 

Fra  Bernardo,  Sicilian,  acquired,  in  the  early  part  of  the  last  cen- 
tury, the  title  of  "  cold-water  doctor,"  and  won  a  liigh  reputation  for 
curing  affections  of  the  chest,  palpitations,  convulsions,  obstinate  dyspep- 
sia, diarrhea,  dropsy,  hemorrhages,  gout,  and  rheumatism,  by  water- 
treatmojit.  He  used  iced-water  freely  internally,  and  applied  ice  to 
hot  and  inflamed  parts.  All  food  was  withheld  during  the  first  foiir 
days — a  point  in  practice  which  our  beef-tea,  mutton-broth,  and  chick- 
en-soup Plopping  and  stuffing  doctore  would  do  well,  for  their  patients, 
to  imitate. 

Cirillo,  Neapolitan,  in  1729,  treated  a  malignant  fever,  which  prevailed 
at  Naples,  with  what  he  called  "the  watery  diet."  He  administered 
a  pint  or  two  of  water,  cooled  by  snow,  every  two  hours  for  several 
days,  permitting  no  kind  of  aliment  whatever.     When  free  perspira- 


HISTORY    OF    BATHING.  4» 

tion  took  place  the  drink  was  omitted,  and  veiy  light  food  allowed.  Ho 
•directed  odd  applications  of  snow  to  painful  and  inflamed  parts,  but  did 
not  prescribe  general  bathing. 

Rovida,  of  Arragon,  is  said  to  have  practiced  the  water-treatment 
extensively  on  the  plan  of  Cirillo  and  Fra  Bernardo. 

Samoiloicitz,  Russian  in  1771,  experienced  signal  success  in  ti'eating 
the  plague  at  Moscov>%  by  means  of  cold  acidulated  drinks,  and  fric- 
tions to  the  whole  body,  with  pounded  ice. 

Rev.  John  Hancock,  an  English  clergj^nan,  in  1722,  published  a  tract 
in  advocacy  of  water  as  the  best  remedy  for  fevers  and  the  plague. 
He  cured  agues,  scarlet  fever,  small-pox,  measles,  jaundice,  and  coughs, 
by  copious  water-drinking. 

John  Smith,  CM.,  English,  ^vrote  a  book  about  a  century  ago,  which 
is  full  of  testimonials  to  the  curative  powers  of  water  in  nearly  ail  the 
prevalent  diseases  of  the  day.  Its  title  was,  "  The  Curiosities  of  Com- 
mon Water,"  and  a  larg-e  proportion  of  its  pages  is  a  compendium  of 
the  opinions  of  many  celebrated  physicians  in  favor  of  the  employment 
of  water  as  a  general  remedy.  Among  his  authorities  are  Manwar- 
ing,  Keill,  Prat,  Duncan,  Elliot,  Allen,  Harris,  Van  Heyden,  and 
Pitt,  all  eminent  in  the  medical  profession. 

Geoffrey,  French,  more  than  a  century  ago,  advocated  the  free  use 
of  water  as  a  preventive  of  the  plague. 

Hecquel,  French,  about  the  same  time,  advocated  the  use  of  water 
as  an  almost  universal  specific. 

Ponimc,  French,  at  a  later  period,  wrote  in  favor  of  cold  water- 
drinking  and  warm  bathing  for  various  remedial  and  hygif-nic  purposes, 
and  particularly  for  the  treatment  of  hysterical  and  hypochondriacal 
disorders. 

Rondeletius,  French,  published  cases  of  gout  cured  by  cold  water  as 
a  beverage,  as  also  did  his  countryman,  Martinus. 

Riverius,  French,  treated  female  complaints,  particularly  mismen- 
struation,  successfully  by  the  use  of  water  alone. 

De  Hahn,  German,  directed  free  bathing  and  cold  water-drinking 
during  an  epidemic  fever  at  Breslau,  in  1737,  and  his  practice  was  far 
more  successful  than  that  of  his  competitors,  who  persisted  in  the  em- 
ployment of  active  drugs. 

Theden,  German,  emploj'ed  cold  water  and  ice  successfully  in  sti*an- 
gulated  hernia,  inflammations,  malignant  fevers,  and  small-pox. 

Sturm,  a  Polish  surgeon,  testifies  to  the  successful  treatment  of  epi- 
demic cholera,  by  means  of  as  much  warm  water  as  the  patients  were 
able  to  drink,  a  glassfiil  being  administered  every  ten  or  fifteen  min- 
ute'^. 

T-5 


50  INTRODUCriON, 


Those  celebrated  medical  philosophers  and  physicians,  Harvey^, 
Louret,  Cocchi,  Sanclorius,  Marziano,  and  Barthez,  advocated  and 
practiced  cold  applications  to  gouty  swellings,  and  inflammations. 

Ambrose  Pare  declaimed  that  the  true  vulnerary,  or  dressing  for 
wounds,  was  water  alone. 

Michael  Angela  Blondl,  Italian,  wrote  an  essay,  in  1542,  on  water 
as  a  remedy  for  gun-shot  wounds. 

Gabriel  Fallopius,  of  Venice,  Felix  Palaiius,  of  Trebia,  and  Jou- 
hart,  JMartel,  and  Lamorier,  of  France,  sti'ongly  advocated  water-dress- 
ings in  surgical  cases,  instead  of  the  more  mystified  and  often  mis- 
chievous plasters,  balsams,  liniments,  lotions,  or  poultices. 

Larrey,  the  most  celebrated  operative  surgee  ^'-ance  ever  produced, 
used  water-dressings  generally. 

Kern,  of  Austria,  praised  the  uses  of  water  in  the  treatment  of 
wounds,  and  even  laid  claim  to  the  discovery  of  its  superior  merit. 

M.  Jose,  of  Amiens,  recommended  cold  water  in  the  treatment  of 
wounds,  burns,  plilegmons,  erysipelas,  and  gangrene. 

Macartney,  of  Dublin,  advises  the  fi-ee  and  methodical  employment 
of  water-dressings  in  wounds  AVith  him  irrigation  was  a  favorite 
mode  of  application. 

Lancassani,  in  1753,  Caldani,  in  1767,  Leanfer,  in  1780,  and  Percy 
m  1785,  published  conclusive  evidences  of  the  superiority'  of  water  alone 
to  all  the  medicated  fluids  and  compounds  known,  for  surgical  diseases. 

Dr.  Wright,  of  England,  in  1777,  employed  cold  ablutions  extensively 
and  successfully  in  the  treatment  of  fevers. 

Dr.  Currie.  of  Liverpool,  commenced  the  ti-eatment  of  fevei-s  by  cold 
aflusions  in  1787.  For  several  years  he  treated  scarlet  and  tj-phus 
fevers,  small-pox,  and  other  diseases,  principally  by  bathing,  and  with  a 
success  universally  admitted  to  have  been  fai"  greater  than  that  of  the 
ordinary  drug-ti'eatraent.  His  work  on  the  subject  was  published  in 
1797. 

Dr.  Robert  JacJcson,  of  the  British  army,  had  equal  success  in  the 
same  practice,  the  facts  of  which  he  published  in  1791,  at  which  time 
he  had  been  in  the  habit  of  ti'eating  fevers  by  cold  afiusions  for  nearly 
twenty  years. 

Giannini,  of  Milan,  strongly  recommends  cold  immersion  in  typhus 
and  petechial  fevers. 

Dr.  Timer,  of  Prussia,  in  1825,  treated  measles  by  cold  bathing,  and 
with  remarkable  success,  as  compared  with  his  drugging  contemporaries. 

Dr.  N.  Smith,  of  New  Haven,  Conn.,  was  in  the  habit  of  dashing 
cold  water  on  the  bodies  of  patients  in  cases  of  typhoid  fever,  so  as  tc 
drench  both  the  body  linen  and  bedding. 


HISTORY    OF    B.rHIKG.  51 

Dr.  Forbes^  present  editor  of  the  ablest  medifial  journal  of  Europe, 
nnd  one  of  the  physicians  to  her  Majesty  Queen  Victoria,  confesses 
that  in  a  large  proportion  of  the  cases  of  gout  and  rheumatism  the 
Water-Cure  seems  to  be  extremely  efficacious.  He  says  further; 
"In  that  very  large  class  of  cases  of  complex  disease,  usually  known 
under  tlie  name  of  chronic  dyspepsia,  in  which  other  modes  [Why 
wait  to  tiy  "  other  modes  ?"]  of  treatment  have  failed,  or  been 
only  partially  successful,  the  practice  of  Priessnitz  is  w^ell  deserving  of 
trial.  In  many  chronic  nervous  affections  and  general  debility  we 
should  anticipate  great  benefit  from  this  system.  In  chronic  diarrhea, 
dysentery,  and  hemorrhoids  the  sitz  bath  appears  to  be  frequently  an 
effectual  remedy." 

Dr.  Johi  Bell,  author  of  the  ablest  historical  woi'k  on  bathing  extant, 
has  treated  scarlatina  in  the  Pennsylvania  Hospital  for  many  years  by 
cold  bathing,  with  the  most  satisfactory  success.  Although  he  does  not 
entirely  reject  all  other  remedies,  he  admits  that  there  is  no  other 
remedy  than  water  which  unites,  to  any  thing  like  the  same  extent, 
efficacy  with  safety  and  immediately  pleasurable  results.  He  says  : 
"  How  often  have  I  seen  the  little  sufferer,  with  burning  heat  and 
delirium,  and  unable  to  obtain  sleep  or  repose  of  any  kind,  tranquillized 
immediately  by  the  cold  affusion,  and  fall  into  a  sweet  and  refreshing 
sleep  immediately  afterward." 

Such  is  a  part  of  the  testimony  volunteered  by  the  regular  profession 
in  favor  of  the  system  we  advocate.  The  reader  will  bear  in  mind  that 
nearly  aU  the  authorities  thus  far  quoted  are  eminent  authors,  professors 
and  practitioners  of  the  allopathic  school.  After  examining  such  a  flood 
of  evidence  in  favor  of  nearly  all  that  is  claimed  by  the  hydi-opathists, 
the  question  naturally  arises.  Why  is  it,  if  regular  physicians,  in  aU 
ages,  and  of  aU  countries,  have  found  water-treatment  so  superior  in 
the  gi-eat  mass  of  human  maladies,  that  the  medical  faculty  of  the 
present  day,  as  a  body,  employ  it  so  little,  in  fact  al:f 'ost  wholly  neglect 
it,  nay,  bitterly  and  vehemently  oppose  it?  This  is  indeed  a  sti-ange 
problem,  but  it  can  be  solved. 

The  minds — professional  minds — of  medical  men  tf  this  day  are  as 
mystified  and  twistified,  as  superstitious  and  fantastical,  as  u'rational  and 
absurd,  so  far  as  medical  logic  is  concerned,  as  were  the  minds  of  med- 
ical men  in  that  by-gone  age  when  charms,  magic,  incantations,  and 
necromancy  were  among  the  remedial  resources.  And  so  their  minds 
will  remain  until  they  have  some  fixed  basis,  some  settled  princi- 
ples to  reason  from.  A  man  may  be  in  possession  of  any  amount  of 
book  knowledge,  he  may  know  all  the  facts  of  aU  the  sciences  in  exist- 
ence, yet  if  he  doe,s  not  recognize  the  principles  to  whbh  those  facts 


62  I  N  T  R  0  D  U  C  T 1 0  N. 


relate,  his  writing  and  his  talking  may  be  unintelligible  jargon,  and  his 
practice  a  promiscuous  medley  of  tinith  and  error.  A  man  may  under- 
stand all  the  letters  of  the  alphabet,  and  all  the  words  of  the  dictionary, 
And  yet  make  bad  words  and  sentences  unless  he  is  also  acquainted 
with  the  principles  of  the  construction  of  language. 

The  ancient  priests  and  monks  placed  their  patients  in  aiiy,  salubri- 
ous situations,  enjoined  strict  abstemiousness  or  the  simplest  food,  gave 
water  for  drink,  and  prescribed  sufficient  washing  or  bathing  for  thor- 
ough cleanliness,  and  then  performed  their  magical  ceremonies.  Their 
patients  recovered ;  natm-e  worked  the  cure,  and  the  doctor  got  the 
credit. 

Our  more  learned  modern  physicians,  more  abundantly  supplied  with 
disease-killing  missiles,  permit  or  recommend  the  grossest  food,  give 
poisoned  or  drugged  waters  instead  of  pure,  pay  scarcely  any  attention 
to  hygienic  regulations,  bathe  insignificantly,  empirically,  or  not  at  all, 
and  pour  down  the  pov^erful  remedies.  Their  patients  die ;  nature 
gets  the  bLime,  and  the  doctor  is  excused,  for  surely  no  one  could  have 
done  more! 

The  rock  on  which  the  water-ti-eatment  has  ever  been  ^v^ecked  is 
eclecticism.  Few  minds,  such  is  the  bias  of  education,  seem  able  to 
comprehend  how  it  can  be  possible  for  a  disease  to  be  removed  without 
a  Hide  medicine  of  some  sort.  It  may  be  very  little,  infinitesimal,  the 
thutieth  dilution,  or  a  ten-millionth  pait  of  a  drop  of  the  tincture  of  a 
shadow,  or  the  weakest  decoction  of  catnip  or  canary  seed  ;  still  it  must 
be  something  z/«natural,  or  nature  cannot  be  assisted  !  And  if  medicine 
of  any  kind  or  any  strength  is  employed  as  an  auxiliary,  notwithstand- 
ing the  use  of  water  is  regarded  as  the  leading  medication,  the  little, 
charming,  mysterious  influence  of  the  drug  will  gi-adually  gain  upon 
the  imagination,  and  in  the  end  expel  the  water  part  of  the  practice  as 
surely  as  weeds  will  run  out  flowers  in  an  uncultivated  field.  It  is  like 
mixing  brandy  and  water  to  make  a  beverage.  Every  one  will  admit 
that  in  such  an  admixture  the  water  is  the  only  strictly  necessary  and 
useful  part  of  the  drink ;  yet  by  employing  them  in  combination  no 
man  ever  had  his  taste  for  water  increase,  and  that  for  brandy  decrease. 
The  contrary  has  always  been  the  fact.  The  safety  and  the  ultimate 
triumph  of  the  Water-Cure  system  depeL:^3  on  seeping  it  clear  of  all 
•'  entangling  alliances,"  and  on  that  alono. 


PART    I. 


ANATOMY. 

DEFiN:dTi3N3. — Anatomy  is  the  science  of  the  structures  of  an  or- 
ganized body.  An  organized  body  consists  of  an  assemblage  of  parts, 
each  of  which  is  called  an  organ,  and  all  mutually  related  to,  and  depend- 
ent on,  each  other.  All  organized  bodies  are  either  animal  or  vegetable 
Comjiarative  anatomy  teaches  the  sti'uctures  of  animals.  Human  anat 
omy  contemplates  a  knowledge  of  the  sti'uctures  of  all  the  organs  and 
parts  of  the  human  body,  and  their  relations  to  each  other. 

Those  sti"uctures  which  exist  in  all  parts  of  the  body  are  called  gen- 
eral ;  those  which  are  found  only  in  particular  parts  are  termed  special. 
The  entire  organism  consists  of  solids^  in  different  degrees  of  density, 
wad  fluids,  which  circulate  through  them.  The  solids  are  bones,  teeth, 
cartilages,  ligaments,  muscles,  nerves,  vessels,  viscera,  membranes,  skin, 
hair,  and  nails.  The  fluids  are  blood,  chyle,  lymph,  saliva,  gastric 
juice,  'pancreatic  juice,  synovia,  mucus,  and  serum.  Bile,  sweat,  ui'iae, 
etc.,  are  excretions. 

Organic  Elements. — Reduced  to  their  ultimate  constituents  by 
fihemical  analysis,  almost  the  entire  bulk  of  the  body,  except  the  bony 
tissue,  is  found  to  consist  of  oxygen,  hydrogen,  nitrogen,  and  carbon 
The  bones  and  teeth  contain  a  large  proportion  of  phosphate  and  car- 
bonate of  lime.  A  very  small  proportion  of  other  substances,  considered 
to  be  elementary,  are  regarded  by  chemists  as  essential  constituents. 
These  are  phosphorous,  sulphur,  silicon,  chlorine,  iodine,  bromine,  fluo- 
rine, p)otassium,  sodium,  calcium,  magnesium,  iron,  manganese,  and 
aluminum.  To  this  list  some  late  chemists  have  added  arsenic  and 
cojjper ;  and  even  lead  and  gold  have  quite  recently  been  found  in 
organized  bodies,  and  have  quite  absurdly  been  put  down  as  con- 
stituents. 

Some  of  these  elements,  however,  are  only  occasionally  found  in  the 
human  body,  particularly  arsenic,  c  >\y3er,  lead,  and  gold  ;  hence  a  more 


64  ANATOMY. 

rational  inference  is,  that  they  are  accidental  ingredients,  instead  of  ele- 
mentar}'  constituents. 

When  it  is  considered  how  extensively  metallic  substances  and  min- 
eral preparations  are  employed  as  medicines,  and  how  generally  metallic 
vessels,  liiible  to  oxidation,  are  used  in  cooking,  to  say  nothing  of  the 
casual  admixtures  of  drags  kept  about  dwellings,  for  various  domestic 
purposes,  wi<^h  the  articles  of  food  and  drink,  it  need  not  be  sm-prising 
that  chemists  should  now  and  then  detect  ingi-edients  in  the  solids  and 
fluids  of  the  auman  body  which  have  no  natm^al  relation  to  the  organ- 
ism, save  as  incidental  poisons. 

Proximate  Principles. — The  combination  of  the  ultimate  elements 
in  various  proportions  forms  the  different  organic  substances  called  proxi- 
mate elements,  or  principles.  The  most  important  are  albumen,  Jibr in, 
and  gelatin,  which  form  the  basis  of  the  nenous,  muscular,  and  cel- 
lular tissues.  The  refinements  of  chemical  analysis  have  added  or 
produced  several  other  substances,  which  are  put  down  as  proximate. 
Most  prominent  among  them  are  osmazome,  procured  by  steeping  mus- 
cular flesh  in  water  or  alcohol;  pepsin,  found  in  the  gasti'ic  glands; 
globulin,  in  the  blood  corpuscles;  spennatin,  in  the  semen;  keratin, 
in  the  hair  and  skin ;  heniatin,  in  the  bile,  etc. 

Most  of  these  are  probably  mere  products  of  the  process  of  analysis ; 
and  there  is  no  end  to  the  "  elements,"  proximate  or  ultimate,  that 
could  be  produced  by  subjecting  animal  matters  to  chemical  actions  and 
re-agents.  Thus  chemists,  in  experimenting  upon  the  bile,  have  al- 
ready "found,"  as  distinct  principles,  bilin ;  fellinic  acid;  cholinic 
acid ;  taurin  ;  dyslysin  ;  cholepyrrhin ;  biliphcein  ;  biliverdin  ;  bili- 
fulvin  ;  cliolesterin  ;  oleate,  mangarate,  and  stearate  of  soda  ;  chloride 
of  sodium ;  sulphate,  lactate,  midi  phosphate  of  soda  ;  phosphate  of  lime. 
I  can  see  no  reason  why  a  hundred  or  a  thousand  others  may  not  be 
developed  by  similar  experiments,  which  certainly  tend  much  more  to 
the  complication  of  scientific  words  and  phrases  than  to  the  demon- 
stration of  true  science. 

Tissues. — Each  distinct  solid  structure  is  called  a  tissue.  All  tissues, 
however  diversified  in  form,  are  produced  from  cells  originating  in  a 
mass  of  soft,  liquid  matter,  and  they  present  the  same  general  chaiac- 
teristics  in  all  parts  of  the  body.  Every  portion  of  the  animal  organism 
is  formed  of  nucleated  cells,  which  are  constantly  maturing,  and  as  the 
body  is  undergoing  continual  decay  and  reproduction,  they  are  always 
found  in  various  stages  of  development. 

The  divisions  of  tissues,  and  their  vita  propoities,  will  l^e  treated  of 
in  the  physiological  pait  of  t'lis  work. 


OSTEOLOGT. 


65 


CHAPTER  1. 


OF   THE  BONES— OSTEOLOGY. 

The  osseous  sti-ucture  constitutes  the  framework  of  the  body.     It 
gives  form,  firmness,  and  individuality  to  the  physiological  character 
and  affords  surfaces  and  points  for  the  connection  of  ligaments  which 
hold  the  bones  in  position,  and 
the  attachment  of  muscles  which 
move  them.     The  proportion  of 
the  bony  stiiicture  to  the  gene- 
ral bulk  may  be  seen  at  a  glance 
in  Fig.  1. 

The   proximate    constituents 
of  bone  ai'e — 

Cartilage  .  .  (parts)  32.17 
Blood-vessels  .  .  .  .  1.13 
Phosphate  of  lime  .  .  51.04 
Ca>'->>onate  of  lime  .  .  11.30 
Fluate  of  lime  ....  2.00 
Phosphate  of  magnesia  .  1.16 
Soda,  chloride  of  sodium     1.20 

100.00 


Structure  of  Boise. — The 
bony  sti^ucture  is  a  dense,  com- 
pact, subfibrous  basis,  filled  with 
minute  cells,  and  traversed  in 
all  directions  by  branching  and 
inosculating  canals,  called  Ha- 
versian, which  give  passage  to 
vessels  and  nerves.  These  cells 
ai"e  irregular  in  form  and  size, 
and  give  off  numerous  branch- 
ing tubes,  which,  by  communi- 
cating with  each  other  in  various 
directions,  constitute  a  veiy  del- 
icate network. 


KELATIOA'    01    BOXES    TO    BULK. 


C6 


ANATOMY. 


Fiff.  2. 


A  microscopic  view  oi  the  minute 
structure  of  bone  is  shown  in  Fi{j. 
2.  1.  One  of  the  Haversian  canals, 
surrounded  by  concertric  lamellse. 
2.  The  same,  with  the  cells  and  tu- 
buli.  3.  Area  of  one  of  the  canals, 
4  4.  Direction  ot  the  medullary,  or 
central  canal.  The  upper  part  oi 
the  cut  represents  several  long  cor- 
puscles, or  cells,  v^ith  their  tubuli . 
the  lovirer  part  exhibits  the  outlines 
of  several  other  canals. 


Investing  Membrane. — 
All  the  bones  are  invested 
with  a  dense  fibrous  mem- 
bi'ane,  called  periosteum,  ex- 
cept at  their  articulating  sur- 
faces, which  are  lined  by  a 
thin  layer  of  cartilage.  That 
portion  of  the  periosteum 
which  covers  the  skull  bones  is  called  pericranium  ;  and  when  it  is 
prolonged  over  external  cartilages,  it  is  termea  perichondrium. 

The  internal  cavities  of  long  bones,  and  the  canals  find  cells  of  oth- 
ers, are  lined  by  a  membrane  called  medullary,  and  filled  with  an  oily 
substance,  called  medulla,  or  maiTOW. 


MINUTE  STRUCTURE  OF  BONE. 


DEVELorMENT  OF  BoNE. — The  osseous,  like  all  organized  struc- 
tures, is  found  to  exist  primordially  in  a  state  of  exti'emely  minute 
vesicles,  or  cells.  Each  cell  is  composed  of  a  thin  membrane,  enclosing 
n  fluid  matter,  in  which  is  a  small,  denser  mass,  constituting  the  nucleus 
Bround  which  the  cell  itself  was  originally  developed.  Within  each 
nucleus  may  usually  be  found  one  or  more  smaller  gi-anules,  or  cells, 
called  nucleolus,  or  nucleoli.  And  whether  there  are  within  these 
nucleoli  yet  smaller  vesicles,  and  within  them  more  minute  nucleoli 
9till,  and  so  on,  must  be  left  to  imagination.  The  human  mind  must 
gnisp  infinit}-  before  it  can  comprehend  the  primal  atom,  or  starting- 
point,  of  vital  organization. 

Stages  of  Ossification.— The  first  recognizable  change  of  ordinary 
vesicles  toward  bony  stiucture  is  an  assemi>lage  of  minute  cells,  of  a 
gelatinous  or  jelly-like  consistence.  In  the  piocess  of  growth  these 
cells  are  separated  by  intercellular  substance,  which  is  ti-ansparent  and 
fluid  at  first,  but  gradually  becomes  condensed  and  opake.  Then  the 
fartilaginoui  B*age  of  ossificnt bi:  exists      In  the  cartilaginous  substance 


OSTEOLOGY.  57 


vascular  canals  are  formed  by  a  union  of  ce'ils  in  ro\vs,  and  the  lique- 
faction of  the  adhering  surfaces.  The  next  distinct  change  is  into 
osseous  substance.  This  is  effected  by  the  concentration  of  all  the 
vascular  canals  to  central  points,  each  one  of  which  is  called  i^unctum 
ossijicationis.  As  the  earthy  particles  are  deposited  around  the  centi'al 
[loint,  the  surrounding  caitilaginous  cells  become  elongated,  and  within 
each  cell  two  or  three  nucleoli  are  developed.  Each  of  these  second- 
aiy  cells  soon  attains  the  size  of  the  parent  cell,  the  membrane  of 
which  disappears,  and  the  newly-formed  ceEs  are  separated  by  freshly 
effused  intercellular  substance.  Still  progi-essing,  each  newly-formed 
ceU  produces  four,  five,  or  six  young  cells,  which  desti'oy  the  parent 
membrane,  and  attain  a  larger  size  than  the  parent  cell,  being  —^ 
of  an  inch  in  diameter,  all  the  cells  being  separated  as  before  by  in- 
tercellular substance.  This  process  of  reproduction  is  repeated  yet 
again,  each  cell  producing  as  many  as  its  parent  before,  Vv'hich  form  in 
clusters  of  from  thhty  to  fifty.  The  clusters  are  oval  in  figure,  and  are 
disposed  longitudinally  to  the  axis  of  the  bone,  while  the  cells  them- 
selves are  aiTanged  transversely.  Very  fine  and  delicate  fibres,  within 
the  intercellular  substance,  commencing  at  the  ossifying  point,  and  ex- 
tending through  every  part  of  the  bone,  longitudinally  in  long,  and 
radiatingly  in  flat  bones,  are,  lastly,  formed,  and  complete  the  process 
of  ossification.  These  fibres  embrace  each  cluster  of  cells,  and  send 
branches  between  the  individual  cells  of  each  group,  by  which  the  net- 
work of  bone  is  formed,  while  the  areola  and  Hervas4an  canals  are 
formed  by  the  conjunction  of  the  cells.  A  highly  magnifying  power 
shows  tlie  ossific  fibres  to  be  composed  of  minute  cells,  of  an  elliptical 
form,  and  having  central  nucleoli. 

THE    SKELETON. 

The  skeleton  of  an  adult  person  consists  of  two  hundred  and  forty- 
six  distinct  pieces : 


Bones  of  the  head    ....     8 
Ear — ossicula  auditus     ...     6 

Face 14 

Teeth 32 

Back — vertebral  column     .     .  24 
Ribs — twelve  pairs    ....  24 
Tongue — os  hyoides       ...     1 
Upper  extremities  —arm,  wi'ist, 
and  fingers 6-i 


Breast — sternum 1 

Pelvis — ^hip,  sacrum,  and  coc- 
cyx       4 

Lower  extremities — leg,  in- 
step, and  toes 60 

Sesamoid — kneej^an,  and  bones 
in  tendons     .  ....     8 

246 


58 


ANATOMY. 


Anatomists  Jistinguish 
tiu'ee  kinds  of  bones :  the 
long,  Jlatj  and  irregular. 
The  long  appertain  to  the 
limbs,  the  arms,  legs,  fin- 
gers, and  toes ;  the  flat 
enclose  cavities,  as  the 
brain  and  pelvis ;  the  u'- 
regular  are  mostly  found 
about  the  base  of  tile 
skull,  face,  ti'unk,  wrist, 
and  instep. 

VERTEBRAL    COIiUMN. 

The  bones  of  the  back, 
constituting  the  vertebral 
column,  are  divided  into 
thirty-thi'ee  pieces  in  the 
young  person,  but  in  ad- 
vanced life  the  nme  lower 
pieces  unite  into  two. 
Each  piece  is  called  a 
vertebra.  The  whole  are 
divided  into  true  and  false. 
The  true  are  the  tw^en- 
ty-four  upper  ones,  and 
the  false  are  the  nine 
lower  ones.  The  true 
are  subdivided  into  seven 
cervical,  belonging  to  the 
neck,  twelve  dorsal,  form- 
ing the  central  portion  of  the  back  proper,  and  Jive  lumbar,  pertaining 
to  the  loins.  The  false  are  divided  into  the  sacrum,  which  consists 
originally  of  five  pieces,  and  the  coccyx,  originally  consisting  of  four 
pieces. 

The  vertebral  column  is  the  central  axis  of  the  body,  and  the  part 
of  the  skeleton  first  developed  in  all  vertebrated  aiiivials. 

Each  veitobra,  except  the  upper  cervical,  whicii  has  no  body,  con- 
sists of  a  body,  by  which  it  is  articulated  with  the  adjoining  vertebrae ; 
two  lamina,  or  plates,  v/liich  anJi  backward  and  enclose  the  passage 
foi  the  s])inal  cordj   a  spinous  p:ocess,  which  projects  backward  for 


OSSEOUS    SYSTEM. 


OSTEOLOGY. 


5€ 


Fig.  4. 


].^:4 


the  attachment  of  muscles;  two  transverse  processes 
projecting  laterally  from  each  side  of  the  laminae  foi 
the  attachment  of  muscles;  and  four  articular  j^ro 
cesses^  which  project  upward  and  downward  fron:. 
tlie  lamin88,  for  articulation  with  adjoining  vertebrsB 

Fig.  4  represents  the  vertebral  column  entire,  seen  from  tne 
left  side.  1.  Two  seml-facettes,  which  articulate  with  the  head 
of  the  rib.  2.  Spinous  process.  3,  4.  Two  foramina,  each  re- 
sulting from  the  union  of  two  vertebrse.  5.  Cervical  region 
and  its  corresponding  curve.  6.  Dorsal  region  and  its  corre- 
sponding curve.  7.  Lumbar  region  and  its  corresponding  curve. 
8.  Sacrum. 


'.4 


The  distinctive  parts  of  a 
vertebra  are  seen  in  Fig.  5. 

1.  The  body,  concave  in  the 
centre,  and  rising-  into  a 
sharp    ridge   on  each    side. 

2.  The  lamina.  3.  The  part 
called  pedicle,  rendered  con- 
cave by  the  superior  inter- 
vertebral notch.  4.  Spinous 
process,  its  extremity  bifui'- 
cated.  5.  Transverse  pro- 
cess. 6.  Vertebral  foramen. 
7.  Superior  articular  pro- 
cess. 8.  Inferior  articular 
process. 


Fig.  5. 


A  CERVICAL,  VERTEBRA. 


fEKTEBRAL  COLTTMN 


The  first  cervical  vertebra  supports  the  hea:/, 
from  which  circumstance  it  is  called  the  atlas. 
It  is  a  simple  ring  of  bone,  and  moves  laterally,  as 
well  as  forward  and  backward  to  some  extent  on 
the  second  cervical,  which  is  called  the  axis. 

The  axis  has  a  large  body,  and  a  strong,  tooth- 
7  like  process,  called  odontoid,  which  rises  perpen- 
dicularly, and  is  articulated  with  the  anterior  arch 
of  the  atlas,  while  its  posterior  surface  is  firmly 
bound  by  a  strong  transverse  ligament. 

The  atlas  (turning  on  the  axis)  moves  the  head, 
as  though  it  were  tm'ning  on  a  pivot. 

The  seventh  cervical  is  called  prominens,  because 
its  spinous  process  projects  backward  beyond  the 
others,  forming  the  prominent  part  of  the  back  of 
the  neck.  This  prominence  is  terminated  by  a 
tuber  ie,  to  which  the  strong  ligament  of  the  neck 
ligcv^mtum  nucha,  is  attached. 


60  ANAIOMY. 


The  dorsal  vertebrie  are  marked  on  each  side  by  articulating  sur- 
fiices,  facets,  for  receiving  the  head  of  the  ribs.  In  size  the  dorsal  are 
midway  between  the  cervical  and  lumbar. 

The  lumbar  vertebra  are  the  largest;  their  bodies  are  thicker  before 
than  bcliind;  their  spin;d  cavity  is  large  and  oval,  and  their  spinous 
processes  are  thick  and  broad. 

The  sacrujn  is  of  a  ti'iangular  figixre,  concave  in  front  and  convex 
posteriorly.  It  is  marked  by  four  transverse  ridges,  which  indicate 
the  consolidation  of  five  sepai'ate  pieces. 

The  coccyx,  which  terminates  the  vertebral  column  below,  is  com- 
posed of  four  small  pieces,  which  giadually  unite  in  one ;  and  this 
one  becomes  consolidated  to  the  sacrum  soon  after  the  middle  period 
of  life. 

'^.no  whole  vertebral  column  represents  two  pyramids,  with  bases 
applied  to  each  other ;  the  sacrum  and  coccyx  constituting  the  lower, 
and  all  the  vertebrae,  except  the  atlas,  forming  the  upper.  The  bodies 
are  broad  in  the  cervical  region,  naiTower  in  the  middle  of  the  dorsal, 
and  again  broad  in  the  lumbar  region.  The  spinous  processes  are  hori- 
zontal in  the  cervical,  gi-adually  becoming  oblique  in  the  upper  part  of 
the  doi-sal,  nearly  vertical  and  inbricated  in  the  middle  of  the  back,  and 
again  horizontal  toward  the  lower  part.  The  transverse  processes  grad- 
ually increase  in  length  from  the  axis  to  the  first  dorsal  vertebra ;  in 
the  dorsal  region  they  project  obliquely  backward,  and  diminish  sud- 
denly in  length  in  the  eleventh  or  twelfth,  where  they  are  veiy  small. 
The  intervertebral  foramina  are  openings  formed  by  the  juxtaposition 
of  the  vertebral  notches ;  they  are  smallest  in  the  cen'ical  region, 
gi-adually  enlarging  to  the  lumbar.  The  vertebral  groove  extends  the 
whole  length  of  the  column  on  either  side  of  the  spinous  processes,  for 
lodging  the  principal  muscles  of  the  back. 


'  bo>'p:s  of  the  skull. 

Phey  are  divided  into  those  of  the  cranium,  and  those  of  the  face. 
The  cninial,  like  all  flat  bones,  are  formed  with  two  plates,  or  tables, 
and  an  intervening  cellular  network,  called  diploe,  which  contains  an 
oily,  medullary  substance.  This  structure  is  admirably  calculated  to 
protect  the  brain  from  shocks,  blows,  etc.  The  cranial  bones  are  eight 
in  number,  and  the  facial  fourteen  : 

Cranial  Bones, 

Oojipital,  Frontal,  Sphenoid, 

Two  parietal,  Two  tempera.  Ethmoid. 


OSTEOLOGl 


61 


Facial  Bones. 
Two  nasal.  Two  palate, 

Two  superior  Kiaxillary,       Two  inferior  turbinated. 
Two  lachrymal,  Vomer, 

Two  malar.  Inferior  maxillary. 

Fig.  6. 


BONES    OF    THE    HEAD. 

In  Fig.  6,  A  represents  the  frontal  bone.  B  B.  Parietal.  C  C.  Temporal.  D  D.  Sphe. 
noid.  E  E.  Malar.  F  F.  Superior  maxillary.  G  G.  Inferior  maxillary.  H.  Occipital. 
I.  Nasal,    a  a.  Mastoid  process  of  the  temporal  bone. 


The  Occipital  hone  forms  the  base  and  back  part  of  the  cranium.  Its 
external  surface  is  marked  by  two  transverse  ridges  ;  in  the  middle  of 
the  upper  one  is  a  projection,  at  which  point  the  bone  is  very  thick  and 
strong.  Tyros  in  phrenology  have  sometimes  mistaken  this  projection 
for  the  hump  of  parentiveness.  About  an  inch  below  this  projection  is 
the  foramen  inagnum,  a  large  opening  for  the  connection  of  the  spinal 
cord  with  the  brain.  On  each  side  of  this  orifice  are  processes,  called 
condyles,  for  articulating  with  the  atlas.  The  internal  surface  of  the 
occipital  bone  is  divided  by  a  crucial  ridge  into  four  fossce.  In  tJie  up- 
per fossae  are  lodged  the  posterior  lobes  of  the  cerebrum,  and  in  the 
two  inferior  the  lateral  lobes  of  the  cerebellum.  In  front  of  the  fora- 
men magnum  is  a  projection  called  the  basilar  jprocess,  on  which  rests 
the  medulla  oblongata. 

The  Parietal  hones  ai'e  quadrilateral  in  form,  situated  at  the  side  and 
vertex  of  the  skull,  and  connected  with  each  other  by  a  sti-aight  suture, 
sailed  sagittal.     On  the  external  surface  of  each  bone  is  an  arched 
G 


«J2  ANATOMY. 

line,  called  the  tempoi  il  ridge.  The  internal  sui-face  is  marked  by 
numerous  furrows,  which  lodge  the  ramifications  of  the  middle  me- 
ningeal nileiy,  and  by  digital  fosses,  coiTesponding  with  the  convolu- 
tions of  the  brain. 

The  Frontal  bone  is  situated  at  the  anterior  part  of  the  cranium, 
forming  the  forehead,  and  a  part  of  the  roof  of  the  nostrils  and  orbits 
of  the  eyes.  Each  lateral  half  of  the  bone  projects  forward,  forming 
the  frontal  eminences.  Below  these  points  are  the  superciliary  ridges, 
which  support  the  eyebrows.  Between  these  ridges  is  a  rough  pro- 
jection, called  nasal  tuberosity,  behind  which  is  a  canal,  called  the 
longitudinal  sinus.  On  the  side  of  the  bone  is  the  temporal  ridge, 
ani  below  this  is  a  depression,  called  the  temporal  fossce.  The  sharp^ 
prominent  arches,  wliich  form  the  upper  part  of  the  orbits  are  called 
the  internal  and  external  angular  processes.  Between  these  processes 
is  a  rough  excavation,  which  receives  the  nsisal  bones,  and  a  projection, 
called  the  nasal  spine.  The  internal  surface  is  divided  by  a  grooved 
ridge  ;  in  the  gi'oove  the  longitudinal  sinus  is  lodged,  and  to  the  edges 
of  the  ridge  the  falx  cerebri  is  attached.  On  the  orbital  portions  ai-e 
foss(B  coiTesponding  to  the  convolutions  of  the  anterior  lobes  of  the 
cerebnim. 

The  Teynporal  bones  are  situated  at  the  side  and  base  of  the  skull, 
and  are  divided  into  squamous,  mastoid,  and  petrous  portions. 

The  squamous  portion  forms  the  anterior  pait  of  each  bone,  and 
the  thin,  ti'anslucent  part  of  the  temple.  A  long,  ai'ched  process  pro- 
jects from  its  external  surface,  called  the  zygoma.  Its  internal  sur- 
face is  iiTegularly  depressed  by  the  convolutions  of  the  cerebinim. 

The  mastoid  portion  forms  the  back  pait  of  the  bone.  Beginners  in 
phrenological  science,  on  feeling  behind  the  ears,  have  often  mistaken 
its  projection  for  an  enormous  "  combativeness."  It  is  thick,  rough, 
and  piercod  with  numerous  holes  for  the  passage  of  very  small  arteries 
and  veins.  Interiorly,  a  part  of  it  is  excavated  into  numerous  cells, 
which  belong  to  the  o;-gan  of  heai-ing.  In  front  of  it  is  the  meatus 
avditorius  cxtcrmis,  or  external  ear  passage. 

The  petrous  poition  is  exti-emely  hai'd  and  dense.  In  shape  it  is  a 
throe-sidod  pyramid.  Near  the  middle  of  its  posterior  surface  is  the 
enti-ance  of  the  meatus  auditorius  internus,  about  one  third  of  an  inch 
in  depth.  At  the  bottom  of  the  meatus  is  a  fossa,  called  reniform ;  it 
is  divided  by  a  sharp  ridge  into  an  upper  and  lower  compartment ;  this 
ridge  is  prolonged  for  some  distance  upon  the  anterior  waU  of  the 
meatus,  and  marks  the  situation  of  the  facial  and  auditory  nerves,  which 
constitute  the  seventh  pair,  and  enter  the  meatus. 

The  basilar  surface  is  rough  ar.l  irregular,  and  assists  to  form  the 


OSTEOLOGY  63 


under  surface  of  the  base  of  the  skull.  To  a  smooth  fossa,  called 
glenoid,  the  condyle  of  the  lower  jaw  is  articulated.  At  the  inner 
angle  of  this  fossa  is  the  forairten  of  the  Eustachian  tube. 

The  Sphenoid  bone  is  situated  at  the  base  of  the  skull,  and  enters 
into  the  formation  both  of  the  cranium  and  face.  Its  shape  has  been 
compared  to  a  bat  with  its  wings  extende-1.  It  is  divided  into  a  centi'al 
portion,  or  hody ;  lesser  wings,  consisting  of  two  small  triangular  plates 
projected  from  the  anterior  and  upper  part  of  the  body  ;  greater  wings, 
expanding  laterally  from  each  side  of  the  body ;  sjnnous  processes,  ex- 
tending backward  from  the  base  of  the  gi'eater  wings ;  and  pterygoid 
processes,  extending  downward  from  the  gi-eater  wings.  On  the  su- 
perior surface  of  its  body  are  seen  the  optic  foramina,  which  ti-ansmit 
the  optic  nerve  and  ophthalmic  arteries.  The  posterior  surface  is  flat, 
rough,  and  articulated  with  the  basilar  process  of  the  occipital  bone. 
The  lesser  loings  form  the  posterior  parts  of  the  roof  of  the  orbits, 
and  are  ti-aversed  by  the  optic  foramina.  The  greater  wings  form 
part  of  the  middle  fossae  of  the  base  of  the  skull,  and  assist  in  forming 
the  outer  walls  of  the  orbits.  The  external  border  of  the  spinous 
pirocess  is  articulated  with  the  squamous  portion  of  the  temporal  bone ; 
its  internal  border  is  gi-ooved  for  the  reception  of  the  Eustachian  tube. 
The  pterygoid  processes  form  the  lateral  boundaries  of  the  posteiior 
nares. 

The  Ethmoid  hone  (sieve-like)  is  a  square,  cellular  bone,  between 
the  orbits  at  the  root  of  the  nose.  It  is  named  from  a  number  of  small 
openings  which  perforate  the  surface.  It  consists  of  a  thin  central 
plate,  which  assists  in  forming  the  septum  of  the  nose,  and  tivo  lateral 
masses.  From  the  upper  part  of  the  septum  a  sti'ong  process  projects 
into  the  cavity  of  the  skull,  called  crista  galli,  to  which  the  falx  cerebri 
is  attached.  On  each  side  of  the  crista  galli  is  a  grooved  plate  perfo- 
rated by  numerous  openings,  the  crihriform  lamella,  which  supports 
the  bulb  of  the  olfactory  nerve,  and  gives  passage  to  its  filaments,  and 
also  to  the  nasal  branch  of  the  ophthalmic  nerve. 

The  lateral  masses  are  composed  of  cells.  The  internal  surface 
forms  the  external  boundary  of  the  upper  part  of  the  nasal  fossae.  The 
external  surface  enters  into  the  formation  of  the  inner  wall  of  the 
orbit.  What  is  called  the  superior  turhinated  hone  is  a  thin,  curled 
plate  of  the  internal  surface,  consti-tuting  the  upper  margin  of  a  nar- 
row fissure — the  superior  meatus  of  the  nose.  Below  the  meatus 
another  thin  plate  curls  outward ;  it  is  called  the  middle  turhinated 
hone. 

The  Nasal  hones  are  small,  quadrangular  pieces,  forming  the  bridge 
and  base  of  the  nose      They  are  convex  superiorly^  and  slightly  con- 


A  N  A  T  0  M  Y. 

tnve  on  their  under  surface,  which  is  grooved  for  the  nasal  branch  of 
the  ophthalmic  nerve. 

The  Sujjcrior  Maxillary  hones  form  the  whole  of  the  upper  jaw,  and 
assist  in  forming  the  orbit,  nose,  cheek,  and  palate.  The  body  of  each 
is  triangular ;  its  interior  is  hollow,  forming  the  antrum ;  and  its  lower 
part  presents  the  alveolar  jnocesses,  for  containing  the  upper  teeth. 
The  2^'^sterwr  surface  forms  part  of  the  zygomatic  fossa,  over  wliich  a 
projection  extends  to  the  malar  bone,  called  the  malar  process.  A 
process  called  nasal  articulates  with  the  frontal  and  nasal  bone.  Be- 
tween the  opening  of  the  anti-um,  which  is  an  in-egulai'  hole  on  its 
nasal  surface,  and  the  nasal  process,  is  a  deep  vertical  groove,  called 
sulcus  lachrymalis,  which  is  formed  into  a  canal  by  the  kchiymal  and 
inferior  turbinated  bones,  constituting  the  nasal  duct.  The  margin 
of  the  nasal  process  is  niai'ked  by  a  small  tubercle,  which  serves  to 
guide  the  knife  of  the  surgeon  in  operating  for  fistula  lachrymalis. 
The  palate  process  projects  horizontally  inwai'd — its  upper  sm-face 
forming  the  floor  of  the  nares,  and  its  under  surface  a  part  of  the  roof 
of  the  mouth. 

Each  Lachrymal  hone  is  a  thin,  ovaJ  plate,  situated  at  the  anterior 
and  inner  angle  of  the  orbit  of  the  eye.  A  portion  of  its  external  sur- 
face assists  in  forming  the  orbit ;  another  portion  is  concave,  and  lodges 
the  lachrymal  sac.  The  internal  surface  assists  in  forming  the  nasal 
fossPB  and  nasal  duct. 

The  Malar  hones  are  the  quadi'angular  pieces  which  form  the 
prominences  of  the  cheeks.  The  external  surface  of  each  has  many 
smaU  openings  for  the  passage  of  •filameats  of  nerves  and  minute  arte- 
ries. A  process,  called  frontal,  ascends  to  aiticulate  with  the  external 
angular  process  of  the  fi'ontal  bone,  and  form  the  outer  border  of  the 
orbit.  It  is  united  to  the  zygoma  of  the  temporal  bone  by  a  pro- 
cess called  zygomatic,  and  to  the  superior  maxillary  by  the  maxillary 
proress. 

The  Palate  bones  are  situated  at  the  back  part  of  the  nares,  and 
enter  into  the  formation  of  the  palate,  side  of  the  nose,  and  the  poste- 
rior part  of  the  floor  of  the  orbit.  Each  bone  resembles  the  letter  L, 
the  perpendicular  and  horizontal  portions  presenting  each  two  quadri- 
lateral surfaces. 

The  Inferior  Turbinated  bones  are  light,  spongy,  iiTegulai-ly  cm-ved 
bones,  projecting  inward  towai'd  the  septum  narium,  or  partition  of  the 
nose.  Each  one  is  attached  to  the  maxUlaiy  bone  in  front,  and  the 
palate  bone  behind. 

The  Vomer  is  a  thin  quadrilateral  piece,  forming  the  back  and  lower 
part  of  the  septimi  of  the  nose. 


OSTEOLOGY 


65 


The  Infeiior  Mc  lillary  bone,  or  lo^^er  jaw,  is  an  arch  of  bone  contain- 
ing the  unrjer  lovv  of  teeth.     Its 
distinctive  parts  are  shown  in  lig.  7. 

1.  The  body.  2.  The  ramus.  3,  The 
eymphisis,  or  point  of  union.  4,  Fossa 
tor  the  depressing  muscle  of  the  lower 
;'aw.  5.  Mental  foramen.  6.  External 
oblique  ridge.  7.  Groove  for  the  facial 
artery.  8.  The  angle.  9.  Extremity  of 
the  milo-hyoidean  ridge.  10.  Coronoid 
process.  11.  The  condj-les,  v/hich  articu- 
late with  the  glenoid  cavity  of  the  tem- 
poral bone.  12.  Sigmoid  notch.  13.  In- 
ferior dental  foramen.  14.  Milo-hyoidean 
groove.  15.  Alveolar  process,  i.  The 
middle  and  lateral  incisor  tooth  of  one 
side.  I.  The  canine  tooth,  b.  The  two 
bicuspids,    m.  The  three  molars. 


LOWER    JAW. 


SUTURES    OF    THE    SKULL. 

The  bones  of  the  skull  are  connected  with  each  other  by  sutures 
y^sutura,  a  seam),  of  which  anatomists  distinguish  several  varieties ;  the 
most  important  are  serrated^  saw-teeth-like  ;  squamous^  or  scaly ;  liar- 
monia,  or  apposite  ;  and  schindylesis,  fissure-like. 

The  most  prominent  cranial  articulations  are  the  coronal,  sagittal^ 
and  lambdoidal  sutures,  all  of  which  are  serrated.  The  coronal  ex- 
tends transversely  across  the  crown  of  the  skull,  uniting  the  frontal 
bone  with  the  two  parietal.  The  sagittal  forms  the  longitudinal  seam 
along  the  vertex,  and  unites  with  two  pai-ietal  bones.  The  lambdoidal 
diverges  at  an  acute  angle  from  the  posterior  exti-emity  of  the  sagittal, 
uniting  the  occipital  and  parietal  bones.  The  squamous  unites  the 
squamous  portion  of  the  temporal  with  the  parietal  and  sphenoid  bones. 
Other  sutures  are  named  according  to  the  bones,  or  parts  of  bones, 
which  they  connect. 

E-EGiONS. — The  skull  is  divisible  into  four  regions — superior,  lateral, 
inferior,  and  anterior ;  or,  vertex,  side,  base,  and  front.  I'he  suj^erio? 
region  i^  bounded  by  the  frontal  eminences  in  front,  temporal  ridges  and 
parietal  eminences  on  each  side,  and  by  the  upper  curved  line  and  pro- 
tuberan^e  of  the  occipital  behind.  The  lateral  is  subdivided  into  tern- 
jmral,  mastoid,  and  zygomatic  portions.  The  inferior  region  is  sub- 
divided into  a  cerebrcd,  or  internal,  and  a  basilar,  or  external,  surface. 
The  cerebral  surface  is  again  subdivided  into  anterior,  middle,  and 
posterior  fossa.     The  face  constitutes  the  anterior  region. 


h6 


AK  ATOMY. 


Fis.  8. 


Fig.  6  exhibits  several  mi:%7te  peculiaritiea 
of  structure  not  described  in  the  text.  i.  Tha 
frontal  portion  of  the  frontal  bone.  2.  Nasal 
tuberositv.  3.  Supra-orbital  ridge.  4.  Optic 
foramen.  5.  A  fissure,  called  sphenoidal.  6. 
Another  fissure,  called  sphono-raaxillary,  7. 
The  lachrymal  fossa.  8.  Opening  of  the  an- 
terior nares,  the  vomer  in  the  centre,  on 
which  the  figure  is  placed.  9.  Infra-orbital 
foramen.  10.  Malar  bone.  11.  Symphisis, 
or  point  of  .union  of  the  lower  jaw.  12. 
I^Iental  foramen.  13.  Ramus  of  the  lower 
jaw.  14.  Parietal  bone.  15.  Coronal  suture. 
16.  Temporal  bone.  17.  Squamous  suture. 
18.  Upper  part,  or  greater  wings,  of  sphenoid 
bone.  19.  Commencement  of  temporal  ridge. 
20.  Zygoma  of  temporal  bone,  forming,  with 
the  malar,  the  zygomatic  arch,  under  which 
is  the  zygomatic  fossa.  21.  The  mastoid 
process. 


FRONT  VIEW  OF  THE  SKULL. 


Fig.  9.  Fig.  9  represents  the  cerebral  surface  ol 

the  base  of  the  skull.  1.  One  side  of  the 
anterior  fossa.  2.  Lesser  wing  of  the 
sphenoid.  3.  Crista  galli.  4.  Foramen 
Cfficum.  5.  Cribriform  lamella  of  the  eth- 
moid. 6.  The  process  called  olivary.  7. 
Foramen  opticum.  8.  Anterior  clinoid 
process.  9.  The  carotid  groove  on  the 
side  of  the  sella  turcica,  for  the  internal 
carotid  artery  and  cavernous  sinus.  10, 
11,  12.  Middle  fossa  of  the  base  of  the 
skull :  10  marks  the  great  ala  of  the  sphe- 
noid ;  11,  the  squamous  portion  of  the 
temporal  bone ;  12,  the  petrous  portion. 
13.  The  sella  turcica.  14.  Basilar  portion 
of  sphenoid  and  occijjital  bones.  The 
uneven  ridge  between  13  and  14  is  called 
dorsum  cphippii,  and  the  prominent  angles 
of  the  ridge  constitute  the  posterior  clinoid 
processes.  15.  Foramen  rotupdum.  16. 
Foramen  ovale.  17.  Foramen  spinosum  ; 
a  small  opening  between  17  and  12  is  called 
kiatiis  Fallopii.  18.  Posterior  fossa  of  the 
base  of  the  skull.  19,  19.  The  groove  for 
the  lateral  sinus.  20.  The  ridge  upon  the  occipital  bone,  to  which  the  falx  cerebelli  is  at- 
tached.   21.  Foramen  magnum.    22.  Meatus  auditorius  internus.    23.  Jugular  foramen. 


INNER    B.VSE    OF    THE    SKTJLL. 


ORBITS    OF    TUP:    EYE. 

These  are  hollow  cones  for  tho  lodgment  of  the  eyeballs,  with  their 


OSTEOLOGY. 


67 


muscles,  vessels,  and  nerves,  and  the  lachrymal  glands.  The  superior 
boundary  is  formed  by  tlie  orbital  plate  of  the  frontal  bone,  and  by  part 
of  the  lesser  wing  of  the  sphenoid ;  the  inferior  by  part  of  the  malar 
bone,  and  by  the  orb.tal  process  of  the  superior  maxillary  and  palate 
bones ;  tne  internal  by  the  lachrymal  bone,  the  external  surface  of  the 
ethmoid,  called  os  planum^  and  part  of  the  body  of  the  sphenoid ;  and 
the  external  by  the  orbital  process  of  the  malar  bone,  and  the  great 
Bla,  or  wing  of  the  sphenoid.  Communicating  ^vith  the  orbit  are  nine 
openings  for  the  ti'ansmission  of  arteries,  veins,  and  nerves. 

The  Nasal  Fossee  are  irregular  cavities  in  the  middle  of  the  face, 
bounded  ahove  by  the  nasal  bones,  ethmoid  and  sphenoid ;  heloio  by  the 
palate  processes  of  the  palate  and  superior  maxillary  bones ;  outivardly 
by  the  superior  maxillaiy,  lachrymal,  ii  .ferior  turbinated,  superior  and 
middle  turbinated  bones  of  the  ethmoid,  palate,  and  internal  pterygoid 
plate  of  the  sphenoid.  The  partition  between  them  is  formed  by  the 
vomer  and  the  perpendicular  lamella  of  the  ethmoid. 

Each  nasal  cavity  is  divided  into  tliree  UTegular  longitudinal  passages, 
called  meatuses^  by  three  projecting  processes  of  bone  from  the  outer 
wall — the  superior,  middle,  and  inferior  turbinated  bones.  The  inferior 
or  lower  meatus  is  much  the  largest. 


THE    TEETH. 

The  human  animal  is  provided  with  two  sets  of  teeth :  the  first  are 


Fig.  10. 


those  of  childhood, 
called  deciduous^  or 
milk  teeth.  The  sec- 
ond ai'e  permanent. 
The  teeth  of  childhood 
are  tvventy :  eight  in-  S^ 
cisor,  or  cutting,  four  m 
canine,  and  eight  mo- 
lars, or  grinding  teeth. 

Fig.  10. — a.  Central  in- 
cisor, h.  Lateral  incisor. 
c.  Canine,  d.  First  molar. 
e.  Second  molar. 

TEMPORARY   TEETH. 

Tlie  permanent  teeth  are  thirty-two,  sixteen  in  each  jaw.  The  eight 
centi'al  are  called  incisors,  or  cutting ;  next  are  the  four  canine,  or  eye 
teeth  *,  then  the  eight  bicuspids,  or  small  double ;  and  lastly,  twelve 
molu/s,  or  gi'inding.  Each  lat^^ral  half  of  each  jaw,  reckoning  from  the 
centre,  contains  two  incisors,  one  canine,  two  bicuspids,  and  three  molars* 


I 


G8 


ANATOMY. 


PERMAA'ENT    TEETH. 

In  Fig.  11,  a  is  the  central  incisor,     b.  Lateral  incisor,    c.  Cuspid,  or  canine,    d.  First 
bicuspid,    c.  Second  bicuspid.    /.  First  molar,    g:  Second  molar,     h.  Third  molar. 

A  tooth  is  composed  of  a  firm  external  crust,  called  enamel ;  the 
tooth  bone  proper,  called  the  ivory ;  and  a  cortical  substance,  called 
cementum.     The  enamel  covers  the  exposed  surface  of  the  crown,  and 

Fi-.  12. 


IJVFANr    TEETH,    AND    ni;DIiil>-r3    OF    THE    PERMAA'EJTl 


OSTEOLOGY 


69 


the  cementum  forms  a  thin  coating  over  the  root  of  the  tooth.  Its 
Btructiire  is  similar  to  bone,  and  exhibits  numerous  calcigerous  cells 
and  tubuli.  The  cementum  becomes  thicker  in  old  age,  and  gives  rise 
to  appearances  in  old  persons  called  exostosed ;  the  same  appearances 
are  also  produced  by  mercury  and  other  di'ugs. 

In  Fig.  12  are  seen  the  number,  aiTangement,  and  nervous  coLinec- 
tioii  of  a  complete  set  of  infant  teeth,  with  the  rudiments  of  the  second 
set,  or  permanent  teeth.  The  cut  represents  the  jaws  of  a  child  at  the 
age  of  about  four  years. 

Periods  of  Dentition. — The  temporary  teeth  usually  appear  in 
the  following  order,  the  lower  teeth  generally  preceding  the  upper  :  In 
the  seventh  month  the  two  middle  incisors  ;  in  the  nintli  the  two  lateral 
incisors ;  in  the  twelfth  the  first  raolares ;  in  the  eighteenth  the  canine ; 
and  in  the  twenty-fourth  the  two  last  molares.  This  order,  however,  is 
subject  to  considerable  irregularity. 

The  permanent  teeth  generally  appear : 


First  molares,  at  6.^  years. 
Two  middle  incisors,  7th  year. 
Two  lateral  incisors,  8th  year. 
First  bicuspids,  9th  year. 


Second  bicuspids,  10th  year. 
Canine,  11th  to  12th  year. 
Second  molares,  12tli  to  13th  year. 
Last  molares,  ]8th  to  21st  year. 


The  last  grinding  tooth,  from  its  late  development,  is  called  dens 
sapienta,  or  wisdom  tooth.  Occasionally  it  does  not  appear  till  twenty- 
five  or  thirty  years  of  age,  or  even  later. 

The  Hyoid,  or  tongiie  bone,  called  os  hyoidcs,  is  situated  at  the  base 
of  the  tongue,  supporting  it  and  the  upper  part  of  the  larynx.  It  consists 
of  a  central  body,  two  processes,  which  project  backward,  called  the 
greater  cornua,  and  two  lesser  cornua,  ascending  from  its  angles. 

Fig.  13  is  a  front  view  of  it.     1.  The  convex  or  antero-  '^o-  ^'^• 

superior  side  of  the  body.    2.  Gnrater  cornua  of  the  left 
side.    3.  Lesser  cornua. 

In  early  life  the  cornua  and  body  are  con- 
nected by  cartilages  and  ligaments  which  be- 
come ossified  in  old  age. 

OS    HYOIDES. 
BONES    or    THE    ttiKST. 

The  sternum,  or  breast  bone,  in  front,  and  the  twelve  pairs  of  ribs 
on  the  sides,  constitute  the  thorax. 

The  Sternum  is  situated  in  the  centi'al  line  of  the  front  part  of 
the  chest;  its  upper  end  lies  within  a  few  inches  of  the  vertebral 
column,  while  its  inferior  extremity  projects  considerably  foi*ward.     Its 


70 


ANATOMY. 


upper  end  is  called  inanybriun,  to  each  side  of  wricli  the  clavicle  ia 
attached.  The  middle  portion  is  called  the  body,  and  the  inferior  ex- 
tremity terminates  in  the  xijplwid,  or  ensiform  cartilage. 


Fig  14. 


9va7, 


An  anterior  view  of  the  thorax  ia 
represented  in  Fig.  14.  1.  The  ma- 
nubrium. 2.  Body.  3.  Ensiform 
cartilage.  4.  First  dorsal  vertebra. 
5.  Last  dorsal  vertebra.  6.  First  rib. 
7.  Head  of  first  rib.  8.  Its  neck. 
9.  Its  tubercle.  10.  Seventh  rib. 
11.  Costal  cartilages  of  the  ribs.  12. 
Last  two  false  ribs.  13.  The  groove 
along  the  lower  border  of  each  rib. 

The  Ribs. — The  first  or 
upper  seven  pairs  ai*e  called 
sternal,  or  true  ribs,  because 
they  are  articulated  with  the 
sternum.  The  five  lower 
pahs  are  called  false,  or  as- 
ternal, and  are  connected 
with  each  other  in  front  by 
cartilages. 

The  ribs  increase  in  length 
from  the  first  to  the  eighth, 
and  then  diminish  to  the 
twelfth.  In  breEtdth  they  diminish  from  the  first  to  the  last, 
excepting  the  two  lower  ones.  The  first  is  horizontal,  and  all  the 
rest  oblique,  the  anterior  end  falling  considerably  below  the  vertebral 
end.  Each  rib  is  curved  to  correspond  with  the  arch  of  the  thorax, 
and  t^visted  upon  itself.  Near  the  vertebral  extremity  the  rib  is  bent 
upon  itself,  forming  an  angle  for  the  attachment  of  the  tendon  of  the 
sacro-lumbalis  muscle.  Behmd  this  angle  is  the  rough  elevation  called 
the  tubercle.  The  vertebral  end  of  the  rib  is  expanded  into  a  head  for 
ai-ticulation  with  two  contiguous  vertebrae.  The  tVN'o  lower  false  ribs 
are  much  shorter  than  the  others,  and  are  called  Jloating  ribs. 

The  sternal  ends  of  the  ribs  ai*e  cartilaginous,  thus  contributing 
mainly  to  the  elasticity-  of  the  thorax ;  infold  age  these  costal  cartilages 
are  more  or  less  ossified.  The  first  seven  cartilages  articulate  with  the 
Btemum ;  the  three  next  with  the  lower  border  of  that  immediately 
preceding;  and  the  last  two  lie  free  between  the  abdominal  muscles. 
Each  rib  articulates  with  two  vertebrae  posteriorly,  and  one  costal  carti- 
lage in  front,  except  the  first,  tenth,  elevemh,  and  twelfth,  which  are 
only  articulated  with  a  simple  verte    *n  each 


THE    THORAX. 


OSTEOLOGY. 


71 


BONES    OF    THE    UPPER    EXTRElNnTIES. 

Each  upper  extremity  comprises  the  clavicle,  or  collar  bone  ;  the 
scapula,  or  shoulder  blade ;  the  humeras,  or  arm  bone ;  the  ulna  and 
radius,  bones  of  the  fore-arm;  the  bones  of  the  carpus,  or  wrist;  and 
the  metacarpus  and  phalanges  of  the  fingers. 

The  Clavicle,  or  collar  bone,  extends  across  the  upper  part  of  the 
Bide  of  the  chest,  from  the  upper  end  of  the  sternum  to  the  point  of  the 
shoulder,  where  it  is  articulated  with  the  scapula.  Its  position  is  some- 
what oblique,  and  in  shape  it  resembles  the  italic  letter  /. 

The  Scapula,  or  shoulder  blade,  is  a  flat,  ti'iangular  bone,  occupying 
the  space  from  the  second  to  the  seventh  rib,  upon  the  posterior  aspect 
and  side  of  the  thorax.  The  anterior  surface  is  concave,  and  marked 
by  several  oblique  ridges.  The  posterior  surface,  called  dorsum,  is  con- 
vex, and  divided  into  two  unequal  portions  by  a  ridge,  called  the  spine. 
The  superior  harder  is  the  shortest ;  one  of  its  terminating  extremities 
is  called  the  superior  angle,  and  the  other  the  coracoid  process.  The 
anterior  angle  is  the  thickest  portion  of  the  bone,  and  forms  its  head. 
On  this  head  is  a  shallow  articulating  surface  called  the  glenoid  cavity, 
which  receives  the  head  of  the  humerus.  Above  and  overhanging  the 
glenoid  cavity  rises  a  projection  called  the  acromion.  Fig.  15. 

on  the  anterior  border  of  which  is  an  oval  articular 
surface  for  the  outer  end  of  the  clavicle.  A  strong, 
curved  prominence  rises  from  the  upper  part  of  the 
neck,  called  coracoid  process,  which  gives  attachment 
to  several  ligaments  and  muscles.  The  position  and 
form  of  the  scapula  and  clavicle  may  be  seen  in  Fig.  1. 

The  Humerus,  or  arm  bone,  is  long,  cylindrical, 
and  divisible  into  a  shaft  and  two  extremities.  The 
upper  extremity  is  divided  into  a  head,  w^hich  is  artic- 
ulated with  the  scapula,  nec/v,  and  greater  and  lesser 
tuberosity.  The  lower  extremity  is  divided  into  two 
articular  surfaces,  the  external  of  which  's  a  rounded 
prominence,  called  eminentia  capitata,  which  articu- 
lates with  the  head  of  the  radius  ;  the  internal  is  con- 
-cave,  and  articulates  with  the  ulna. 


Fig.  15  is  a  front  view  of  the  right  humeral  bone.  1.  The  shaft. 
2.  Head.  3.  Neck.  4.  Greater  tuberosity.  5.  Lesser  tuberosity. 
6.  A  groove  called  bicipital.  7,  8.  Bicipital  ridges.  9.  A  rough 
surface  to  which  the  deltoid  muscle  is  attached,  10.  A  foramen 
for  nutrient  vessels.  11.  Eminentia  capitata.  12.  The  troclilea. 
13.  External  condyle.  14.  Internal  jondyle.  15,  16.  Condyloid 
Tidges.  17.  Fossa  for  receiving  thrj  coronoid  process  of  the 
Qlaa. 


<6 


/2> 


HUMERUS 


72 


A  N  A  T  0  M  Y. 


1 


Fig.  16. 


The  Ulna  and  Radius  are  the  bones  of  the  fore-arm.  The  uhm  is 
a  long  bone,  slender  in  the  middle,  and  lai-ger  at  its  upper  than  its 
lower  extremity.  The  upper  end  forms  principally  the  articulation  of 
the  elbow;  the  lower  end  is  excluded  friim  the  ^vi'ist  joint  by  an  inter- 
venin<T  caitilage.  On  its  upper  exti-emity  is  a  large  semilunar  con- 
cavity, called  the  greater  sigmoid  notch,  for  articulation  with  the 
humerus;  and  on  its  outer  side  is  a  smaller  sigmoid  notch,  which 
articulates  ■with  the  head  of  the  radius.  On  the 
posterior  side  of  the  greater  notch  is  the  olecranon 
process.  The  lower  extremity  terminates  in  a  small 
rounded  head,  from  one  side  of  which  projects  a  pro- 
cess, called  styloid  ;  on  the  opposite  side  of  the  head 
is  a  smooth  surface  for  aiticulation  with  the  side  of 
the  radius. 

The  Radius  is  the  rotatory  bone  of  the  fore-arm. 
Its  upper  end  is  small,  and  its  lower  large,  forming 
almost  the  whole  of  the  wi'ist  joint.  Its  upper  ex- 
ti'cmit}'  presents  a  rounded  head,  the  side  of  which 
articulates  with  the  ulna.  The  lower  end  is  broad 
and  triangular,  having  two  articular  surfaces — one  at 
the  side,  for  the  head  of  the  ulna,  and  the  other  at 
its  extremity,  for  connecting  with  the  scaphoid  and 
semilunar  bones  of  the  wiist. 


Fig.  16  exhibits  the.  ulna  and  radius  in  front.  1.  Shaft  of  tho 
ulna.  2.  Greater  sigmoid  notch.  3.  Lesser  sigmoid  notch.  4. 
Olecranon  process.    5.  Coronoid  process.     6.  Nutritive  foramen. 

7.  Sharp  ridges  to  which  the  interosseous  membrane  is  attached. 

8.  Capitulum  ulnfe.    9.  Stj'ioid  process.     10.  Shaft  of  ihe  radius. 
..1.  Its  head.     12.  Its  neck.     13.  Its  tuberoiity.    14.  The  obliqua 


ULNA  AN"D  RADIUS. 


line.     15.  Lower  exti'emity.     Ifi.  Its  styloid  process. 


The  anterior  surface  of  the  iddius  is  somewhat  concave  superiorly, 
where  the  long  flexor  muscle  of  the  finger  is  lodged,  and  flat  below 
where  it  supports  the  pronator  quadratus  muscle.  The  nutritive  fora- 
men  is  seen  near  the  upper  third  of  this  surface,  duected  upward. 
The  posterior  surface  is  round  above,  where  it  supports  the  short 
supinator  muscle,  and  marked  by  several  shallow,  oblique  grooves  be- 
low, where  the  extensor  muscles  of  the  thumb  are  attached.  Most 
of  the  tendons  of  the  extensor  muscles  of  the  fingers  arise  from 
grooves  and  ridges  around  the  projecting  point  of  its  lower  extremity, 
which  point  is  called  its  styloid  process. 


O  S  T  E  J  L  0  G  Y. 


78 


BONES    OF    THE    WRIST. 

These  are  eight  in  number,  arranged 
in  two  rows,  which  constitute  the  car- 
pus.  The  first  row,  counting  from  the 
side  of  the  radius,  comprises  the  sca- 
phoid, semilunar,  cuneiform,  and  pisi- 
form  ;  the  second  row,  the  trapezium, 
trapezoides,  magnum,  and  unciform. 
Their  shape  and  position  are  seen  in 
Fig.  17,  which  represents  the  outside 
of  the  right  hand. 

1,  Lov/er  end  of  the  radius,  2.  Lower  end  of 
the  ulna.  3.  Inter  articular  cartilages,  attached  to 
the  styloid  process  of  the  ulna,  and  to  the  margin 
of  the  articular  su^'face  of  the  radius.  S.  The 
scaphoid.  L.  Semilunar.  C.  Cuneiform.  P.  Pi- 
siform. T.  Trapezium.  T.  Trapezoides.  M.  Os 
magnum.     U.  Unciform. 

BONES    OF    THE    HAND. 

These  are  divisible  into  the  meta- 
carpus and  phalanges.  The  metacarpus 
is  composed  of  the  five  long  bones  be- 
tween the  fingers  and  ^vrist ;  that  per- 
taining to  the  thumb  is  one  third  shorter 
than  the  others.  The  pihalanges  are 
the  finger  bones;  they  are  fourteen  in 
number,  three  belonging  to  each  finger, 
and  two  to  the  thumb. 

Fig.  18  shows  the  aspect  of  the  hand  anteriorly. 
1.  The  scaphoid  bone.  2.  Semilunar.  3.  Cunei- 
form. 4.  Pisiform.  5.  Trapezium.  6.  A  groove 
in  the  trapezium,  which  lodges  the  tendon  of  the 
flexor  carpi  radialis.  7.  Trapezoides.  8.  Os 
magnum.  9.  Unciform.  10,  10.  The  five  meta- 
(Ti/pal  bones.  11,  11.  First  row  of  phalanges. 
12,  12.  Second  row.  13,  13.  Third  row.  14.  First 
phalanx  of  the  thumb.    15.  Second  do. 


Fig.  17. 


Fig.  18. 


METACARPUS  AND  PHAIiANOBS. 


BONES    OF    THE    PELVIS. 

The  pelvis  is  composed  of  the  two  ossa  innominata,  which  form  its 
«des  and  front,  and  the  sacrum  and  coccyx  behind.     Anatomists  divide 
1—7 


74 


ANATOMY. 


it  into  a  true  and  false  pelvis.  The  true  is  the  poition  beneath  a  line, 
called  Unea  ilio  peclinea,  which  forms  the  margin,  or  brim,  of  ita 
proper  cavity ;  the  false  pelvis  is  the  part  above,  ana  is  in  reauty  the 
lower  part  of  the  abdominal  cavity. 

Fig.  19.  ^^3-  ^^  ^^  ^  front 

view  of  a  female  pel- 
vis, which  is  broader 
its  cavity  more  shal- 
low, and  the  bones 
lighter  than  in  the 
male.  1.  The  last 
lumbar  vertebra.  2, 
2.  The  intervertebral 
substance  connecting 
the  last  lumbar  ver- 
tebra with  the  fourth 
and  sacrum.  .3.  Pro- 
montory of  the  sa- 
crum. 4.  Anterior 
surface  of  the  sa- 
crum, on  which  the 
transverse  lines  and 
foramina  are  seen, 
5.  Lower  point  or  tip 
of  the  coccyx.  6,  6 
The  iliac  fossae,  form 
ing  the  Interal  bound 
aries  of  the  false  pel 
vis.  7.  Anterior  su 
pcrior  spinous  process  of  the  ilium — left  side.  8.  Anterior  inferior  spinous  process.  9. 
The  acetabulum,  a.  The  notch  of  the  acetabulum,  b.  Body  of  the  ischium,  c.  Its 
tuberosity,  d.  The  spine  of  the  ischium  seen  through  the  obturator  foramen,  c.  Os 
pubis.  /.  Symphisis  pubis,  ff^.  Arch  of  the.  pubes.  h.  Angle  of  the  os  pubis,  i.  Spine 
of  the  pubes ;  the  prominent  ridge  between  a  and  i  is  the  crest  of  the  pubes.  k,  k.  Pecti- 
neal line  of  the  pubes.  /,  I.  The  ilio-pectineal  line  ;  m,  m,  its  prolongation  to  the  promontory 
of  the  sacrum.  The  brim  of  the  true  pelvis  is  represented  by  the  lino  A,  2,  k  k,  1 1,  m  m. 
n.  The  ilio-pcctineal  eminence,  o.  The  smooth  surface  which  supports  the  femoral  ves- 
eels.    p,  p.  The  great  sacroischiatic  notch. 

The  pelvis  is  situated  obliquely  in  relation  to  the  trunk  of  the  body, 
the  inner  surface  of  the  ossa  pubis  being  directed  upward  to  support 
the  superincumbent  viscera  of  the  abdomen.  Its  cavity'  measures  in 
depth  four  inches  and  a  half  posteriorly,  three  and  a  half  in  the  mid- 
dle, and  one  and  a  half  at  the  symphisis  pubis.  Its  inlet  has  three 
diameters,  antcro-posterior,  transverse,  and  oblique.  Its  outlet  has  two, 
the  antero-posterior  and  transverse. 

Each  OS  invominatnm  is  divided  into  three  portions,  which,  in  the 
young  subject,  constitute  separate  bones ;  they  are  called  os  ilium,  03 
ischium,  and  os  pubis.  The  ilium  is  the  upper  expanded  portion  fonii- 
ing  the  prominence  of  the  hip,  and  articulating  with  the  sacrum.     The 


PELVIS. 


OSTEOLOGY. 


ischium  is  the  inferior  sti-ong  part  of  it  on  which  the  body  rests  in 
sitting.  The  pubis  forms  the  front  of  tlie  pelvis,  and  supports  the  ex- 
ternal genital  organs. 

The  acetabulum  is  a  deep  cavity  at  the  junction  of  the  three  portions 
of  the  innominatum,  for  receiving  the  head  of  the  femur,  or  thigh  bone. 
Betw^een  the  ischium  and  pubis  is  a  large  oval  opening,  called  obturator 
foramen ;  it  is  covered  by  a  ligamentous  membrane ;  a  groove  in  ita 
upper  part  lodges  the  obturator  vessels  and  nerves. 


BONES    OF    THE    LOWER    EXTREMITIES. 

These  are  the  femur,  pateUa,  tibia  and  fibula,  tarsus,  metatarsus,  and 
phalanges. 

The  Femur,  or  thigh  bone,  is  the  longCvSt  in  the  body ;  it  stands  ob 
liquely  between  the  hip  and  knee,  this  obliquity  pj^  2o 

being  gi*eatest  in  the  female,  on  account  of  the 
greater  breadth  of  the  pelvis.  Its  upper  extremity 
is  divided  into  a  rounded  head,  a  neck,  a  large  pro- 
cess, called  trochanter  major,  situated  on  the  outside, 
and  a  smaller  projection  on  the  inside,  called  tro- 
chanter minor.  The  lower  exti-emity  is  broad,  and 
divided  into  two  condyles,  which  articulate  with 
the  tibia  and  fibula. 

Fig.  20  is  the  right  femur,  seen  anteriorly.  1.  The  shaft.  2. 
Head.  3.  Neck.  4.  Great  trochanter.  5.  Anterior  intertro" 
chanteric  line.  6.  Lesser  trochanter.  7.  External  condyle. 
8.  Internal  condyle.  9.  The  tuberosity  to  which  the  external 
lateral  ligament  is  attached.  10.  The  fossa  for  the  tendon  of  the 
origin  of  the  popliteal  muscle.  11.  The  taberosity  ft)r  the  inter- 
nal  lateral  ligament. 

The  Patella,  or  knee-pan,  is  one  of  the  sesamoid 
bones ;  it  is  developed  in  the  tendon  of  the  muscle 
called  quadriceps  extensor ;  its  figure  is  heart- 
shaped,  and  it  is  articulated  with  the  condyles  of 
the  femur. 

The  Tibia  and  Fibula  are  the  bones  of  the  leg. 
The  Tibia  is  the  inner  and  largest.  Its  upper  end 
is  expanded  into  two  tuberosities,  the  upper  surfaces 
of  which  fire  smooth,  for  articulation  with  the  femur. 
On  the  outer  side  of  the  external  tuberosity  is  an 
articular  surface  which  receives  the  head  of  the 
fibula.     A  spinous  process  rises  between^tbe  artic-        os  femoris 


76 


ANATOMY 


ular  surfaces,  on  each  side  of  which  are  depressions  for  the  attachment 
of  the  cruc'al  ligament. 

The  lower  extremity  is  nearly  quadrilateral  in  shape,  and  prolonged 
on  its  iinier  side  into  a  process,  called  internal  malleolus.  On  its  outer 
side  is  an  articular  surtace,  which  unites  it  with  the  fibula.  Below  is  a 
smooth  triangular  siu-face,  which  articulates  with  the  astragalus. 

A  front  view  of  the  tibia  and  fibula,  as  articulated  with  each 
other,  is  seen  in  Fig.  21.  1.  The  shaft  of  the  tibia.  2.  Inner 
tuberosity.  3.  Outer  tuberosity.  4.  Spinous  process.  5.  The 
tubercle.  G.  Internal  or  subcutaneous  surface  of  the  shaft.  7. 
Lower  extremity  of  tibia.  8.  Internal  malleolus.  9.  Shaft  of  the 
fibula.  10.  Its  upper  extremity.  11.  Its  lower  extremity,  called 
external  malleolus.  The  sharp  border  between  1  and  6  is  called 
the  crest  of  tlie  tibia. 

The  Fibula  is  the  outer  and  smaller  bone.  Its 
upper  end,  or  head,  is  lai'ge  Eind  thick,  having  a  con- 
cave sm'face,  which  aiticulates  with  the  external 
tuberosit}^  of  the  tibia.  The  lower  end  is  prolonged 
beyond  the  articular  surface  of  the  tibia,  thus  forming 
the  external  malleolus,  the  internal  surface  of  which 
is  ai'ticulated  with  the  astragalus. 

The  Tarsus. — The  tai*sal  bones  are  seven  in 
number :  asti'agalus,  calcaneus,  scaphoid,  internal, 
middle,  and  external  cuneiform,  and  cuboid. 

The  Astragalus  has  a  convex  surface  above  for 
articulating  with  the  tibia  and  fibula,  and  a  concave 
surface  oelow,  which  articulates  with  the  calcaneus 
and  scaphoid. 

The  Calcaneus,  o^  heel  bone,  is  of  an  oblong  figure, 
articulated  with  the  astragalus  and  cuboid.  Into  its 
BON-EsoFTHE  LEG.  jo^yer  pait  the  tendo  Achillis,  or  sU'ong  cord  of  the 
heel,  is  inserted,  which  is  sometimes  iTiptm'ed  in  dancing,  jumping, 
and  otln^r  violent  exercises. 

The  Scaphoid  is  boat-shaped,  convex  before,  where  it  ai'ticulates 
with  the  three  cuneiform  bones,  and  concave  behind,  to  articulate  with 
the  rounded  head  of  the  asti*agalus. 

The  Cuneiform  bones  are  wedge-shaped,  whence  theh'  name.  The 
internal  is  tlie  largest,  and  its  convex  internal  surface  assists  in  forming 
the  inner  border  of  the  foot.  It  articulates  with  the  scaphoid,  middle 
cuneiform,  and  the  fii-st  two  metatarsal  bones.  The  middle  cuneiform 
is  the  smallest ;  it  is  connected  with  the  scaphoid,  internal  and  external 
cuneiform,  and  second  metatarsal.     The  external  cuneiform  is  articu 


OSTEOLOGY. 


77 


lated  with  the  scaphoid,  middle  cuneiform,  cu- 
boid, and  second,  thii'd,  and  fourth  metatai'sal. 

The  Cuboid  is  irregularly  cuboid  in  figure, 
articulating  ^vith  the  calcaneus,  external  cunei- 
form, and  fourth  and  fifth  metatarsal. 

The  dorsal  surface  of  the  left  foot  is  shown  in  Fig.  22.  1. 
The  astragalus ;  its  superior  quadrilateral  articular  sui-face. 
2.  The  anterior  extremity  of  the  astragalus,  which  articulates 
with  the  scaphoid.  3.  Os  calcis.  4.  Scaphoid.  5.  Internal 
cuneiform.  6.  Middle  cuneiform.  7.  External  cuneiform. 
8.  Cuboid.  9.  Metatarsal  bones  of  first  and  second  toes.  10. 
First  phalanx  of  the  great  toe.  11.  Second  do.  12.  First 
phalanx  of  second  toe.     13.  Second  do.     14.  Thiid  do. 

The  Metatarsus. — The  metatarsal  bones 
are  five  in  number,  situated  between  the  toes 
and  the  tarsus.  The^rs^,  pertaining  to  the  gi'eat 
toe,  is  the  thickest  and  shortest ;  the  second  is 
the  largest ;  the  third  is  smaEer  ;  the  fourth  still 
smaller ;  and  the  jifth  has  a  large  tuberosity  on 
its  outer  side,  in  place  of  an  ai'ticular  surface. 
They  are  articulated  with  the  tarsal  bones  pos- 
teriorly, and  the  first  row  of  phalanges  anteriorly,    boives  of  the  rooT. 

The  Phalanges. — The  phalanges  of  the  toes  con-espond  with  those 
of  the  fingers,  there  being  two  for  the  gi'eat  toe,  and  three  for  each  ol 
the  other  toes.  The  first  row  is  convex  above,  concave  beneath,  and 
compressed  on  the  sides.  The  second  is  short,  yet  rather  broader 
than  the  first.  The  bones  of  the  third  are  called  unequal  jyhalanges, 
and,  including  the  second  phalanx  of  the  great  toe,  are  flattened  and 
spread  laterally  at  the  extremities,  to  aiticulate  with  the  second  row, 
and  support  the  toe  nails.  i. 


SESAMOID    bONES. 

These  are  small  osseous  masses,  formed  in  tendons,  which  exert  a 
degi-ee  of  force  upon  the  surface  over  which  they  glide.  They  serve 
to  pi'otect  neighboring  parts  fi-om  injm-ious  pressure  and  friction,  by 
furnishing  a  sort  of  pulley  for  the  tendons  to  play  upon.  The  patella 
is  a  sesamoid  bone.  Besides  this,  there  are  four  pairs  found  in  differ- 
ent parts  of  the  skeleton,  as  pr'  perly  belonging  to  it — two  upon  the 
metacarpo-phalangeal  articulation  of  each  th-imb,  and  two  upon  the 
corresponding  joint  of  the  gi-eat  toe.  Sesamoid  bones  are  frequently 
found  upon  the  corresponding  joints  of  the  little  finger  and  little  toe. 


78  ANATOMY. 

also  in  the  tendon  of  the  peroneus  longus  muscle,  where  it  passes 
tlu-ough  the  groove  in  the  cuboid  bone.  Sometimes  they  are  found  in 
the  tendons  ai-ound  the  malleolai'  processes ;  in  the  psoas  and  iliacus 
muscles,  where  they  pass  over  the  body  of  the  os  pubis,  and  in  the 
external  head  of  the  gastrocnemius.  The  hones  of  the  tympanum^  be- 
onging  to  the  auditory  apparain^,  ai-e  sesamoid. 


CHAPTER  II. 

OF  THE  LIGAlklEJ^TS— SYNDESMOLOGr. 

The  connection  between  any  t^vo  bones  constitutes  a  joint,  or  articu- 
lation. In  movable  joints  the  opposing  surfaces  ai'e  coated  by  an  elastic 
substance,  called  cartilage ;  this  is  lubricated  by  a  fluid,  called  synovia, 
secreted  by  an  enclosing  membrane,  called  synovial ;  while  the  bones 
are  firmly  held  together  by  bands  of  glistening  fibres,  called  ligaments. 

The  foTJiis  of  articulation  are  divided  into  thi*ee  classes.  1.  Synar- 
throsis, or  fixed  joint,  as  in  the  skull,  upper  jaw,  vomer,  and  teeth. 
2.  Diarthrosis,  or  movable,  the  shoulder,  hip,  elbow,  wi-ist,  knee,  ankle, 
carpus,  and  tarsus.  3.  Amphi-arthrosus,  or  intermediate,  as  in  the 
bodies  of  the  vertebrae. 

Tlie  motions  of  joints  are  of  four  kinds.  1.  Gliding,  the  sliding 
motion  of  one  articular  surface  upon  another.  It  exists  to  some  extent 
In  all  joints,  and  is  the  only  motion  in  the  carpus  and  tarsus.  2.  Angu, 
tar,  which  may  be  fonvard,  called  ^e.rzo?i ;  backward,  called  extension ; 
inward,  called  adduction  ;  or  outward,  called  abduction.  Flexion  and 
extension  are  illustrated  in  the  knee  and  elbow,  and,  more  or  less,  in 
most  other  joints ;  adduction  and  abduction  are  seen  complete  in  the 
shoulder,  hip,  and  thumb.  3.  Circumduction,  which  consists  in  a  shght 
motion  of  the  head  of  a  bone,  while  the  exti'emity  is  made  to  describe 
a  large  circle,  as  in  the  hip  and  shoulder.  4.  Rotation,  the  movement 
of  a  bone  on  its  own  axis,  as  with  the  radius,  the  atlas  upon  the  axis, 
and  in  the  hip  and  shoulder. 

The  structures  in  the  formation  of  a  joint,  in  addition  to  the  bone, 
are  cartibge,  fibrous  tissue,  adipose  tissue,  and  synovial  membrane. 

The  cartilage  of  joints  sen-es  not  only  to  connect  different  bones, 
but  also  as  a  separating  medium.  It  forms  a  thin  coating  to  the  articu- 
lar surface,  and  has  been  classed  into  true,  reticular,  sxid  fibrous. 

Fihnris  tissue  about  the  joints  exists  in  the  form  of  ligament,  some- 


SYNDESMOLOGY. 


79 


times  constituting  bands  of  various  breadth  and  thickness,  and  some- 
times layers,  which  extend  around  the  joints  ;  these  are  called  capsular 
ligaments. 

Adipose  tissue  is  found  in  greater  or  less  quantities  about  jomts, 
where  it  serves  to  fill  up  vacant  spaces,  and  probably  increase  their 
elasticity. 

Synovial  membrane  is  the  smooth,  polished  lining  of  a  joint  which 
secretes  the  synovia,  and  enables  opposing  surfaces  to  move  upon  each 
other  with  the  most  perfect  ease  and  freedom. 

Fig.  23. 


FIBROUS    CARTILAGE. 

in  Fig.  23  is  seen  a  portion  of  fibrous  cartilage,  largely  mRgnified.  Its  devolopment 
aas  already  been  described ;  the  different  kinds  of  cartilaginous  structure  are  vowing  t» 
subsequent  changes  in  the  cells  and  intercellular  substance. 


PARTICULAR    ARTICULATIONS. 

The  connecting  media  of  joints  are  generally  named  from  nome 
prominent  circumstance  in  relation  to  form,  position,  points  of  connec- 
tion, efc,  as  capsular,  suiTounding ;  transverse,  mnning  across ;  occi- 
pito-axoid,  attached  to  and  holding  together  the  occipital  and  axis 
bones ;  lateral,  connecting  the  sides  of  articulating  bones,  etc. ;  hence, 
except  with  the  most  important  ligaments,  the  name  will  be  a  sufficient 
description 

The  Vertebral  Joints. — The  vertebroe  are  held  together  by  the 
following  ligaments:  1.  Intervertebral  substance,  a  disc  of  fibrous  car- 
tilage interposed  between  the  bodies  of  all  the  vertebra^.  This  vai'ieg 
in  thickness  in  different  parts  of  the  column,  which  circumstance  con- 
tributes much  to  the  formation  of  the  vertebral  curves.  2.  Anterior 
common  ligament,  a  broad,  thin  band  of  fibres  attached  to  the  bodies  of 
the  vertebrge  in  front,  and  extending  along  the  whole  column  from  the 
aeck  to  the  sacr  .m      3.  Posterior  common  ligament,  attached  to  th» 


80 


ANATOMY 


ris;.  24. 


bodies  behind  in  a  similar  manner.  4.  Ligamenta  suhfiava,  two  tliin 
plates  of  yellow  fibrous  tissue,  situated  between  the  arches.  5.  Cap- 
sular liframents,  loose  synovial  membranes  surrounding  the  articular 
processes.  G.  Inter-spinous  ligaments,  thin  membranous  bands  ex- 
tended between  the  spinous  processes  in  the  doi-sal  and  lumbal-  regions. 
7.  Supraspinous  ligament,  a  strong,  inelastic  fibrous  cord,  extending 
from  the  apex  of  the  spinous  process  of  the  last  cervical  vertebra  to 
the   sacinim,  being   attached    in  its  course  to   each   spinous   process. 

8.  Inter-trafisverse  ligamenlSy 
connecting  only  the  transverso 
processes  of  the  lower  dorsal 
vertebrae. 


The  connection  of  the  anterior  liga- 
ments and  those  of  the  ribs  is  seen  in 
Fig.  24.  1.  Anterior  common  hgament. 
2.  Anterior  costo-vertebral  ligament.  3. 
Anterior  costo-transverse  ligament.  4. 
Interarticular  ligament  connecting  the 
head  of  the  rib  to  the  intervertebral  sub- 
stance, and  separating  the  two  synovial 
membrarift  of  this  articulation. 


VERTEBRAL    LIGAMENTS. 


The  Neck  Joint. — There  are  seven  ligaments  connecting  the  atlas 
with  the  OS  occipitis :  Two  anterior  ligajnents,  one  of  which  is  a 
rounded  cord,  attached  above  to  the  base  of  the  occipital,  and  below  to 
the  anterior  tubercle  of  the  atlas ;  the  other  is  a  broad  membranous 
layer,  lying  deeper,  attached  to  the  margin  of  the  occipital  foramen 
above,  and  to  the  whole  length  of  the  anterior  arch  of  the  atlas  below ; 
a. posterior  ligament,  thin  and  membranous,  attached  above  to  tlie  mar- 
gin of  the  occipital  foramen,  and  below  to  the  posterior  arclr  of  the 
atlas ;  two  lateral  ligaments,  sti-ong  fascicula  of  fibres,  attached  below 
to  the  base  of  the  transverse  process  of  the  atlas,  at  eacll  side  and 
above  to  the  transverse  process  of  the  occipital  bone ;  two  capsular 
ligaments,  thin  ligamentous  capsules  surrounding  the  synovial  mem- 
branes of  the  articulation,  between  the  condyles  of  the  occipital  bone 
and  the  superior  articular  processes  of  the  atlas.  The  motions  between 
the  cranium  and  atlas  are  flexion  and  extension. 

The  axis  is  articulated  with  the  occipital  bone  by  three  ligaments — 
the  occipito-axoid,  a  broad  band  covering  the  odontoid  process  and  its 
ligaments,  and  two  odontoid,  shert,  thick  fibrous  fasciculi,  which  pass 
outward  from  the  apex  of  the  odontoid  process  to  the  sides  of  tho 
occipital  foramen  and  condyles.  These  ligaments  are  called  check  liga- 
ments, because  they  liirit  the  rotatory  movements  of  the  head. 


SYNDESMOLOG  Y. 


81 


The  atlas  is  articulated  with  the  axis  by  five  ligaments.  The  ante- 
rior consists  of  ligamentous  fibres,  passing  from  the  anterior  tubercle 
and  arch  of  the  atlas  to  the  base  of  the  odontoid  process  and  body  of 
the  axis.  The  posterior  is  a  thin  membranous  layer,  which  passes  be- 
tween the  posterior  arch  of  the  atlas  and  the  laminae  of  the  axis.  The 
two  capsular  loosely  surround  the  articular  processes  of  the  atlas  and 
axis,  and  permit  great  freedom  of  movement.  The  transverse  is  a 
strong  band,  arching  across  the  area  of  the  ring  of  the  atlas,  from  one 
ai  ticular  process  to  the  other.  It  retains  the  odontoid  process  of  the 
axis  in  connection  with  the  anterior  arch  of  the  atlas.  Where  it 
crosses  the  odontoid  process,  some  fibres  pass  downward  to  be  attached 
to  the  body  of  the  axis,  and  others  are  sent  upward  to  the  basilai*  pro- 
cess of  the  occipital  bone.  This  disposition  enables  the  atlas,  and 
with  it  the  whole  head,  to  rotate  upon  the  axis,  its  extent  of  rotation 
being  limited  by  the  odontoid  ligaments. 


Fig.  25  is  a  posterior  view  of  the  ligaments 
connecting  the  atlas,  axis,  and  occipital 
bone,  The  back  part  of  the  occipitis  and 
the  arches  of  the  atlas  and  axis  have  been 
removed.  1.  The  superior  part  of  the 
occipito-axoid  ligament,  which  has  been 
cut  away  to  show  the  ligaments  beneath. 
2.  Transverse  ligament  of  the  atlas.  3,  4. 
Ascending  and  descending  slips  of  the 
transverse  ligament,  which  have  given  to  it 
the  title  of  criiciform.  5.  One  of  the  odon- 
toid ligaments ;  the  other  is  seen  on  the 
opposite  side.  6.  One  of  the  occipito-atloid 
capsular  ligaments.  7.  One  of  the  atlo- 
axoid  capsular  ligaments. 


Fig.  25. 


NECK    J'OIIVT    POSTERIORLY 


Joints  of  the  Lower  Jaw. — These  are  formed  by  the  external 
lateral  ligaments,  short,  thick  bands  of  fibres  extending  obliquely  back- 
ward from  the  zygomas  to  the  external  surface  of  the  necks  of  the 
lower  jaw ;  the  capsular  ligament,  consisting  of  a  few  irregular  fibres 
passing  from  the  edges  of  the  glenoid  cavities  to  the  necks ;  the  inter- 
articular  fibrous  cartilages,  thin,  oval  plates,  thicker  at  the  edges  than 
in  the  centre,  placed  horizontally  between  the  heads  of  the  condyles 
and  the  glenoid  cavities,  thus  dividing  each  joint  into  an  upper  and  a 
lower  cavity ;  and  the  synovial  membranes,  one  situated  above  and  one 
below  the  caitilages. 

The  movements  of  the  lower  jaw  are  depression  and  elevation^ 
by  which  the  mouth  i?  opened  and  shut ;  also  a  forward,  backward., 
and  lateral  movement  from  side  to  side,  constituting  the  grinding 
motion. 


82 


ANATOMY. 


Fig.  26. 


Fig.  27. 


JOINTS    or    THE    LOWER    JAW. 

Fig.  26  is  an  exteraal  view  of  this  articulation.  1.  The  zygomatic  arch.  2  Tuborcld 
of  the  zygoma.  3.  Ramus  of  the  lower  jaw.  4.  Mastoid  portion  of  the  temporal  bone. 
5.  External  lateral  ligament.     6.  Stj^lo-maxillary  ligament. 

Fig.  £7  is  an  internal  view.  1.  A  section  through  the  petrous  portion  of  the  temporal 
bone,  and  spinous  process  of  the  sphenoid.  2.  An  internal  view  of  the  ramus  and  part 
of  the  body  of  the  lower  jaw.  3.  Internal  portion  of  the  capsular  ligament.  4.  Internal 
lateral  hgament.  5.  A  small  opening  at  its  insertion,  where  the  milo-hyoidean  nerve 
passes.     6.  Stylo-maxillary  ligament.    • 

The  Costo-Vertebral  Joints. — The  ribs  have  a  double  aitieular 
connection  vrith  the  vertebra.  1.  By  ligaments  connecting  the  head 
of  the  rib  with  the  bodies  of  the  vertebra.  2.  Those  connecting  the 
necJc  and  tubercle  of  the  rib  with  the  transverse  processes  of  the  vertebrae. 
This  arrangement  renders  dislocation  impossible,  as  the  neck  of  the  rib 
would  break  before  dislocation  could  occur.  In  addition,  most  of  these 
costo-veitebral  articulations  have  a  capsular,  inter  articular,  and  three 

transverse  ligaments,  named,  from  their 
^^     *  positions,  anterior,  middle,  BJid  posterior 

costo-transverse  ligaments. 


Fig.  28  is  a  posterior  view  of  a  part  of  the  tho- 
racic portion  of  the  vertebral  column,  showing 
the  ligaments  connecting  the  vertebrae  with  each 
other,  and  the  ribs  with  the  vertebrae.  1,  1.  Tho 
supraspinous  ligament.  2,  2.  Ligamenta  subflava, 
connecting  the  laminae.  3.  Anterior  costo-trang» 
verse  ligament.  4.  Posterior  costo-transverse  lig 
ameuts. 

The  movements  of  these  articulations 
are  upward  and  doicnward,  and  slightly 
backward  and  forward,  aU  the  move- 
ments increasing  from  the  head  to  the 
anterior  exti'emity  of  the  rib. 


COSTO-VERrEBRAL  JOIXTS. 


SYNE  ESMOLOGY. 


Costo-Sternal  Joints. — In  front  the  ribs  are  articulated  with  the 
Bternum,  and  some  of  them  with  each  other.  The  ligamentous  con- 
nections are  the  anterior,  posterior,  superior,  and  inferior  costo- sternal, 
and  the  synovial  membranes.  The  sixth,  seventh,  eighth,  and  some- 
times the  fifth  and  ninth  costal  cartilages  have  a  perfect  synovial  mem- 
brane, and  articulate  with  each  other. 

The  motions  of  these  articulations  are  limited  to  a  slight  sliding 
movement. 

Joints  of  the  Sternum. — The  pieces  of  this  bone  are  connected 
ty  a  thin  plate  of  interosseous  ligament,  and  anterior  and  posterior 
sternal  ligaments,  which  contribute  very  much  to  its  strer:gth,  and  to 
the  elasticity  of  the  front  of  the  chest. 

Vertebro-Pelvic  Joint. — The  last  lumbar  vertebra  and  the  sa- 
cnim  are  connected  by  the  same  general  ligaments  bs,  are  the  vertebrae 
with  each  other ;  in  addition  to  which  there  are  two  proper  ligaments, 
called  lumbosacral  and  lumbo-iliac. 

Joints  of  the  Pelvis. — There  are  four  articulations  of  the  pelvic 
bones.  1.  Sacro-iliac,  the  connection  of  which  is  formed  by  an  ante- 
rior and  posterior  sacro-iliac  ligament.  The  latter  is  also  called  inter- 
osseous ;  it  is  composed  of  sti'ong  fibres  passing  horizontally  between 
the  rough  surfaces  of  the  sacro-iliac  articulations.  2.  Sacro-ischiatic, 
the  union  of  the  sacrum  and  ischium,  formed  by  the  anterior  nnA  p>oste- 
rior  sacro-ischiatic  ligaments.  The  upper  border  of  the  anterior  forms 
part  of  the  boundary  of  the  great'  sacro-ischiatic  foramen ;  and  its  lower 
border  a  part  of  the  lesser  sacro-ischiatic  foramen.  The  superior  border 
of  the  posterior  forms  also  a  part  of  the  lesser  sacro-ischiatic  foramen, 
and  its  lower  border  a  part  of  the  boundary  of  the  perineum.  The 
two  ligaments  convert  the  sacro-ischiatic  notches  into  foramina. 

Sacro-Coccygean  Joint. — Between  the  sacrum  and  coccyx  yb  a 
soft  fibrous  cartilage.  The  bones  are  held  together  also  by  the  ante- 
rior and  posterior  sacro-coccy gean  ligaments.  This  articulation  admits 
of  a  backward  motion  during  parturition. 

Pubic  Joint. — The  ossa  pubis  are  connected  together  by  an  inter- 
osseous cartilage,  the  anterior,  posterior,  superior,  and  sub-pubic  liga- 
ments, which  variously  cross  the  symphisis,  or  place  of  union.  The 
articulation  becomes  movable  during  parturition,  and  admits  of  a  slight 
separation  of  the  bones. 


81 


ANATOMY. 


The  numerous  vacuities  in  the  walls  of  the  pelvis,  aud  their  closure 
by  ligamentous  structures,  diminish  materitdly  the  pressure  on  tiie  soft 
pai'ts  during  the  passage  of  the  head  of  the  foetus. 

Note. — The  obturator  ligament  or  memhrane  is  a  tendo-fibrous  ex- 
pansion sti-etched  across  the  obturator  foramen.  It  is  not  concerned  in 
articulation,  but  gives  attachment  to  the  obtui-ator  muscles,  and  leave* 
a  space  in  the  upper  part  of  the  foramen  for  the  passage  of  the  obturator 
vessels  and  nerves. 

Sterno-Clavicular  Joi>t. — The  breast  and  collar  bones  are  con- 
nected by  the  anterior^  posterior,  sterno-clavicular,  inter-clavicular,  and 
cosio-clavicular  ligaments,  an  interarticidar  cartilage,  and  two  synovial 
membranes.  Tlio  motions  of  this  aiticulation  ai*e  gliding  and  circum- 
duction. This  joint  is  the  centi-e  of  the  movements  of  the  shoulder. 
In  dislocations  of  the  sternal  end  of  the  clavicle,  the  costo-clavicular 
ligament,  called  also  rhomboid,  is  ruptured,  occasioning  a  peculiar  de- 
form it)'. 

Fig.  29.  Fig.  29    shows    the    ligaments    of  th« 

Bterno-clavicular  and  costo-sternal  articu- 
lations. 1.  Anterior  sterno-clavicular  liga- 
raenL  2.  Inter- clavicular  ligament  3. 
Costo-clavicular.  4.  Interarticular  carti- 
lage. 5.  Anterior  costo-sternai  ligamentg 
of  the  first  and  second  ribs. 

Sc-apulg-Clavicular  Joint 
— The  shoulder  blade  and  breast 
bone  are  connected  b}^  two  sy- 
novial  membranes,  an  interarticu 
lar  cartilage,  a  superior  acromio' 
clavicular,  an  inferior  acromio- 
clavicular, and  a  coraco-clavicular 
ligament.  This  articulation  admits  of  a  gliding  and  rotatory  move- 
ment. 

Note. — The  shoulder  blade  has  two  ligaments,  cor aco- acromial  and 
transverse,  v*'hich  are  proper  to  itself.  The  first  is  a  thick  ti-iangular 
band,  forming  a  protecting  arch  over  the  shoulder  joint.  The  second 
crosses  the  notch  in  its  upper  border,  thus  converting  it  into  a 
foramen. 


STERNO-CLAVICULAR    JOINT. 


The  Shoulder  Joint. — The  scapula  and  humerus  form  a  ball-and- 
socket  articulation ;  its  ligaments  are  the  capsular,  coraco-huvieral,  and 
gltnoid. 


SYNDESMOLOGY. 


86 


The  ligaments  of  the  scapula  and  shoulder 
joint  are  seen  in  Fig  30.  1.  Superior  acromio- 
clavicular. 2.  Coraco-clavicular.  3.  Coraco- 
acromial.  4.  Transverse.  5.  Ccipsular.  6.  Co- 
raco-humeral.  7.  The  long  tendon  of  the 
biceps  muscle  issuing  from  the  capsular  liga- 
ment, and  entering  the  bicipital  groove. 

The  capsular  ligament  encircles  the 
heads '  of  the  scapula  and  humerus. 
The  coraco-humeral  is  a  broad  band 
between  the  coracoid  process  of  the 
scapula  and  the  gi'eater  tuberosity  of 
the  humerus.  The  glenoid  is  a  car- 
tilaginous band  around  the  margin  of 
the  glenoid  cavity,  which  it  deepens. 

The  synovial  membrane  of  this 
joint  is  very  extensive,  and  the  articu- 
lation admits  of  every  kind  of  motion. 


Fig.  30. 


SHOULDER    JOINT. 


Fig.  31. 


The  Elbow  Joi>"r. — At  this  articu- 
lation the  humerus,  ulna,  and  radius  are  connected  by 
four  ligaments  in  addition  to  its  synovial  memhrane. 
They  are  the  anterior^  composed  of  fibres,  which  pass 
vertically,  transversely,  and  obliquely,  forming  a  broad 
membranous  layer,  between  the  anterior  surface  of 
the  humerus  and  the  coronoid  process  of  the  ulna  and 
orbicular  ligament ;  the  posterior,  a  broad  loose  layer 
between  the  posterior  surface  of  the  humerus  and  the 
olecranon ;  the  internal  lateral,  a  thick  triangular 
layer  passing  between  the  inner  condyle  of  the  hu- 
merus to  the  margin  of  the  gi*eater  sigmoid  cavity  of 
the  ulna ;  and  the  external  lateral,  a  strong  narrow 
band  descending  from  the  external  condyle  of  the 
humerus  to  the  orbicular  ligament  and  ridge  of  the 
ulna. 

The  motions  of  this  articulation  are  flexion  and  ex- 
tension, the  former  being  limited  by  the  coronoid 
process,  and  the  latter  by  the  olecranon. 


An  internal  view  of  the  ligaments  is  seen  in  Fig.  31.     1.  Ante- 
rior.    2.  Internal  lateral.      3.  Orbicular.     4.  Oblique.      5.  Inter- 
osseous.    6.  Internal  con  iyle  of  the  humerus,  which  conceals  the  j^lbq w    JOINT   II*< 
post wor  ligament.  TERNALLY 

8 


P8 


ANATOMY. 


Fig.  32  is  an  external  view  of  the  elbow  articulation.  1.  Hu 
merus.  2.  Ulna.  3.  Radius.  4.  External  lateral  ligament  in- 
serted below  into  the  orbicular  (5).  6.  The  posterior  extremity 
of  the  orbicular,  spreading  out  at  its  insertion  into  the  ulna.  7. 
Anterior  ligament.    8.  Posterior  ligament. 

Radio-Ll>ar  Joint. — The  radius  ana  uina  are 
held  together  by  an  inter  articular  cartilage,  the 
lower  surface  of  which  enters  into  the  articulation 
of  the  \vi*ist ;  the  orbicular  ligament,  which  sur 
rounds  the  head  of  the  radins,  and  is  attached  at 
each  end  to  the  exti'emities  of  the  lesser  sigmoid 
cavity ;  the  oblique  ligament,  a  narrow  slip  betweea 
the  coronoid  process  and  the  inner  side  of  the  ra- 
dius ;  the  interosseous  ligament,  a  broad  aponeurosis 
between  the  ridges  of  the  radius  and  ulna ;  and  the 
anterior  inferior,  and  posterior  inferior  ligaments. 
The  orbicular  ligament  is  necessai'ily  ruptured  in 
dislocations  of  the  head  of  the  radius. 

The  lower  part  of  the  interosseous  ligament  is 
perforated  for  the  passage  of  the  anterior  interosseous 
artery.  The  posterior  interosseous  artery  passes 
backward  between  the  oblique  ligament  and  the 
upper  border  of  the  interosseous  ligament.  This 
ligament  affords  an  extensive  surface  for  the  attach- 
ment of  muscles. 
The  movements  of  this  joint  are,  the  rotation  of  the  radius  upon  the 
ulna ;  the  forward  rotation  is  called  pronation,  and  the  backward  supina- 
tion. The  head  of  the  radius  also  turns  upon  its  own  axis  within  the 
orbicular  ligament  and  the  lesser  sigmoid  notch  of  the  ulna;  and  inferiorly 
a  concavity  in  the  radius  moves  on  the  rounded  head  of  the  ulna. 

The  anterior  and  posterior  inferior  ligaments  ai'e  chiefly  concerned 
in  limiting  the  movements  of  the  radius,  and  hence,  in  great  muscular 
efforts  ai'e  frequently  ruptured. 

The  Wrist  Joint. — This  articulation  is  formed  by  the  anterior^ 
posterior,  internal  lateral,  and  external  lateral  ligaments,  with  the  sy- 
novial membrane.  Its  motions  are  flexion,  extension,  adduction,  ab- 
duction, and  circumduction,  in  all  of  which  movements  the  articular 
surfaces  glide  upon  each  other.  The  \vi-ist  joint  is  an  example  of  the 
articulation  called  ginglymoid.  The  radial  artery  rests  on  the  ex- 
ternal lateral  ligament  as  it  passes  backward  to  the  first  metacarpal 
8pac«. 


ELBOW   JOINT    EX- 
TERNALLY. 


SYNDESMOLOGY. 


87 


Fig.  33. 


The  ligaments  of  the  wrist  and  hand  are  seen  an- 
teriorly in  Fig.  33.  1.  Interosseous  membrane.  2. 
Anterior  inferior  radio-ulnar  ligament.  3.  Antez'ior 
Ugament  of  the  wrist.  4.  Its  external  lateral.  5.  Its 
internal  lateral.  6.  Palmar  ligaments  of  the  carpus. 
7.  Pisiform  bone,  with  its  ligaments.  8.  Ligaments 
connecting  second  range  of  carpal  bones  with  the  me- 
tacarpal, and  these  with  each  other.  9.  Capsular  liga- 
ment of  the  carpometacarpal  articulation  of  the  thumb. 
10.  Anterior  ligament  of  the  metacarpo-phalangeal  ar- 
ticulation of  the  thumb.  11.  One  of  the  lateral  hga- 
rnents  of  that  articulation.  12.  Anterior  ligament  of 
the  metacarpo-phalangeal  articulation  of  the  index 
finger.  13.  Lateral  ligaments  of  the  same  joint ;  the 
corresponding  ligaments  are  seen  in  the  other  ai'ticu- 
latioiis.  14.  Transverse  ligament  connecting  the  heads 
of  the  metacarpal  bones  of  the  index  and  middle  fin- 
gers ;  the  sanie  ligament  is  seen  between  the  other 
fingers.  15.  Anterior  and  one  lateral  ligament  of  the 
phalangeal  articulation  of  the  thumb.  16.  Anterior 
and  lateral  ligaments  of  the  phalangeal  articulations 
of  the  index  finger ;  the  anterior  ligaments  are  re- 
moved in  the  other  fingers. 


The  Carpal  Joints. — The  carpal  bones 
ai'e  connected  by  ligamentous  bands,  which 
pass  transversely  and  longitudinally  fi'om 
bone  to  bone  on  the  back,  caUed  dorsal 
ligaments ;  by  palmar  ligaments,  which 
have  a  similar  disposition  in  front ;  by  interosseous  cartilages  between 
the  bones ;  and  by  a  strong  ligamentous  band  connecting  the  bones  of 
the  two  sides,  called  anterior  annular  ligament.  Five  distinct  synovial 
memhranes  enter  into  the  carpal  articulations. 

Between  the  bones  of  each  range  there  is  a  slight  movement  of 
flexion  and  extension. 


WRIST    JOINT 


The  Carpo-Metacarpal  Joints. — The  second  row  of  carpal  bones 
articulates  with  the  metacarpal  finger  bones  by  dorsal  and  palmar  liga- 
ments ;  and  the  metacarpal  of  the  thumb  is  joined  to  the  trapezium 
by  a  true  capsular  ligament.  The  metacai'pal  bones  of  the  four  fin- 
ger are  connected  at  their  bases  by  dorsal,  palmar,  and  interosseous 
ligaments.  The  thumb,  shoulder,  and  hip  joints  are  the  only  ones  in 
the  body  having  true  capsular  ligaments. 

The  movements  of  the  carpo-metacarpal  articulations  ai'e  limited  to 
a  slight  degi'ee  of  sliding  motion,  except  in  the  case  of  the  metacarpa. 
bone  of  the  thumb  with  the  ti'apezium,  which  has  flexim,  extension^ 
adduction,  abduction,  and  circumduction. 


88 


ANATOMY 


Mktacarpo-Phalangf.al  Joints. — The  metacarpal  and  finger 
bones  are  united  hy  anterior  tibro-cartilaginous  ligaments,  sti'ong,  nar- 
row lateral  ligaments,  and  strong  ligamentous  bands,  called  transversa. 
ligaments. 

These  articulations  have  the  motions  of  flexion,  extension,  a  limited 
adduction  and  abduction,  and  a  slight  degree  of  circumduction. 

Phalangeal  Joints. — The  finger  bones  are  connected  by  an  an- 
terior and  two  lateral  ligaments.     The  extensor  tendon  performs  the    i 
office  of  a  posterior  ligament,  as  with  the  preceding  articulations.  j 

The  movements  are  flexion  £md  extension. 


Fig.  34. 


The  Hip  Joint. — The  head  of  the  femur  is  received  into  the  cup- 
shaped  cavity  of  the  acetabulum,  forming  a  ball-and-socket  joint.  Its 
ligaments  are  the  cajJsular,  which  embraces  the  acetabulum  superiorly, 
and  the  neck  of  tlie  femur  inferiorly ;  the  ilio-femoral,  an  accessory 
Attachment  to  the  anterior  portion  of  the  capsular;  the  ligamenlum 
teres,  which  holds  the  centre  of  the  head  of  the  femm*  to  the  acetabu- 
lum ;  the  cotyloid,  a  cartilaginous  cord  around  the  margin  of  the  ace- 
tabulum, which  cavity  it  serves 
to  deepen ;  the  transverse,  ex- 
tending across  the   notch  of  the 


acetabulurL  ;    and    the    syyiovial 
membrane,  which  invests  the  hea< 
of  the  femur,  and  spreads  around 
the  hgamentum  teres. 

The  hip  joint  has  an  extensive 
range  of  movements — flexion,  ex- 
tension, adduction,  abduction,  cir- 
cumduction,  and  rotation. 

The  ligaments  of  the  pelvis  and  hip 
joint  are  partly  shown  in  Fig.  34.  1 
Lower  part  of  the  anterior  common  lig 
iment  of  the  vertebrai,  extending  down 
ward  over  the  front  of  the  sacrum.  2 
Lumbosacral.  3.  Lumbo  iUac.  4.  Ante 
rior  sacroiliac.  5.  Obturator  membrane, 
6.  Poupart's  ligament.  7.  Gimbernat'e 
8.  Capsular.  9.  lUo-femoral,  or  acces 
8ory. 

The  fossa  at  the  bottom  of  the  acetabulum  is  filled  by  an  adipose 
mass,  covered  by  synovial  membrane,  which  serves  as  an  elastic  cushiou 
to  the  head  of  the  bone  durins:  its  movements. 


PELVIS    AND    HIP    ANTERIORLY. 


SYNDESMOLOGY. 


89 


Fig.  35., 


PELVIS    AND    Hir    LATERALLY. 


A  side  view  of  the  ligaments 
of  the  pelvis  and  hip  joint  is 
Efien  in  Fig.  35.  1.  Oblique  sa- 
cro-iliac.  2.  Posterior  sacro-is- 
chiacic.  3.  Anterior  sacro-ischi- 
ntic.  4.  Great  sacro-ischiatic  for- 
amen, o.  Lesser  sacro-ischiatic 
foramen.  6.  Cotyloid  ligament 
of  the  acetabulum.  7.  Ligamen- 
tum  teres.  8.  Edge  of  the  cap- 
sular. 9.  Obturator  membrane 
;)artly  exhibited. 

The  Knee  Joint. — 
The  femur,  tibia  and  fibu- 
la, and  the  patella,  are  con- 
nected at  the  knee  joint 
bj^  thirteen  ligaments  ;  the 
first-named  five  are  exter- 
nal, and  the  next  five  are 
internal  to  the  articulation, 
and  the  remaining  three 
are  mere  folds  of  synovial 
membrane. 

The  anterior,  or  llgamentum  jMtella,  is  a  prolongation  of  tho  tendon 
of  the  extensor  muscles  of  the  thigh  downward  to  the  tubercle  of  tho 
tibia,  enclosing  the  patella ;  the  iwsterior  is  a  broad  expansion  covering 
the  whole  back  part  of  the  joint;  the  internal  lateral  is  a  broad  layer 
extending  between  the  internal  condyle  of  the  femur  and  the  inner 
tuberosity  of  the  tibia;  the  two  external  lateral  connect  the  external 
condyle  of  the  femur  to  the  outer  part  of  the  head  of  the  tibia,  and  the 
external  semilunar  cartilage  of  the  articular  surfaces  with  the  fibula. 
Within  the  joint  are  the  anterior  and  posterior  crucial,  which  connect 
the  head  of  the  tibia  with  the  condyles  of  the  femur ;  the  trans- 
verse, a  slip  of  fibres  extending  between  the  semilunar  and  internal 
cartilages;  the  coronary,  short  fibres  connecting  the  borders  of  the 
semilunar  cartilages  to  the  head  of  the  tibia  and  surrounding  liga- 
ments. 

The  semilunar  cartilages  are  two  falciform  fibrous  plates  around  the 
margin  of  the  head  of  the  tibia,  serving  to  deepen  the  articular  surface 
for  the  condyles  of  the  femur. 

The  synovial  membrane  of  this  joint  is  the  most  extensive  in  the 
skeleton,  investing  the  cartilaginous  surfaces  of  the  condyles  of  the 
femur,  of  the  head  of  the  tibia,  and  of  the  inner  surface  of  the  patella. 
Between  it  and  the  ligamentum  pateli)  is  a  mass  of  fatty  substance 


90 


ANATOMY. 


which  presses  the  membrane  toward  the  mteriorof  the  joint,  and  occu- 


Fi?.  36. 


Kfii  ■£    JOINT    AXTE- 
RIORLY. 


pies  the  fossa  between  the  condyles. 

A  slender,  conical  process  of  synovial  membrane, 
called  Ligamentum  mucosum,  proceeds  from  the 
transverse  ligament.  Its  apex  is  connected  with 
the  anterior  part  of  the  condyloid  notch,  and  its 
base  is  lost  in  the  mass  of  fat  which  projects  into 
the  joint  beneath  the  patella.  The  alar  ligaments 
ai'e  two  fringed  folds  of  synovial  membrane,  ex- 
tending fi-om  the  ligamentum  mucosum  along  the 
edges  of  the  mass  of  fat  to  the  sides  of  the 
patella. 

Fig.  36  exhibits  a  front  view  of  the  ligaments,  l.  ITie  ten- 
don of  the  quadriceps  extensor  muscle  of  the  leg.  2.  Patella. 
3.  Anterior  ligament.  4,  4.  Synovial  membrane.  5.  Internal 
lateral  ligament.  6.  The  long  division  of  the  external  lateral. 
7.  Anterior  superior  tibio-fibular  ligament. 


Fig.  37. 


Fig.  37  gives  a  posterior  view  of  the  ligaments.  1.  The 
fasciculus  of  the  posterior  ligament.  2.  The  tendon  of  the 
semi-membranous  muscle,  from  which  the  posterior  ligament 
is  derived.  3.  The  process  of  the  tendon  which  spreads  out 
in  the  fascia  of  the  popliteus  muscle.  4  VThe  process  which 
is  sent  inward  beneath  the  internal  lateral  ligament.  5.  Pos- 
terior part  of  the  internal  lateral  ligament.  6.  The  long 
division  of  the  externnl  lateral.  7.  Its  short  division.  8. 
Tendon  of  the  popliteus  cut  short.  9.  Posterior  superior 
tibio-fibular  ligament. 

The  movements  of  this  joint  are  Jlexion  and 
extension,  with  a  slight  degree  of  rotation  when 
the  knee  is  semi-flexed. 


TiBio-FiBULAR  Joints. — The  bones  of  the 
leg  are  firmly  connected  together  at  each  ex- 
tremity by  five  ligaments :  the  interosseous, 
transverse,  anterior,  and  posterior,  to  which  is 
to  be  added  the  synovial  inemhrane. 
The  movements  between  these  bones  is  a  very  slight  degree  of  yield- 
ing or  sliding  motion. 


KNEK    JOIXT    POSTE- 
RIORLY. 


Thf  Ankle  Joint.— This  is  formed  by  the  tibia  and  fibula  with 
their  malleolar  processes  above,  and  the  asti-agalus  below,  connected 
by  three  ligaments:  the  anterior,  a  thin  membranous  layer;  the  in- 
ternal lateral,  or  deltoid,  a  triangular  layer  of  fibres  attached  above  to 


SYNDESMOLOGY. 


91 


the  internal  malleolus,  and  below  to  the  astragalus,  caxis,  and  scaphoid; 
and  the  external  lateral,  which  consists  of  three  separate  bundles  of 
fibres,  proceeding  from  the  external  mal-  Pio.  33 

leolus.  the  anterior  of  which  is  attached  to 
the  asti'agalus,  the  posterior  to  the  back 
part  of  the  same  bone,  and  the  middle  to 
the  outer  side  of  the  os  calcis.  The 
motions  of  this  joint  are  flexion  and  ex- 
tension. 


Fig.  38  is  an  external  view  of  the  ankle  articulation. 
1.  Tibia.  2.  External  malleolus  of  the  fibula.  3,  3. 
Astragalus.  4.  Os  calcis.  5.  Cuboid.  Anterior 
fasciculus  of  the  external  lateral  ligament  attached 
to  the  astragalus.  7.  Its  middle  fasciculus  attached 
to  the  calcis.  8.  Its  posterior  fasciculus  attached 
to  the  astragalus.    9.  Anterior  ligament. 


ANKLE    JOINT    EXTERNALLY. 


Fig.  39  is  a  posterior  view  of  the  ankle  joint.  1.  Lower  part  of 
the  interosseous  membrane.  2.  Posterior  inferior  hgament  con- 
necting the  tibia  and  fibula.  3.  Transverse  ligament.  4.  Internal 
lateral.  5.  Posterior  fasciculus  of  the  internal  lateral.  6.  Middle 
fasciculus  of  the  external  lateral.  7.  Synovial  membrane.  8.  Os 
calcis. 

The  Tarsal  Joints. — The  bones  of  the  tarsus 
are  connected  by  dorsal  ligaments,  which  pass  from 
each  bone  to  all  others  contiguous :  the  plantar, 
which  connect  their  under  surfaces  similarly,  and 
the  interosseous,  of  which  there  are  five,  situated 
between  adjoining  bones.  These  articulations  admit 
of  a  slight  degree  of  motion — -forward,  backward, 
and  laterally ;  and  between  the  first  and  second  range 
of  bones  adduction  and  abduction,  with  slight  ^e.rion 
and  extension  take  place. 


ANKLE  JOINT 
POSTERIORLY. 


Tarso-Metatarsal  Joints. — The  ligaments  connecting  the  tarsal 
and  metatarsal  bones  are  also  dorsal,  plantar,  and  interosseous.  The 
synovial  membranes  are  three.  The  only  motion  is  a  slight  yielding  to 
pressure. 


Metatarso-Phalangeal  Joints. — The  bones  of  the  metatarsus 
are  connected  with  those  of  the  toes  by  ligaments,  called  plantar, 
lateral,  and  transverse,  so  arranged  as  to  admit  of  flexion,  extension, 
adduction,  and  abduction.  The  expansion  of  the  extensor  tendon  sup' 
plies  th©  place  of  a  dorsal  ligament. 


92 


ANATOMY. 


Fig.  40. 


II  / 


SOLE    OF   THE    FOOT. 


The  Toe  Joints. — The  phalanges  of  the  toes 
have  the  same  lignmentous  connection  as  those  of 
the  fingers,  and  the  same  variety  and  extent  of 
motion. 


The  ligaments  of  the  sole  of  the  foot  are  seen  iu  Fig.  40.  1. 
Os  cakis.  2.  Astragalus.  3.  Tuberosity  of  the  scaphoid.  4, 
Long  calcaneocuboid  ligament.  5.  Part  of  the  short  calcaneo- 
cuboid. 6.  Calcaneo-scaphoid.  7.  Plantar  tarsal.  8,  8.  Ten- 
don of  the  peroneus  longus  muscle.  9,  9.  Plantar  tarso-meta* 
tarsal  ligaments.  10.  Plantar  ligament  oi  the  metatarso- 
phalangeal joint  of  the  great  toe ;  the  same  ligament  is  seen 
upon  the  other  toes.  11.  Lateral  ligaments  of  the  metatarso- 
phalangeal joint.  12.  Transverse  ligament.  13.  Lateral  Uga- 
ments  of  the  phalanges  of  the  gi'eat  toe ;  the  same  ligaments 
are  seen  upon  the  other  toes. 


Note. — In  amputations  at  the  tai'so-raetatarsal 
joint,  it  must  be  understood  that  the  metatai-sal 
bone  of  the  second  toe  is  strongly  wedged  between 
the  internal  and  external  cuneifonn  bones,  being 
the  most  firmly  articulated  of  all  the  metatarsal 
bones. 


CHAPTER  III. 


OF  THE   MUSCLES— MYOLOGY. 


1  HE  musoes  are  the  moving  organs  of  the  body,  They  are  com- 
posed of  parallel  fibres,  of  a  deep  red  color,  constituting  lean  flesh. 
These  fibres  are  held  together  by  a  delicate  web  of  areolar  tissue, 
which  becomes  condensed  and  so  modified  toward  the  extremities  of 
the  muscles  as  to  form  glistening  fibres  and  cords,  called  tendons,  by 
which  they  are  attacli.ed  to  the  surface  of  the  bones. 

The  greater  portion  of  the  bulk  of  the  body  is  composed  of  muscu- 
lar tissue.  In  the  limbs  the  muscles  invest  and  protect  the  bones  and 
Bome  of  the  joints.  In  the  tmnk  they  are  spread  out  to  enclose  cavi- 
ties, and  form  a  defensive  wall,  capable  of  yielding  to  external  press- 
ure and  again  returning  to  its  original  position.  The  tendons  of  broad 
muscles  are  often  spread  out,  forming  expansions  called  aponeuroses. 


M  YOLO  dr. 


93 


The  names  of  muscles  are  generally  de-  Fig- <i. 

rived  from  some  prominent  character  in 
shape,  sti'ucture,  or  use,  or  points  of  attach- 
ment. The  more  fixed  or  central  point  of 
attachment  is  called  the  origin  of  a  muscle, 
and  its  movable  extremity  its  insertion.  Some 
muscles,  however,  pull  equally  at  both  ex- 
tremities. 

Structure  of  Muscle. — Muscular  tis- 
sue is  composed  of  bundles  of  fibres,  of 
variable  size,  called  fasciculi,  enclosed  in  a 
cellular  sheath.  'Each  fasciculus  is  composed 
of  smaller  bundles,  and  each  bundle  of  single 
fibres.  These  ultimate  fibres,  by  microscopic 
examination,  appeal*  to  be  composed  of  still 
smaller  fasciculi,  called  ultimate  fibrils,  en- 
closed in  a  delicate  sheath,  called  myolemma. 
Anatomists  distinguish  two  kinds  of  ultimate 
muscular  fibre :  that  of  voluntary,  or  animal 
life,  and  that  of  involuntary,  or  organic  life. 

The  ultimate  fibre  of  animal  life  is  distin- 
guished by  uniformity  of  calibre,  by  its  longi- 
tudinal striae,  and  by  transverse  markings, 
which  occur  at  short  regular  distances. 
The  ultimate  fibrils  are  regarded  as  beaded 
filaments,  consisting  of  a  regular  succession 
of  segments  and  constrictions.  An  ultimate 
fibre  is  composed  of  a  bundle  of  these  fibrils, 
so  disposed  that  all  the  segments  and  all  the  mxtscular  system. 
constrictions  correspond,  in  this  manner  giving  rise  to  alternate  light 
and  dark  lines  of  the  transverse  striae. 

Fig.  42  represents  an  ultimate  fibre  of  animal  life,  Fig.  42. 

in  which  the  transverse  splitting  into  discs,  in  the 
direction  of  the  constrictions  of  the  ultimate  fibrils, 
is  seen. 


The  ultimate  fibre  of  organic  life  is  a 
smiple  homogeneous  filament,  flat,  without 
transverse  markings,  and  much  smaller 
than  that  of  animal  life.  The  fibres  are 
collected  into  fasciculi  of  various  sizes,  and 
held  together  by  dark  nuclear  fibre*     Gen- 


ULTIMATE    FIBRE. 


64 


ANATC  MY. 


erally  a  dark  line,  or  several  dark  points,  may  be  seen  in  the  interior 
of  the  organic  fibres ;  and  sometimes  the  fibre  is  enlarged  at  irregular 
distances ;  these  appearances  are  owing  to  the  presence  of  unobliter- 
ated  nuclei  of  the  cells  from  which  the  fibre  was  originally  developed. 

Fig.  43.  jjj  pjg   ^3^  -^  exhibits  a  muscular  fibre  of  organic  life  from  the 

bladder,  magnified  600  times.     Four  of  the  nuclei  are  seen.    2  rep- 
resents a  fibre  of  organic  life  from  the  stomach,  equally  magnified. 

Development  of  Muscular  Fibre. — This  is 
effected  by  the  formation  of  nucleated  cells  out  of  an 
original  blastema  or  fluid  substance  capable  of  becom- 
ing organized,  ana  the  conversion  of  the  cells  into  the 
tubuli  of  ultimate  fibres,  by  the  process  aheady  de- 
scribed in  relation  to  the  development  of  bone,  while 
their  contents  are  ti'ansformed  into  ultimate  fibrils ;  in 
this  way  the  cell  membranes  constitute  the  myolem- 
ma,  and  theh*  contents  a  blastema,  out  of  which  new 
cells  are  formed. 


riBRE8. 


Fig.  44. 


In  Fig.  44,  1  is  a  muscular  fibre  of  animal  life,  enclosed  in 
its  myolemma.  The  transverse  and  longitudinal  strise  are 
seen.  2,  2.  Muscular  fibres  of  animal  life,  more  highly  mag 
nified  than  the  former.  The  myolemma  is  so  thin  and  trans- 
parent that  the  ultimate  fibrils  can  be.  seen  through  it.  They 
show  the  nature  of  the  longitudinal  strise,  as  well  as  the 
formation  of  the  transverse  striae. 


The  voluntary  system,  or  that  of  animal  life^ 
is  developed  from  the  external  or  serous  layer 
of  the  germinal  membrane,  and  comprehends 
all  of  the  muscles  of  the  limbs  and  trunk.  The 
involuntary,  or  organic  system,  is  formed  fi-om 
the  internal  or  mucous  layer,  and  constitutes  the  thin  muscular  stmc- 
ture  of  the  alimentary  canal,  bladder,  and  internal  organs  of  genera- 
tion. At  the  commencement  and  termination  of  the  alimeutaiy  canal, 
both  classes  of  fibres  ai'e  blended  in  the  formation  of  the  muscular  coat. 
The  heart  is  developed  from  the  middie  or  vascular  layer  of  germinal 
membrane,  and  is  composed  of  ultimate  fibres  having  the  transverse 
striae  of  the  muscles  of  animal  life,  although  its  action  is  involuntary. 


TEVELOPMENT    OF 
MUSCLE. 


MUSCLES    OF    THE    HEAD    AND    FACE. 

These  have  been  divided  into  eight  groups — cranial,  orbital,  ocular, 
nasal,  superior  labal,  inferior  labal,  maxillary,  and  auricular. 

Cranial  Group. — This  has  but  one  muscle,  the  occipito-frontalu 


MYOLOGY. 


©5 


It  is  abroad  expansion,  covering  the  whole  side  of  the  vertex  of  the 
Bkull  from  the  occiput  to  the  eyebrow.  It  arises  by  tendinous  fibrea 
from  the  outer  two  thirds  of  the  upper  curved  line  of  the  occipital, 
and  from  the  mastoid  process  of  the  temporal  bone.  It  is  inserted 
above  the  orbit  by  means  of  a  blending  of  its  fibres  with  those  of  the 
orbicularis  palpebrarum,  corrugator  supercilii,  levator  labii  superioris 
alaque  nasi,  and  pyramidalis  nasi-  Its  use  is  to  raise  the  eyebrows,  in 
doing  which  the  mteguments  of  the  forehead  are  wrinkled.  In  some 
persons  the  whole  scalp  moves  by  the  conti'action  of  this  muscle. 


Fig.  45. 


Fig.  45  shows  the  muscles  of  the  head  and 
face.  1.  Frontal  portion  of  the  occipito-fron- 
talis.  2.  Its  occipital  portion.  3.  Its  aponeu- 
rosis, or  expansion.  4.  Orbicularis  palpebra- 
rum, v/hich  conceals  the  corrugator  supercilii 
and  tensor  tarsi.  5.  Pyramidalis  nasi.  6. 
Compressor  nasi.  7.  Orbicularis  oris.  8. 
Levator  labii  superioris  alaeque  nasi.  9.  Le- 
vator labii  superioris  proprius  ;  the  lower  part 
of  the  levator  anguli  oris  is  seen  between  10 
and  11.  10.  Zygomaticus  minor.  11.  Zygo- 
maticus  major.  12.  Depressor  labii  inferioris. 
13.  Depressor  anguli  oris.  14.  Levator  labii 
inferioris.  15.  Superficial  portion  of  the  mas- 
seter.  1-6.  Its  deep  portion.  17.  Attrahena 
aurem.  18.  The  buccinator.  19.  Attollens 
aurem.  20.  Temporal  fascia  covering  in  the 
temporal  muscle.  21.  Retrahens  aurem.  22. 
Anterior  belly  of  the  digastricus ;  its  tendon 
is  seen  passing  through  its  aponeurotic  pul- 
ley. 23.  Stylo-hyoid,  pierced  by  the  posterior 
belly  of  the  digastricus.  24.  Mylo-hyoideus. 
25.  Upper  part  of  the  stemo-mastoid.  26. 
Upper  part  of  the  trapezius.  The  splenius  is  MUSCLES  OF  THE  HEAD  AND 
seen  between  25  and  26. 


FACE. 


The  Orbital  Group. — Tliree  muscles :  1.  Orbicularis palpehrarum^ 
a  sphincter  or  closing  muscle,  which  surounds  the  orbit  and  eyelids 
2.  Corrugator  supercilii,  a  naiTow,  pointed  muscle,  arising  from  the 
inner  extremity  of  the  superciliary  ridge ;  inserted  into  the  orbicularis 
palpebrarum.  3.  Tensor  tarsi,  a  very  small  muscle,  arising  from  the 
orbital  surface  of  the  lachrymal  bone ;  inserted  by  two  slips  into  the 
lachrymal  canals.  The  use  of  this  group  is  to  close  the  lids,  draw  the 
eyebrows  downward  and  inward,  and  extend  the  lachrymal  canals. 


The  Ocular  Group. — This  group  consists  of  seven :  1.  Levator 
palpebra,  long  thin,  and  triangular,  situated  in  the  upper  part  of  the 
orbit :  arises  from  the  upper  margin  of  the  optic  foramen  and  sheath 


?6 


ANATOMY. 


of  the  optic  nerve ;  inserted  into  the  upper  border  of  the  upper  tarsaj 
cartilage.  2.  Rectus  superior,  arising  with  the  preceding;  inserted 
into  the  globe  of  the  eye  about  three  hues  trora  the  margin  of  the 
cornea.  3.  Rectus  inferior ;  arises  fi-om  the  inferior  margin  of  the 
optic  foramen  and  sheath  of  the  optic  nerve ;  inserted  into  the  inferior 
surface  of  the  globe  near  the  margin  of  the  cornea.  4.  Rectus  internus, 
a  short,  tliick  muscle  ;  arises  from  the  rommon  tendon  and  the  sheath 
of  the  optic  nerve;  inserted  into  the  inner  surface  of  the  globe  near 
the  margin  of  the  cornea.  5.  Rectus  externus ;  arises  fi-om  the  common 
tendon,  and  from  the  margin  of  the  optic  foramen ;  inserted  into  the 
outer  surface  of  the  globe  near  the  cornea.  G.  Ohliquus  superior ; 
arises  from  the  margin  of  the  optic  foramen  and  sheath  of  the  optic 
nerve ;  inserted  into  the  sclerotic  coat  near  the  entrance  of  the  optic 
nerve.  7.  Ohliquus  inferior ;  arises  fi-om  the  inner  margin  of  the 
superior  maxillaiy  bone ;  inserted  into  the  outer  and  posterior  pait  of 
the  eyeball  near  the  entrance  of  the  optic  neiTe. 

Uses. — The  levator  raises  the  upper  eyelids ;  the  four  recti,  when 
acting  singly,  pull  the  eyeball  upward,  downwai'd,  inwai-d,  and  out- 
ward ;  the  superior  oblique  rolls  the  globe  inward  and  forwai'd  ;  the 
inferior  oblique  rolls  the  globe  outwai'd  and  backward. 


Fig.  46  Fig.  46  is   a  view   of   the   ocular 

group,  taken  from  the  outer  side  of 
tlie  right  orbit.  I.  A  small  fragment 
of  the  sphenoid  bone  around  the  en- 
trance of  the  optic  nerve  into  the 
orbit.  2.  Optic  nerve.  .3.  Globe  of 
the  eye.  4.  Levator  palpebree  mus- 
cle. 5.  Superior  oblique.  6.  Ita 
cartilaginous  pulley.  7.  Its  reflected 
tendon.  8.  Inferior  oblique.  9.  Su- 
perior rectus.  10.  Internal  rectus, 
almost  concealed  by  the  optic  nerve. 
11.  Parts  of  the  external  rectus, 
eaowing  its  two  heads  of  origin.  12.  Extremity  of  the  external  rectus  at  its  insertion.  13. 
Inferior  rectus.  14.  The  tunica  albuginea,  which  is  formed  by  the  expansion  of  the  ten- 
dons of  the  four  recti  muscles. 


MUSCLES    OF    THE    EYEBALL. 


The^Nasal  Group. — Three  muscles  :  1.  Pyramidalis  nasi,  a  slip 
of  fibres  extending  from  the  occipito-frontalis  downward  upon  the 
bridge  of  the  nose  ;  inserted  into  the  tendinous  expansion  of  .he  com- 
pressores  nasi.  2.  Compressor  nasi,  a  thin  triangular  muscle ;  arises 
from  the  canine  fossa  of  the  superior  maxillary  bone,  and,  spreading  out 
on  the  side  of  the  nose  into  a  tendinous  expansion,  is  continuous  across 
its  ridge  with  its  fellow  of  the  opposite  side.  3.  Dilitator  naris,  a  thin 
muscular  slip  expanded  upon  tlie  nla  of  the  nostril. 


MYOLOGY.  97 


Uses. — The  first  draws  down  the  inner  ang.e  of  the  eyebrow,  and 
assists  the  occipito-frontalis ;    the  second   expands  rather  than  com 
presses  the  nostril :  the  last  dilates  the  cavity  of  the  nostril. 

The  Superior  Labial  Grout. — Seven  muscles  constitute  thii» 
group  :  1.  Orbicularis  oris,  a  sphincter  completely  surrounding  thr^ 
mouth,  the  use  of  which  is  to  tlose  the  lips.  2.  Levator  labii  supenorix 
alceque  nasi ;  thin,  triangular,  arising  from  the  nasal  process  ;  inserted, 
by  two  distinct  portions,  into  the  ala  of  the  nose  and  upper  lip ;  its  vsc 
is  to  raise  the  upper  lip,  and  expand  the  opening  of  the  nose.  3.  Leva- 
tor lahii  sujjerioris  proprius ;  thin,  quadrilateral,  arising  from  the  lower 
border  of  the  orbit;  inserted  into  the  integument  of  the  upper  lip;  its 
use  is  to  elevate  the  upper  lip.  4.  Levator  anguli  oris,  arising  from 
the  canine  fossa  of  the  upper  jaw,  and,  passing  outwardly,  is  inserted 
into  the  angle  of  the  mouth,  which  it  draws  inward  and  upward.  5. 
Zygomaticus  major,  and  zygomaticus  minor ;  two  slender  fasciculi  of 
fibres,  arising  from  the  malar  bone ;  inserted  into  the  angle  of  the 
mouth;  they  pull  the  angle  upward  and  outward,  as  in  laughing.  7. 
Depressor  lahii  superioris  alceque  nasi,  an  oval  slip  arising  from  the 
''ncisive  fossa ;  inserted  into  the  upper  lip,  and  into  the  ala  and  columna 
■)f  the  nose ;  it  lifts  the  upper  lip,  with  the  ala  of  the  nose,  and  expands 
the  opening  of  the  nares. 

The  Ijvferior.  Labial  Group. — Comprising  three  muscles:  J. 
Depressor  lahii  inferioris ;  arises  fi-om  the  side  of  the  symphisis  of 
the  lower  jaw;  inserted  into  the  orbicularis  muscle  and  integuments 
of  the  lower  lip ;  it  draws  the  under  lip  directly  downward  and  a  little 
outward.  2.  Depressor  anguli  oris,  a  triangular  plane,  arising  from 
the  external  oblique  side  of  the  lower  jaw ;  inserted  into  the  angle  of 
the  mouth ;  it  pulls  the  angle  of  the  mouth  either  downward  and  in- 
ward, or  downward  and  outward,  by  the  radiation  of  its  fibres,  as  in  the 
expression  of  grief.  3.  Levator  lahii  inferioris,  a  conical  slip,  arising 
fi-om  the  incisive  fossa  of  the  lower  jaw;  inserted,  into  the  integuments 
of  the  chin,  which  it  raises  and  protnides. 

The  Maxillary  Group. — Five  muscles :  1.  Masseter,  short  and 
thick,  composed  of  two  planes  of  fibres,  superficial  and  deep ;  the 
superficial  arises  from  the  tuberosity  of  the  upper  jaw,  the  lower  edge 
of  the  malar  bone  and  zygoma,  and  is  inserted  into  the  ramus  and  angle 
of  the  lower  jaw;  the  deep  layer  arises  from  the  back  part  of  the 
zygoma,  and  is  inserted  into  the  upper  half  of  the  ramus.  2.  Tempo- 
alis,  a  broad  radiating  muscle,  occupying  a  considerable  extent  of  th© 
1—9 


«e 


ANATC  MY. 


Bide  of  the  head,  nnd  fitting  the  temporal  fossa ;  arises  from  the  tem- 
poral ridge,  temporal  fascia,  and  temporal  fossa,  and  converging  into  o 
strong,  narrow  tendon,  is  inserted  into  the  coronoid  process.  3.  Bucci- 
nator;  arises  from  the  alveohn-  processes  of  the  upper  jaw,  and  from 
the  external  oblique  line  of  the  lower  jaw;  inserted  into  the  angle  of 
the  mouth,  where  its  converging  fibres  cross  each  other.  4.  External 
iHenjgoid,  a  short,  thick  muscle,  arising  two-headed  from  the  sphenoid 
bone  ;  inserted  into  the  neck  of  the  lower  jaw.  5.  Internal  pterygoid, 
thick,  quadrangular,  arising  from  the  pterygoid  fossa ;  inserted  into  the 
ramus  and  angle  of  the  lower  jaw. 

Uses. — This  gi'oup  comprises  the  active  agents  in  mastication.  The 
Duccinalor  circumscribes  the  cavity  of  the  mouth,  and  shortens  the 
cavity  of  the  pharynx  in  deglutition  The  raasseter,  temporal,  and 
internal  pteiygoid  close  the  jaws,  and  perform  the  bruising  motions. 

The  two  last  mentioned,  with  the 
external  pterygoid,  cany  the  lower 
jaw  forward  upon  the  upper,  thus 
producing  the  gi'inding  motion.  All 
of  these  muscles,  acting  successively, 
produce  a  lateral  and  rotatory  move- 
ment of  the  lower  jaw. 

The  two  pterygoid  muscles  are  seen  in  Fig. 
47.  Tht'  zygomatic  arch  and  mo.st  of  the  ramus 
have  been  removed  to  bring  them  into  view. 
1.  The  sphenoid  origin  of  the  external  ptery- 
goid. 2.  Its  pterygoid  origin.  3.  Internal  pte- 
PTERYGOID  3IUSCLES.  rygoid  muscles. 


Fig.  47. 


The  Auricular  Group. — Three  muscles:  1.  Attollens  aurem ;  2. 
Attrahens  aurem ;  3.  Retraliens  aurem.  These  small  muscles  of  the 
ear  possess  ordinarily  but  little  contractility ;  they  raise,  extend,  and  re- 
tract the  eai'  in  the  lower  animals. 


MUSCLES    OF    THE    NECK. 

The  muscles  of  the  neck  are  divided  into  eight  gi'oups,  viz. : 
The  Superficial  Grgui-  — Twc  muscles :  1.  Platysma  myoides ; 
arises  from  the  integument  over  the  pectoralis  major  and  deltoid  mus- 
cles;  inserted  into  the  side  of  the  chm,  oblique  line  of  the  lower  jaw, 
angle  of  the  mouth,  and  cellular  tissue  of  the  face.  It  draws  the  angle 
of  the  mouth,  de]>resses  the  lower  }»vw,  also  produces  ti-action  on  the 
integuments  of  the  neck.  2.  Sterno-cleido-mastoid  is  the  large  oblique 
muscle  of  the  neck ;  arises  fron^  the  sternum  and  clavjrle ;  inserted 


M  1  0  L  0  G  Y.  89 


into  the  mastoid  process  and  occipital  bone.  Uses. — "When  both  act 
together  the  head  is  bowed  forward ;  either  one  acting  singly  draws 
the  head  toward  the  shoulder,  and  carries  the  face  toward  the  opposite 
side.  When  the  clavicular  portions  act  more  forcibly  than  the  sternal, 
they  give  steadiness  to  the  head,  enabling  it  to  support  great  weights. 

The  Laryngeal  Group. — This  gi'oup  is  subdivided  into  depressors 
and  elevators  of  the  os  hijoides  and  larynx.  The  depressors  are  four : 
1.  Sterno-hyoideus,  a  ribbon-like  band  arising  from  the  back  of  the 
upper  bone  of  the  sternum  and  inner  exti'emity  of  the  clavicle ;  in- 
serted into  the  back  of  the  os  hyoides.  2.  Sterno-thyroideus,  a  broader 
band,  arising  from  the  sternum  with  the  preceding,  and  from  the  carti- 
lage of  the  first  rib ;  inserted  into  the  oblique  line  of  the  great  ala  of 
the  thyroid  cartilage.  3.  Thyro-hyoideus,  arises  fi'om  the  oblique  line 
of  the  thyroid  cartilage  ;  inserted  into  the  lower  part  of  the  body  and 
great  cornua  of  the  hyoid  bone.  4.  O?no-hyoideus,  arises  from  the 
upper  border  of  the  scapula  and  transverse  ligament  of  the  supra- 
scapular notch ;  inserted  into  the  lower  border  of  the  body  of  the 
hyoid  bone. 

Uses. — All  these  muscles  pull  down  the  os  hyoides  and  laiynx.  The 
first  three  draw  them  downward  in  the  middle  line ;  the  latter  inclines 
them  to  one  or  the  other  side,  according  to  the  position  of  the  head. 

The  elevators  are  four  muscles:  1.  Digastricus,  a  two-bellied  mus- 
cle, arising  from  the  inner  side  of  the  mastoid  process  of  the  temporal 
bone  ;  inserted  into  the  lower  jaw  near  its  centre.  2.  Stylo-hyoideusy 
a  slender  muscle,  arising  from  the  middle  of  the  styloid  process ;  in- 
serted into  the  centi'al  part  of  the  body  of  the  os  hyoides.  3.  Mylo- 
liyoideus,  a  triangular  plane,  forming,  with  its  fellow,  the  floor  of  the 
mouth ;  arising  from  the  molar  ridge  of  the  lower  jaw ;  inserted  into 
the  body  of  the  os  hyoides,  and  into  the  raphe  of  the  two  muscles. 
4.  Genio-hyoideus,  arising  on  the  inner  side  of  the  centre  of  the  lower 
jaw;  inserted  into  the  upper  part  of  the  body  of  the  os  hyoides. 

Uses. — All  these  muscles  raise  the  os  hyoides  when  the  lower  jaw  is 
closed,  and  act  upon  the  lower  jaw  when  the  os  hyoides  is  drawn  down 
and  fixed  by  its  depressors. 

The  LiNGUiNAL  Group. — Five  muscles  :  1.  Genio-hyo-glossus ;  thia 
is  the  proper  muscle  of  the  tongue ;  arises,  narrow  and  pointed,  from 
a  tubercle  on  the  inner  side  of  the  centre  of  the  lower  jaw;  inserted 
by  a  fan-shaped  attachment  into  the  whole  length  of  the  tongue  and 
body  of  the  os  hyoides.  2.  Hyo-glossus,  a  square  plane,  arising  fi'om 
the  great  cornua  anc  Sody  of  the  os  hyoides ;  inserted  into  the  side  of 


<.00  ANATOMY. 

the  tongue.  3.  Lingualis,  consisting  of  a  small  bundle,  running  from 
the  base  to  the  apex  of  the  tongue.  4.  Stylo-glossus,  arising  from 
the  styloid  process  and  stylo-maxillary  ligament;  inserted  into  the  sub- 
stance and  side  of  the  tongue.  5.  Palato-glossus,  constituting,  with 
its  fellow,  the  constrictor  of  the  isthmus  of  the  fauces ;  is  extended 
between  the  soft  palate  and  base  of  the  tongue. 

Uses. — The  various  du-ections  of  the  fibres  of  the  linguinal  muscles 
give  the  tongue  every  conceivable  variety  of  motion.  The  palato- 
glossi,  assisted  by  the  uvula,  close  the  fauces  completely  in  the  act  of 
deglutition. 

The  Pharyngeal  Group. — Five  muscles:  1.  Constrictor  inferior^ 
arises  from  the  upper  rings  of  the  trachea,  cricoid  and  thyi'oid  carti- 
lages;  inserted  into  the  middle  of  the  pharynx.  2.  Constrictor  medius^ 
arises  from  the  gi-eat  cornu  of  the  os  hyoides  and  stjio-hyoidean  liga- 
ment, and  its  fibres,  radiating  from  the  origin,  are  inserted  into  the 
pharynx  and  basilar  process  of  the  occipitis.  3.  Constrictor  superior^ 
arises  from  the  molar  ridge  of  the  lower  jaw.,  the  internal  pteiygoid 
plate,  and  the  pterygo-maxillary  ligament ;  inserted  with  the  preceding. 
4.  Stylo-pharyngeus,  arising  from  the  inner  side  of  the  base  of  the 
styloid  process  ;  its  fibres  spread  out  beneath  the  miicons  membrane  of 
the  ])harynx,  and  are  inserted  into  the  posterior  border  of  the  thyroid 
cartilage.  5.  Palato-plm.ryngeus,  arises  from  the  soft  palate  ;  inserted 
into  the  inner  surfiice  of  the  phaiynx  and  posterior  border  of  the  thy- 
roid cartilage. 

Uses. — The  cousti'ictors  contract  upon  the  food  as  soon  as  it  passes 
into  the  phaiyux,  and  convey  it  downward  to  the  oesophagus.  The 
stylo-pharyngei  draw  the  phaiynx  upward  and  widen  it  laterally  ;  and 
the  palato-pharyngei  draw  it  upward  and  assist  in  closing  the  opening 
of  the  fauces. 

Palatal  Group. — The  muscles  of  the  soft  palate  are  tiiree  ;  their 
situation  is  indicated  by  their  names.  They  are :  1.  Levator  palati, 
which  raises  the  soft  palate.  2.  Tensor  palati,  which  extends  the 
palate  laterally,  so  as  to  form  a  septum  between  the  pharynx  and  pos- 
terior nares.     .3.  Azygos  uvula,  which  shortens  the  mTila. 

Pr^evertebral  Group. — Five  muscles:  1.  Rectus  anlicus  major, 
arises  from  the  anterior  tubercles  of  the  transverse  processes  if  the 
third,  fourth,  fifth,  and  sixth  ceiTical  vertebrse  ;  inserted  into  the  basilar 
process  of  the  occipitis.  2.  Rectus  anlicus  minor,  arises  from  the  side 
of  the  atlas ;  inserted  with  the  preceding.     3.  Scalenus  anticus,  a  tri- 


MYOLOGY. 


101 


Fig.  48. 


angular  muscle,  arising  with  the  rectus  anticus  major;  inserted  into 
the  inner  border  of  the  first  rib.  4.  Scalenus  posticus ;  arises  from  the 
posterior  tubercles  of  all  the  cervical  vertebrae,  except  the  first;  inserted 
into  the  first  and  second  ribs  by 
fleshy  fibres.  5.  Longus  colli,  a 
long  flat  muscle,  consisting  of  two 
portions,  the  upper  arising  from  the 
anterior  tubercle  of  the  atlas,  and 
inserted  into  the  transverse  processes 
of  the  third,  fourth,  and  fifth  cervi- 
cal vertebrae ;  and  the  loiver  arising 
from  the  bodies  of  the  second  and 
third,  and  transverse  processes  of 
the  fourth  and  fifth,  and  passing  down 
the  neck,  to  be  inserted  into  the  bo- 
dies of  the  three  lower  cervical  and 
three  upper  dorsal  vertebrae. 

Uses. — The  rectus  major  and  mi- 
nor preserve  the  equilibrium  of  the 
head  upon  the  atlas  ;  and  when  act- 
ing with  the  longus  colli,  flex  and 
rotate  the  head  and  vertebrae  of  the 
neck.  The  scaleni  flex  the  vertebral 
column,  and  assist  in  elevating  the 
ribs  in  inspiration. 

The  Laryngeal  Group  will  be 

described  with  the  anatomy  of  the 

larj'nx. 

la  Fig.  48  the  mo  prominent  muscles  of 
the  head  and  neck  ve  seen.  A.  Occipito- 
fVontaUs.  B.  Attollen.  aurem.  C.  The  con- 
cha. D.  Orbicularis  palpebrarum.  E.  Com- 
TJi'essor  naris.  F.  Zygomaticus  major.  G. 
Levator  labii  superioris  alseque  nasi.  H. 
Zygomaticus  minor.  I.  Levator  anguli  oris. 
K.  Masseter.  L.  Depressor  anguli  oris.  M. 
Stcrno-cleido  mastoideus.  O.  Depressor  la- 
bii inierioris.  P.  Orbicularis  oris.  Q.  Tem- 
poral/s.  R.  Splenius.  S,  Trapezius.  T. 
Stei7.o-hyoideus.  a.  Helix,  b.  Anti-helix. 
c.  Concha. 


ft; 


\ 


MUSCLES  OF  THE  HEAD  AA'D  NECK 


MUSCLES    OF    THE    BACK. 

The  muscles  of  the  back  are  divided  into  six  layers. 

First  Layep  —I^wd  muscles:  1.  Trapezius ;  arises &oia the  u^pet 


]02 


ANATOMY. 


rurved  line  of  the  occipitis,  ligament  of  the  neck,  and  spines  of  the  | 

dorsal  vertebrae ;  inserted  into  the  spine  and  acromion  of  the  scapula,  j 

and  scapular  third  of  the  clavicle.     2.  Latissimus  dorsi,  coverms;  the  | 

Fig  49.  "J 


EXTERNAL   MUSCLES    OF   THE    BACK. 

In  Fig.  49  the  first,  second,  and  part  of  the  third  layer  are  seen  ;  the  first  on  the  right, 
and  the  second  on  the  left  side.  1.  Trapezius.  2.  The  tendinous  portion  which  forms, 
with  the  corresponding  part  of  the  opposite  muscle,  the  tendinous  ellipse  on  the  back  of 
the  neck.  3.  Acromion  process  and  spine  of  the  scapula.  4.  Latissimus  dorsi.  5.  Del- 
toid. 6.  Infra  spinatus,  teres  minor,  and  teres  major,  all  muscles  of  the  dorsum  of  the 
scapula.  7.  Extrrnal  oblique.  8.  Gluteus  medius.  9.  Glutei  maximi.  10.  Levator 
nnguli  scapu'ae.  11.  Rhomboideus  minor.  12.  Rho""hoideu3  major.  1.3.  Splenius  capi- 
tis; the  comiplexus  is  immediate!}'  above,  and  overlaid  oy  it.  14.  Splenius  colli ;  partially 
seen.  15.  Vertebral  aponeurosis.  16.  Serratus  posticus  interior.  17.  Supra-spinatus. 
18.  Infra-spinatus.  19.  Teres  minor.  20.  Teres  major.  21.  Long  head  of  the  triceps, 
passing  between  the  t«res  minor  and  major  to  the  upper  arm.  22.  Scrratus  magnua, 
proceeding  forward  from  its  origin  at  the  base  of  the  scapu.'„    23.  Internal  oblique. 


M  Y  0  L  0  Cf  It  lOA 


whole  lower  part  of  the  back  and  loins ;  arises  from  the  spines  of  the 
seven  lower  dorsal  and  all  the  lumbar  vertebrae,  sacral  spines,  back 
part  of  the  crest  of  the  ilium,  and  three  lower  ribs  ;  the  fibres  converge 
as  they  ascend,  cross  the  lower  angle  of  the  scapula,  curve  around  the 
lower  border  of  the  teres  major,  and  ai-e  inserted  into  the  bicipital 
groove  of  the  humerus. 

Uses. — The  upper  fibres  of  the  trapezius  draw  the  shoulder  upward 
and  backward,  the  middle  directly  backward,  and  the  lower  downward 
and  backward.  The  latissimus  dorsi  draws  the  arm  backward  and 
downward,  and  rotates  it  inward  ;  if  the  arm  be  fixed  it  will  draw  the 
spint  to  that  side,  and  raise  the  lower  rib,  thus  aiding  inspiration ;  if 
both  arms  be  fixed,  both  muscles  will  draw  the  whole  trunk  forward,  as 
in  climbing,  walking  on  crutches,  etc. 

J  JTE. — The  ligameiitum  nuchce  is  a  thin  cellulo-fibrous  layer  between 
the  jccipital  bone  and  spine  of  the  seventh  cervical  vertebrae. 

Second  Layer. — Three  muscles:  1.  Levator  anguli  scapulfs ; 
arises  from  the  transverse  processes  of  the  four  cervical  vertebrae ; 
inserted  into  the  upper  angle  and  posterior  border  of  the  scapula.  2. 
Rhomboideus  minor ;  arises  from  the  spines  of  the  two  last  cervical 
vertebrae  and  ligamentum  nuchae ;  inserted  into  the  posterior  border  of 
the  scapula.  3.  RJiomhoideus  minor  ;  arises  from  the  spines  of  the  last 
cervical  and  four  upper  dorsal  vertebrae  ;  inserted  with  the  preceding. 

Uses. — The  levator  lifts  the  upper  angle  of  the  scapula,  and  with 
the  rhomboidei  carry  the  shoulder  upwai'd  and  backwaixl. 

Third  Layer. — These  muscles  all  arise  from  the  spines  of  the  ver- 
tebi-al  column,  and  pass  outwardly.  There  are  three  of  them  :  1. 
Serratus  jJosticus  superior;  arises  from  the  spines  of  the  lower  cervical 
and  upper  dorsal  vertebrae ;  inserted  into  the  upper  borders  of  the 
upper  ribs.  2.  Serratus  p>osticus  inferior ;  arises  from  the  spines  of 
the  two  last  dorsal  and  three  upper  lumbar  vertebrae  ;  inserted  into  the 
lower  borders  of  the  four  lower  ribs.  3.  Tlie  splenius  muscle,  arising 
from  the  lower  part  of  the  ligamentum  nuchae,  and  spines  of  the  four 
lower  cervical  and  six  upper  dorsal  vertebra  ;  inserted  by  two  divisions, 
the  first,  called  sj)lenius  capitis,  into  the  occipital  bone,  and  the  second, 
called  splenius  colli,  into  the  transverse  processes  of  the  upper  cervical 
vertebrae. 

Uses. — The  serrati  are  muscles  of  respiration ;  their  actions  antago- 
nize, the  posterior  drawing  the  ribs  upward  to  expand  the  chest,  and 
the  inferior  drawing  down  the  lower  ribs,  and  diminishing  the  cavity  of 
tlie  chest,  thus  rendering  the  first  an  inspire  tvry,  and  the  second  an 


JOI  ANATOMY. 


expiratory  muscle.     The  splenii  of  one  side  draw  the  vertebral  col-  ■ 

umn  backwiird  and  to  one  side,  and  rotate  the  head  toward  the  cor-  \ 

responding  shoulder.     The  splenii  of  both  sides  acting  together  draw  i 

the  head  forward ;  they  antagonize  the  sterno-mastoid  muscles.  I 

Fourth  Laykr. — Sen  en  muscles:  1.  Sc  "ro-lumhalis  ;  arises  from 

the  back  part  of  the  cresl  of  the  ilium,  postenar  surface  of  the  sacrum  i 

und  lumbar  vertebraB ;  inserted  by  separate  tendons  into  the  angles  of  1 

the  six  lower  ribs.     2.  Longissimus  dorsi ;  ames  with  the  preceding;  \ 

inserted  into  all  the  ribs  between  their  tubercles  and  angles.    3.  Spinalis  '• 

dorsi ;  arises  from  the  spines  of  the  two  upper  lumbar  and  throe  lower  ; 

doi'sal  veitebrre  ;  inserted  into  the  spines  of  all  the  upper  dorsal  verte-  , 

bra?.    4.  Cervicalis  ascendens  ;  arises  from  the  angles  of  the  four  upper  ' 

ribs ;  inserted  into  the  ti-ansverse  processes  of  the  four  lower  cervical  | 

vertebr;e.    5.  Transversalis  colli ;  arises  from  tlie  ti'ansverse  processes  \ 
of  the  four  upper  dorsal  vertebrae  ;  inserted  into  the  like  processes  of 

the  five  middle  cervical.     G.    Trachleo-mastoid  ;  arises  from  the  trans-  ' 

verse  processes  of  the  four  upi)er  dorsal  and  five  lower  cei-vical  verte-  1 

bra? ;  inserted  into  the  mastoid  process.     7.  Coniplexus,  a  large  muscle,  i 
forming,  with  the  splenius,  the  great  bulk  of  the  back  of  the  neck ; 
arises  fi-om  the   transverse  processes  of  the  four  uj)j)er  dorsal,  and 

transverse  and  articular  processes  of  the  five  lower  cervical  vertebrae ;  i 
inserted  into  the  occij)ital  bone,  near  its  spine. 

Uses. — These  muscles  hold  the  vertebral  column  erect,  and  assist  in  , 

steadying  the  head ;  the  complexus  contracts  the  muscles  on  the  ante-  i 

rior  side  of  the  neck ;  when  the  muscles  of  one  side  act  alone,  they  i 

produce  a  rotation  of  tlie  head.  ! 

Fifth  Laykr. — Seven  muscles:  1.  Scmi-spinalis  dorsi ;  arises  from  '< 

the  transverse  processes  of  the  six  lower  dorsal,  and  is  inserted  into  the  ! 

spines  of  the  four  upper  dorsal  vertebrcE.    2.  Semi-spinalis  colli ;  arises  \ 
from  the  ti-ansvei-se  processes  of  the  four  upper  dorsal,  and  is  inserted  into 

the  spines  of  the  rive  upper  cervical  vertebrae.    3.  Rectus  posticus  major ;  '. 

arises  from  the  spines  of  the  axis ;  inserted  into  the  lower  curved  line  j 

of  the  occipitis.      4.   Rectus  posticus  minor ;  arises  from  the  sj)inou3  i 
tubercle  of  the  atlas  ;  inserted  into  the  occipitis,  below  the  former.     5 

Rectus  lateralis  ;  arises  from  the  transverse  process  of  the  atlas :   in-  [ 

serted  into  the  occipitis,  external  to  the  condyle.     G.  O-bliquus  inferior;  , 

arises  from  the  spine  of  the  axis ;  inserted  into  the  exti'emity  of  tht  j 

transverse  process  of  the  atlas,     7.   Obliquus  superior;  ames  where  ' 

the   preceding  is  inserted  ;   inserted  ia*o  the  cecipitis,  between  the  ' 
•urved  lines. 


MYOLOGY. 


106 


Uses. — ^Th-3  semi-spinalep  contribute  to  the  support  of  the  back  in 
the  erect  position ;  tho  recti  produce  the  antero-posterior,  and  the 
obliqui  the  rotatory  movement  of  the  atlas  on  the  axis. 


Sixth  Layer. — Five  muscles:  1.  MuWJidus  sjnnce^  consisting  of 
bundles  of  fibres,  arising  from  the  transverse  processes  of  all  the  ver- 
tebrae from  the  sacrum  to  the  axis ;  inserted  into  the  spines  of  the  first 
or  second  veitebra3  above  their  origin.  2.  Levatores  costarum,  con- 
sisting of  twelve  distinct  fasciculi  on 
each  side,  which  arise  from  the  trans- 
verse processes  of  the  d.orsal  vertebrae, 
and    are  inserted   into   the  ribs    below, 


50. 


m- 


between  the  tubercles  and  angles.  3. 
Siqyra-spinalis^  composed  of  fjisciculi 
ansing  from  the  lower  cervical  and  upper 
dorsal  vertebra? ;  inserted  into  the  spine 
of  the  axis.  4.  Interspinalcs,  small  slips 
arranged  in  pairs,  situated  between  the 
spines  of  all  the  vertebrie.  5.  Liter- 
transvcrsales,  small  quadrilateral  slips 
between  the  ti'ansverse  {processes  of  all 
the  vertebriE. 

Uses. — The  levators  raise  the  poste- 
rior parts  of  the. ribs  in  inspimtion ;  the 
others  are  auxiliaries  to  tlie  larger  mus- 
cles in  supporting  the  body,  and  holding 
the  bones  in  jiosition. 

In  Fig.  50  are  seen  the  fourth  and  fifth,  and  part 
of  the  sixth  layer.  1.  Origin  of  the  .sacro-lumbalis 
and  longissimus  dorsi.  2.  .Sacro-lambalis.  3. 
Longissitnus  dorsi.  4.  Spinalis  dorsi.  5.  Cervi- 
calis  ascendens.  6.  Transversalis  colli.  7. 
Trachleo-mastoidcus.  8.  Complexus.  9.  Trans- 
versalis colli.  10.  Semi-spinalis  dorsi.  11.  Semi- 
spinalis  colli.  12.  llectus  posticus  minor.  13. 
Rectus  posticus  major.  14.  Obliquus  superior. 
15.  Obliquus  inferior.  16.  Multitidus  spinas.  17. 
Levatores  eostarum.  18.  Intcrtransversales.  19. 
Ciuadratus  lumborum. 


INJVER  MUSCLES  OF  THE  BACK 


MUSCLKS    OF    THE    THORAX. 

The  principal  muscles  of  the  thomx  belong  sJsj  to  the  upper  ex» 
tremity.     Tliose  >voper  to  the  thoyax  are  three  ; 


i06  ANATOMY. 


1.  External  intercostals  2.  TiUernal  Interccstals.  3  Triangularis 
sterni. 

The  intercostals  are  eleven  internal  and  eleven  external  planes  of 
muscular  and  tendinous  fibres,  situated  obliquely  betrween  the  adjacent 
ribs,  and  filling  the  intercostal  spaces.  The  fibres  of  the  external  are 
directed  obliquely  d-wnward  and  inward,  and  those  of  the  internal  ob- 
liquely downw;ird  a  jd  backward,  so  that  they  cross  each  other. 

The  triangularis  sterni  is  situated  within  the  chest,  connecting  the 
side  of  the  sternum  and  sternal  exti'emities  of  the  costal  cartilages 
with  the  cartilages  of  the  sfv^ond,  third,  fourth,  fifth,  and  sixth  ribs. 
The  lower  fibres  of  this  muscle  are  continuous  with  the  diaphragm. 

Uses. — The  intercostals  raise  or  depress  the  ribs,  as  they  act  fi'om 
above  or  below,  being  thus  both  inspiratory  aiid  expiratory.  The  tri- 
angulai'is  is  a  muscle  of  expiration,  by  drawing  down  the  costal  carti- 
lages. 

MUSCLES    OF    THE    ABDOMEN. 

The  muscles  ®f  the  abominal  region  are  nine  in  number  : 
1.  Obliquus  externus  ;  this  is  the  external,  flat,  descending  muscle; 
its  fibres  arise  by  fleshy  digitations  from  the  eight  lower  ribs,  and 
spread  out  to  a  broad  aponeurosis,  which  is  inserted  into  the  outer  part 
of  the  crest  of  the  ilium  for  one  half  its  length,  into  the  anterior  supe- 
rior spine  of  the  ilium,  spine  of  the  pubis,  pectineal  line,  front  of  the 
pubis,  and  linea  alba. 

Note. — The  lower  border  of  the  aponeurosis,  between  the  spines 
of  the  ilium  and  pubis,  is  rounded  from  being  folded  inward,  and  forms 
PouparCs  ligament.  GimhernaVs  ligament  is  that  part  of  the  aponeu- 
rosis inserted  into  the  pectineal  hne.  The  linea  alba  is  a  white  tendi- 
nous slip  extending  along  the  middle  of  the  abdomen  from  the  ensiform 
cartilage  to  the  os  pubis.  Externally,  on  each  side  of  it,  ai*e  two 
curved  lines,  extending  from  the  sides  of  the  chest  to  the  pubis,  called 
the  lincce  semilunares ;  these  lines  are  connected  with  the  linea  alba 
by  several  cross  lines,  usually  three  or  four  in  number,  called  linea; 
transversa!.  Just  above  the  crest  of  the  pubis  is  a  ti'iangular  opening, 
formed  by  the  sepai'ation  of  the  fibres  of  the  aponeurosis,  called  the 
external  abdominal  ring.  Through  t'lis  ring  passes  the  spermatic  cord 
in  the  male,  and  the  round  ligament  of  the  uterus  in  the  female  ; 
both  are  iiivested  in  their  passage  1  y  a  thin  foscia  derived  fi'om  the 
edges  of  the  ring,  called  inter  column  j.r,  or  spermatic  fascia.  In  ingui- 
nal hernia  the  pouch,  in  projecting  through  th's  opening,  receives  aa 
aJJitional  covering  ft-om  this  spermatic  fascia. 


MYOL.")GY. 


107 


Fig.  51. 


N';.;  n/./;y/' 


MUSCLES    OF    THE    TRtTNK. 

in  Fig.  51  are  seen  the  muscles  of  the  trunk  anteriorly.  The  superficial  layer  Is  seen 
on  the  left  side,  and  tli*  deeper  on  the  right.  1.  Pectoralis  major.  2.  Deltoid.  3.  Ante- 
rior border  of  the  latissimus  dorsi.  4.  Serrations  of  the  serratus  magnus.  5.  Subclavius 
of  the  right  side.  6.  Pectoralis  minor.  7.  Coracho-brachialis.  8.  Upper  part  of  the 
biceps,  showing  its  two  heads.  9.  Coracoid  process  of  the  scapula.  10.  Serratus  mag- 
nus of  the  right  side.  11.  External  intercostal.  12.  External  oblique.  13.  Its  aponeu- 
rosis ;  the  median  line  to  the  right  of  this  number  is  the  linea  alba ;  the  flexuous  line  to  the 
left  is  the  linea  semilunaris ;  the  transverse  lines  above  and  below  the  number  are  the  linear 
transversa3.  14.  Poupart's  ligament.  15.  External  abdominal  ring;  the  margin  above  is 
called  the  svpcrior  or  internal  pillar ;  the  margin  below  the  inferior  or  external  pillar;  the 
curved  inten-olumnar  fibres  are  seen  proceeding  upward  from  Poupart's  ligament  to 
strengthen  the  ring.  The  numbers  !4  and  15  arc  situated  upon  the  fascia  lata  of  the 
thie'^  :  the  opening  to  the  right  of  15  is  called  saphenous.  16.  Rectus  of  the  right  side. 
17.  Pyramidalis.  18.  Internal  oblique.  19.  The  common  tendon  of  the  internal  oblique 
and  transversalis  descending  behind  Poupart's  ligament  to  the  pectineal  Jne.  SO.  The 
arch  formed  between  the  lower  curved  border  of  the  internal  oblique  and  Paupart's  liga- 
ment, beneath  whi^h  the  eoermatic  cord  passes,  and  hernia  occurs. 


f08  AN  ATOM!. 

2.  Internal  oblique  ;  called  the  middle  ascending  flat  muscle.  It 
arises  from  the  outer  half  of  Poupart's  ligament,  fi-om  the  middle  two 
thii-ds  of  the  crest  of  the  ilium,  and  from  the  spines  of  the  lumbar  ver- 
tebraj ;  and  is  inserted  into  the  pectineal  line,  crest  of  the  pubis,  liuea 
alba,  and  five  lower  ribs. 

3.  Cremaster  ;  arises  from  the  middle  of  Poupart's  ligament ;  it  forms 
a  series  of  loops  upon  the  spermatic  cord,  and  some  of  its  fibres  are 
inserted  into  the  tunica  vaginalis,  the  rest  into  the  pectineal  line  of  the 
pubis. 

4.  Transversalis  ;  this  is  the  internal  flat  muscle  ;  it  arises  from  the 
outer  thii-d  of  Poupart's  ligament,  internal  lip  of  the  crest  of  the  ilium, 
spines  and  transverse  processes  of  the  lumbar  vertebrae,  and  fiom  the 
six  lower  ribs,  indigitating  with  the  diaphragm ;  inserted  into  the  pecti- 
neal line,  crest  of  the  pubis,  and  linea  alba. 

5.  Rectus  ;  arises  by  a  flat  tendon  tiom  the  crest  of  the  pubis ;  in- 
serted into  the  cartilages  of  the  fifth,  sixth,  and  seventh  ribs. 

6.  Pyramidalis  ;  arises  from  the  crest  of  tlie  pubis  in  front  of  the 
rectus ;  inserted  into  the  linea  alba  midway  between  the  umbilicus  and 
pubis. 

7.  Quadratus  lumhorum ;  arises  from  the  last  rib  and  ti*ansverse 
processes  of  tlie  four  upper  lumbar  vertebras ;  inserted  into  the  crest 
of  the  ilium  and  ilio-lumbar  ligament. 

8.  Psoas  parvus  ;  a ?7'5e5  from  the  tendinous  arches  and  intervertebral 
substance  of  the  last  dorsal  and  first  lumbar  vertebrce ;  inserted  by  an 
expanded  tendon  into  the  ilio-pectineal  line  and  enninence. 

9.  Diaphragm  ;  this  forms  a  muscular  partition  between  tlie  cavities 
of  the  chest  and  abdomen.  In  shape  it  is  somewhat  conical,  and  is 
composed  of  two  portions,  called  greater  and  lesser  muscles.  Tho 
greater  muscle  arises  from  the  ensiform  cartilage,  inner  surfaces  of  tho 
six  inferior  ribs,  and  ligamentum  arcuatum  externum  and  internum ; 
from  these  points  its  fibres  converge  to  the  central  tendon,  into  which 
thej^  ai-e  inserted.  The  lesser  muscle  arises  by  two  tendons  from  the 
bodies  of  the  lumbar  vertebrae ;  these  tendons  form  two  large  fleshy 
bellies,  called  crura,  w^hich  ascend  and  are  inserted  into  the  centra 
tendon. 

Note. — The  ligamentum  arcuatum  externum  is  .he  upper  border  of 
the  anterior  lamella  of  the  aponeurosis  of  the  ti'ansver-salis.  The  liga- 
mentum arcuatum  internum,  or  praprium,  is  a  tendinous  arch  across  the 
psoas  magnus  muscle  as  it  emerges  from  the  chest.  The  tendinous 
centre  of  the  diaphragm  is  called  the  central  tendon.  Between  the 
Bides  of  the  ensiform  cartilage  and  the  cartilages  of  the  adjoining  ribs 
is  a  triangular  space  where  the  muscular  fibres  of  the  diaphragm  are 


MYOLOGY. 


lOS 


¥u 


wanting  ;  this  space  is  closed  by  tlie  peritoneum  on  the  abdominal  side, 
and  the  plem-a  on  the  side  of  tlie  chest.  Sometimes,  from  violent  ex- 
ertion, a  portion  of  the  alimentary  canal  is  forced  through  this  space, 
producing  what  is  called  phrenic  or  diaphragmatic  hernia. 

There  are  three  openings  in  the  diaphi'agm :  one  in  the  centre,  for 
the  passage  of  the  inferior  vena  cava ;  an  elliptic  opening  in  its  muscu- 
lar portion,  formed  by  the  two  crura,  for  the  passage  of  the  (zso'phagus 
and  •pneumo  gas  trie  nerves ;  and  a  third,  called  the  aortic,  formed  by  a 
tendinous  arch  which  passes  from  the  tendon  of  one  crus  to  that  of  the 
other;  beneath  this  the  aorta,  thoracic  duct,  and  right  vena  azygos 
pass.  There  are  also  small  openings  in  the  lesser  muscle  on  each  side 
for  the  grt-at  splanchnic  nerves. 

Uses. — The  oblique  muscles  flex  the  thorax  on  the  pelvis ;  either, 
acting  singly,  would  twist  the  body  to  the  opposite  side.  Either  trans- 
versalis  will  diminish  the  size  of  the  abdomen,  and  both  consti'ict  it? 
general  cavity.  The  recti  and  pyramidaiis  together  pull  the  thorax 
forwai-d  ;  the  latter  alone  are  tensors 
of  the  linea  alba.  The  quadratus 
lumborum  draws  the  lower  rib  down- 
ward, and  serves  to  bend  the  verte- 
bral colamn  to  one  side.  The  psoas 
parvus  extends  the  iliac  fascia,  and 
assists  in  flexing  the  back.  The  dia- 
phragm assists  the  abdominal  muscle 
in  expiration. 

Fig.  52  is  a  side  view  of  the  muscles  of  the 
trunk.  1,  Costal  region  of  the  latissimus 
dorsi.  2,  Serratus  inagnus.  3.  Upper  part 
of  external  oblique.  4.  Two  external  inter- 
costals.  5.  Two  internal  intercostab.  6. 
Transversalis.  7.  Its  posterior  aponeurosis. 
8.  its  anterior.  9.  Lower  part  of  the  left 
!  -ictus.  10.  Right  rectus.  11.  The  arched 
opening  where  the  spprmatic  cord  passes  and 
hernia  takes  place.  12.  The  gluteus  maxi- 
mus,  and  medius,  and  tensor  vaginae  femoris 
muscles  invested  by  fascia  lata. 

All  the  abdominal  nmscles  are 
respiratory,  and  constitute  the  chief 
forces  in  the  act  of  expiration.  Con- 
sidering the  lungs  as  a  bellows,  they 
constitute  the  handles ;  they  are  aided 
in  this  office  by  the  muscles  of  the  sh^scles  of  the  tf.uxk  laterallic. 
loins  and  back,  ^nd  to  some  extent  by  the  upper  muscles  of  the  ti'unk, 
10 


no  ANATOMY. 

They  compross  the  cavity  of  the  abdomen  in  all  directions,  thus  aiding 
llie  expulsion  of  the  contenfs  of  the  stomach,  bowels,  gall-ducts,  blad- 
der, and  uterus,  and  also  raucous  and  in'itating  substances  fi-om  tlie 
bronchia,  windpipe,  and  nose. 

MUSCLES    OF    THE    PERINEUM. 

Tliese  muscles  pertain  to  the  H.--?thra,  the  outlet  of  the  bowels,  an 
he  organs  of  generation.  There  are  eight  of  them.  In  the  male  ai-e: 
1.  Accelerator  urinee ;  arises  from  the  centre  of  the  perineum ;  its 
fibres,  dividing,  are  inserted  into  the  ramus  of  the  pubes  and  ischium, 
and  into  the  fibrous  substance  and  spongy  body  of  the  penis.  2.  Erector 
penis ;  arises  from  the  ramus  and  tuberosity  of  the  ischium,  and,  curv-.. 
ing  around  the  root  of  the  penis,  is  instrtc  I  intc  the  upper  surface  of  its 
corpus  cavernosum.  3.  Comirressor  urelxrce;  arises  from  the  ramus 
of  the  ischium,  and  inner  surface  of  the  arch  of  the  pubes  on  each  side 
of  the  symphisis ;  inserted  into  the  back  part  of  the  urethra,  fi-om  the 
apex  of  the  prostate  gland  to  which  they  are  attached,  to  its  bulbous 
portion.  4.  Transversus  pcrinei ;  arises  from  the  tuberosity  of  the 
ischium ;  inserted  into  the  tendinous  centi'e  of  the  perineum.  5. 
Sphincter  ani,  a  thin  band  suiTOunding  the  opening  of  the  anus.  6. 
Sphincter  ani  internus,  a  muscular  ring  formed  by  an  aggregation  of 
the  circular  fibres  of  the  rectum.  7.  Levator  ani,  a  thin  plane  of  mus- 
cular fibres  on  each  side  of  the  pelvis,  between  the  os  pubis  and  spine 
of  the  ischium ;  inserted  into  the  lower  part  of  the  coccyx,  rectum, 
base  of  the  bladder,  and  prostate  gland.  8.  Coccygeus^  a  ti'iangular 
layer  arising  from  the  spine  of  the  ischium ;  inserted  into  the  side  of 
the  coccyx  and  lower  pait  of  the  sacrum. 

The  uses  of  these  muscles  are  expressed  by  their  names.     In  the 
female  the  perineal  muscles  are  smaller,  and  are  modified  to  the  dif-    j 
ference  in  org:i nidation.    The  muscle  coiresponding  with  the  accelei'ator 
arinie  in  the  male,  is  called  constrictor  vagince ;   and  the  analogue  of 

the  erector  penis,  >s  called  erector  cliloridis. 

I 

MUSCLES    OF    THE    UPPER    EXTREMITY. 

These  may  be  conveniently  grouped  according  to  dififerent  regions  j 
\{  the  limb.  i 

Thoracic  Region. — This  region  comprises  three  anterior  and  one  i 
lateral  muscle:  1.  Pcc/ora//s  7;ifl;o?-;  ^rws  from  the  sternal  two  thirds  i 
of  the  clavicle,  the  whole  length  of  the  sternum,  the  cartilages  of  all  the  i 
tiue  ribs  excejjt  the  first  ani  last,  and  from  tl>e  aponeurosis  of  the  ex-  i 
ternal  obrujue  muscle ;  insc\  'ed  by  a  broad  tendon  into  the  anterior  ; 
bicipital  ridgo  cf  tlio  luur.evrg.     0.  Pectoralis  minor ;  crises  by  three    i 


MYOLOGY  '111 


digitations  from  the  third,  fo'irth,  and  fifth  ribs ;  inserted  into  the  cora- 
coid  process  of  the  scapula.  3.  Subclavius  ;  arises  from  the  cartilage 
of  the  first  rib ;  inserted  into  the  under  surface  of  the  clavicle.  4. 
Serratus  magnus ;  arises  by  fleshy  serrations  from  the  nine  upper  ribs, 
excepting  the  first ;  inserted  into  the  whole  length  of  the  base  of  the 
scapula  anteriorly.  % 

Udes. — The  pectoralis  major  di'aws  the  arm  against  the  chest ;  its 
upper  fibres  assist  in  raising,  and  its  lower  in  depressing  the  shoulder. 
When  its  fixed  point  is  at  the  shoulder,  it  assists  in  elevating  and  expand- 
ing the  chest.  The  minor  pectoral  muscle  acts  with  the  former,  and 
assists  in  the  rotatory  movement  of  the  scapula  upon  the  chest.  The 
subclavius  draws  the  clavicle  downward  and  forward  in  steadying  the 
shoulder.  All  th'^e  muscles  are  called  into  action  in  forced  resph'ation, 
but  cannot  act  unless  the  shoulders  are  fixed.  The  seiTatus  raises  the 
ribs,  and  thereby  increases  the  cavity  of  the  chest  in  inspiration.  When 
it  acts  upon  the  scapula,  the  shoulder  is  drawn  forward,  as  in  many 
cases  of  diseased  lungs  and  deformed  chests. 

Scapular  Region. — Six  muscles:  1.  Suhscajyularis ;  arises  fi'om 
nearly  the  whole  of  the  under  surface  of  the  scapula ;  inserted  by  a 
broad,  thick  tendon  into  the  lesser  tuberosity  of  the  humerus.  2.  Sujpra- 
spinatus ;  arises  from  the  whole  of  the  supra-spinous  fossa ;  inserted 
into  the  upper  depression  of  the  great  tuberosity  of  the  humerus.  3. 
Infraspinatus ;  arises  from  the  whole  of  the  infra-spinous  fossa;  in- 
serted into  the  middle  depression  upon  the  greater  tuberosity  of  the 
humerus.  4.  Teres  7ninor  ;  amc5  from  the  middle  third  of  the  lower 
border  of  the  scapula;  inserted  into  the  lower  depression  on  the  gTea-ter 
tuberosity  of  the  humerus.  5.  Teres  major ;  arises  from  the  lowei 
third  of  the  inferior  border  of  tlie  scapula ;  inserted  into  the  posterior 
bicipital  ridge.  6.  Deltoid,  a  large  triangular  muscle  forming  the  con- 
vexity of  the  shoulder  ;  arising  from  the  outer  third  of  the  clavicle,  tho 
acromion  process,  and  from  the  whole  length  of  the  scapula ;  its  fibres 
converge  to  the  middle  of  the  outer  side  of  the  humerus,  where  they 
are  inserted  into  a  rough  elevation. 

Uses. — Tlie  subscapularis  rotates  the  head  of  the  humerus  inward  ; 
when  the  arm  is  raised  it  draws  the  humerus  downward.  It  is  a 
powerful  defence  to  the  shoulder  joint.  The  supra-spinatus  raises  tha 
arm  feebly  from  the  side  ;  the  infra-spinatus  and  teres  minor  rotate  tho 
head  of  the  humeras  outward ;  the  teres  minor  assists  its  rotation  in- 
ward, carrying  it  also  toward  the  side,  and  somewhat  backward.  The 
most  important  use  of  the  supra-spinatus,  infra-spinatus,  and  teres  minor 
is  to  protect  the  joint  against  vlisplacement,  for  wb^ch  purpose  theif 


112 


ANATOMY. 


tendons,  with  that  of  the  subscapularis,  are  in 
immediate  contact,  forming  a  part  of  its  liga- 
mentous capsule.  They  are,  consequently, 
generally  ruptured  in  luxations  of  the  shoulder 
joint. 

Fig.  .53  exhibits  the  muscles  of  the  anterior  aspect  of  the 
upper  arm.  1.  Coracoid  process  of  the  scapula.  2. 
Coraco-clavicular  ligament  passing  outward  to  the  scapular 
end  of  the  clavicle.  3.  Coraco-acromial  ligament,  passing 
outward  to  the  acromion.  4.  Subscapularis.  5.  Teres 
major ;  through  the  triangular  space  above  the  dorsalia 
Ecapulaj  vessels  pass.  6.  Coracobrachialis.  7.  Biceps. 
8.  Upper  end  of  the  radius.  9.  Brachialis  anticus ;  a  por- 
tion of  this  muscle  is  seen  on  the  outer  side  of  the  tendoa 
of  the  biceps'.     10.  Internal  head  of  the  biceps. 


Fig.  54. 


MUSCLES  OF  THE  UPPER  ^f  j-jje  humerus 

ARM.  „.  .  , 

Biceps ;  anscs  by 
two  tendons,  one,  called  the  short  head,  from 
the  coracoid  process ;  the  other,  the  long 
head,  which  passes  through  the  capsular 
ligament  of  the  joint,  from  the  upper  pait 
of  the  glenoid  cavity;  inserted  by  a  rounded 
tendon  into  the  tubercle  of  the  radius.  3. 
Brachialis  anticus,  a  broad  muscle  covering 
the  anterior  surface  of  tlie  lower  part  of  the 
humerus ;  arises  from  fleshy  sensations  on 
both  sides  of  the  insertion  of  the  deltoid,  the 
anterior  surfiice  of  the  humerus,  and  from 
the  intermuscular  septa  attached  to  the  con- 
dyloid ridges ;  its  fibres  converging  are  in- 

Fig.  54  is  a  posterior  view  of  the  upper  arm,  showing 
the  triceps  muscle.  1.  Its  external  head.  2.  Its  long, 
or  scapular  head.  3.  Its  internal,  or  sh(  rt  head.  4. 
Olecranon  process  of  the  ulna  5.  Radi^cs.  6.  Ca^au- 
lar  U^ameat. 


Humeral  Regio>'. —  Four  muscles: 
first  thi-ee  are  anterior,  the  last  posterior. 
Coraco  -  brachialis ; 
arises  from  the  cor- 
acoid process ;  in- 
serted into  a  rough 
line  on  the  inner 
side  of  the  middle 
2. 


the 
1, 


^'^ 


TBICEPS    MUSCX^. 


MYOLOGY. 


118 


ftevtcd  into  the  coronoid  process  of  the  ulna.  4.  Triceps  extensor  cuhiti^ 
a  three-headed  muscle ;  the  external  head  arises  from  the  humerus, 
below  the  insertion  of  the  teres  minor,  and  from  the  intermuscular 
septum;  the  internal  head  arises  from  the  septum  and  the  humerus, 
below  the  insertion  of  the  teres  major ;  the  middle,  or  scapular  head, 
arises  from  the  upper  third  of  the  inferior  border  of  the  scapula ;  the 
three  heads  unite,  and  form  a  broad  muscle,  which  is  inserted  into  the 
olecranon  of  the  ulna. 


Fisr.  55. 


Brachial  Region. — This  group  comprises  twenty  muscles:  the 
first  five  constitute  the  anterior  superficial  layer ;  the  next  three  the 
anterior  deep  layer ;  the  seven  succeeding  the  posterior  superficial 
layer  ;  and  the  five  remaining  the  posterior  deep  layer. 

1.  Pronator  radii  teres ;  arises  by  two  heads, 
one  from  the  inner  condyle  of  the  humerus  and 
adjoining  fascia,  the  c4^her  from  the  coronoid 
process  of  the  ulna ;  inserted  into  the  middle 
third  of  the  oblique  ridge  of  the  radius.  2. 
Flexor  carpi  radialis ;  arises  from  the  inner 
condyle  and  intermuscular  fascia,  and  its  tendon, 
passing  through  a  groove  formed  by  the  scaphoid 
and  trapezium,  is  inserted  into  the  base  of  the 
metacarpal  bone  of  the  index  finger.  3.  Pal- 
maris  longus ;  arises  with  the  preceding ;  in- 
serted into  the  annular  ligament  and  palmar 
fiiscia.  4.  Flexor  suhlimls  digitorum ;  arises 
fi'om  the  inner  condyle,  internal  lateral  ligament, 
coronoid  process  of  the  ulna,  and  oblique  ridge 
of  the  radius,  and  divides  into  four  tendons, 
which  pass  beneath  the  annular  ligament  into 
the  palm  of  the  hand ;  inserted  into  the  base  of 
the  second  phalanges  ef  the  fingers.  5.  Flexor 
carpi  idnaris ;  arises  ry  two  heads,  one  fi'om 


In  Fig.  55  is  seen  the  superficial  layer  of  the  muscles  of 
the  fore-arm.  1.  Lower  part  of  the  biceps,  with  its  tendon. 
2.  Part  of  the  brachiahs  anticus.  3.  Pait  of  the  triceps.  4. 
Pronator  radii  teres.  5.  Flexor  carpi  radialis.  6.  Palmaris 
longus.  7.  One  of  the  fasciculi  of  the  flexor  sublimis  digi- 
torum. 8.  Flexor  carpi  ulnaiis.  9.  Palmar  fascia.  10. 
Palmaris  brevis.  11.  Abductor  pollicis.  12.  One  portion 
of  the  flexor  bi-evis  pollicis.  13.  Supinator  longus.  14. 
Extensor  ossis  metacarpi.  and  extensor  primi  internodi;  gvpERj-iciAL  A]N'TERI09 
pollicis,  curving  around  the  Ic  wer  border  o*  tb  ;  fore-aroi.  LAYER. 


(14 


A  X  A  T  O  AI  y 


Fig.  56. 


the  inner  condyle,  the  other  from  the  olecranon  and  Vcpper  two  thh'ds 
of  the  inner  border  of  the  ulna;  its  tendon  is  inserted  into  the  pisiform 
bene,  and  base  of  the  metacarpal  bone  of  the  little  finger.  6.  Flexor 
'profundus  digilorum  ;  arises  fro  n  the  upper  two  thirds  of  the  ulna  and 
part  of  the  interosseous  membrane,  and  terminates  in  four  tendons, 
which  pass  beneath  the  annular  ligaments,  to  be  inserted  into  the  base 
of  the  last  phalanges.  7.  Flexor  lonp-us  i^ollicis ;  arses  from  the  upper 
tsvo  thirds  of  the  radius  and  part  ci  the  interosseous  membrane ;  its 
tendon  passes  beneath  the  annular  ligament  to  be  inserted  into  the  last 
phalanx  of  the  thumb.  8.  Pronator  quadratus  ;  arises  from  the  ulna; 
inserted,  vito  the  lower  pait  of  the  obliqus  line  on  the  outer  side  of  the 
radius. 

lu  Fig.  55  is  seen  the  deep  layer  of  muscles  of  the 
fore-ai-m.  1.  Internal  lateral  ligament  of  tiie  elbow  joint. 
2.  Anterior  ligament.  3.  Orbicular  ligament  of  the  head  of 
the  radius.  4.  Flexor  profundus  digitorutn.  5.  Flexor 
longus  pollicis.  G.  Pronator  quadratus.  7.  Adductor  pol- 
licis.  8.  Dorsal  interosseous  muscle  of  the  middle  finger, 
and  palmar  interosseous  of  the  ring  finger.  9.  Dorsal  inter- 
osseous muscle  of  the  ring  finger,  and  palmar  interosseous 
of  the  little  finger. 

9.  Supinator  longus  ;  arises  from  the  exter- 
nal condyloid  region  of  the  humerus,  and,  pass- 
ing along  the  radial  border  of  the  fore-arm,  ia 
inserted  into  the  styloid  process  of  the  ulna. 
]  0.  Extensor  carpi  radialis  longus ;  arises  from 
the  humerus  below  the  preceding;  inserted  into 
the  base  of  the  mctacarjml  bone  of  the  index 
finger.  11.  Extensor  carpi  radialis  brevis ; 
irises  adjoining  the  preceding;  inserted  into 
the  base  of  the  metacarpal  bone  of  the  middle 
finger.  12.  Extensor  communis  digitorum ; 
arises  with  the  preceding,  and  divides  into  four 
tendons,  which  are  inserted,  into  the  second  and 
third  phalanges  of  the  fingei-s.  13.  Extensor 
minimi  digiti,  is  an  offset  from  the  extensor 
communis;  inserted  into  the  last  two  phalanges. 
14.  Extensor  carpi  ulnaris ;  arises  from  the 
external  condyle  and  upper  two  thirds  of  the 
border  of  the  ulna;  inserted  into  the  metacarpal 
bone  of  the  little  finger.  15.  Anconeus,  a  small 
ti*iangular  muscle,  arising  from  the  outer  con- 
OKEP  antehioh  LAYEi .  dylc  ;  inserted  in  the  olecranon  and  upper  end 
of  the  ulna- 


MYOLOGr. 


116 


In  Fig.  57  is  seen  the  superficial  layer  of  the  muscles  of 
the  posterior  aspect  of  the  fore-arm.  1.  Lower  part  of  the 
biceps.  2.  Part  of  the  brachialis  anticus.  3.  Lower  part 
of  the  triceps  inserted  into  the  olecranon.  4.  Supinator 
Jongus.  5.  Extensor  carpi  radialis  longior.  6.  Extensor 
carpi  radialis  brevior.  7.  Tendons  of  insertion  of  these 
muscles.  8.  Extensor  digitoruni  communis.  9.  Extensor 
minimi  digiti.  10.  Extensor  carpi  ulnaris.  11.  Anconeus. 
12.  Part  of  the  flexor  carpi  ulnaris.  13.  Extensoi  ossis 
mctacarpi  and  extensor  primi  internodii,  lying  together. 
14.  Extensor  secundi  internodii ;  its  tendon  is  seen  cross 
ing  the  two  tendons  of  the  extensor  carpi  radialis  longior 
nnd  brevior.  1.5.  Posterior  annular  ligament.  The  ten- 
dons of  the  common  extensor  are  seen  upon  the  back  of 
the  hand,  and  their  mode  of  distribution  on  the  dot  sum 
of  the  fingers. 

16.  Supinator  brevis ;  arises  from  the  ex- 
ternal condyle,  lateral  and  orbicular  ligament, 
and  the  ulna,  and  winds  around  the  upper  part 
of  the  radius,  to  be  inserted  into  tb'.  upper 
third  of  its  oblique  line.  17.  Extensor  ossis 
metacarjpi  'polllcis ;  arises  from  the  ulna,  ra- 
dius, and  interosseous  membrane,  and  is  in- 
serted into  the  base  of  the  metacarpal  bone  of 
the  thumb.  18.  Extensor  ]}rinii  internodii 
pollicis ;  arises  from  the  interosseous  mem- 
brane and  ulna,  and  is  inserted  into  the  base 
of  the  first  phalanx  of  the  thumb.  19.  Ex- 
tensor secundi  internodii  p)ollicis  ;  arises  with 
the  preceding,  and  is  inserted  into  the  base  of 
the  last  phalanx  of  the  thumb.  20.  Extensor 
indicis ;  arises  with  and  a  little  above  the  two 
preceding  ;  inserted  into  the  aponeurosis  form- 
ed by  the  common  extensor  tendon  cf  the  index  finger. 


Fig.  57. 


SUPERFICIAL,    LAY 
POSTERIORLY 


ER 


NoTK. — The  tendons  of  the  flexor  and  extensor  muscles  of  the  fore 
arm  are  provided  with  synovial  buj-sas,  as  they  pass  beneath  the  annular 
ligament ;  those  of  the  back  of  the  wrist  have  distinct  sheaths  formed 
by  the  posterior  annular  ligament.  These  bursee  are  small  membran- 
ous sacs  filled  with  a  mucous  fluid,  and  they  serve  as  soft  cushions  for 
the  tendons  to  play  upon,  in  a  situation  exposed  to  a  gi'eat  degree  and 
rapidity  of  motion.  The  advantages  and  even  necessity  of  an  additional 
covering,  or  distinct  sheath,  for  the  tendons  on  the  back  of  the  wrist,  is 
obvious,  from  their  exposed  situation  and  feeble  protection  by  flesh  and 
integument. 


no 


ANATOMY 


Fig.  58. 


Fiff.  58  exhibits  the  deep  layer  of  muscles  on  the  poa 

terior  aspect  ot"  the  iore-arm.     1.  Lower  part  of  tho  hu-  I 

mcrus.    2.  Olecranon.     3.  Ulna.     4.  Anconeus.     5.  Su  | 

pinator  brevis.      6.  Extensor  ossis  metacarpi  pollici3.  •' 

7.  Extensor  primi  intemcdii  pollicis.     8.  Extensor  se.  i 

cundi  internodii  poUicis.    9.  Extensor  iudicis.     10.  First  ] 
dorsal  interosseous  ligament.     The  other  three  dorstil 

interossii  are  seen  between  the  metacarpal  bones  of  their  j 

respective  fingers.  ; 

I 

Uses. — The  pronator  radii  teres  and  pro-   \ 
nator  quadratus  rotate  the  I'adius  upon  the   ' 
ulna,  producing  pronation  of  the  hand.     Tho    ! 
flexor   carpi   radialis   and   uhiai'is    bend    the    , 
wrist ;    the   flexor    sublimis    and    profundus   j 
bend  the  second  and  last  joints  of  the  fingers;    \ 
the  flexor  iongus  pollicis  bends  the  last  joint    ; 
of  the  thumb.     The  palmaris  Iongus  draws    i 
the   palmar  fascia  tense,  and  assists  in  the    ! 
flexion  of  the  wrist  and  fore-arm.     The  an-    j 
coneus  assists  the  triceps  in  extending  the 
fore-arm  upon  the  arm;  the  supinatus  Iongus    \ 
and  brevis  produce  supination  of  the  fore-    j 
arm,  and  antagonize  the  pronators ;  the  ex-   j 
tensor  carpi  radialis  longior  and  brevier,  and    ' 
ulnaris,  extend  the  wrist,  antagonizing   the    ' 
two  flexors  of  the    carpus.     The   extensor   j 
communis  digitorum  extends  the  fingers,  an- 
tagonizing the  flexors,  sublimis,  and  profun- 
dus.     The    extensor   ossi   metacarpi,    primi 
intei'nodii,  and  secundi  internodii  pollicis,  are 
the  special  extensors  of  the  thumb,  and  coun- 
terbalance the  actions  of  the  flexor  ossis  metacarpi,  flexor  brevis,  and 
flexor  Iongus  poUicis.     The  extensor  indicis  extends  the  first  finger, 
and  is  hence  called  "indicator;"  the  extensor  minimi  digiti  is  the  spe- 
cial extensor  of  the  little  finger,  enabling  it  to  be  extended  distinctly 
from  the  other  fingers. 

MUSCLES    OF    THE    HAND. 

Radial  Region. — Four  muscles:  1.  Ahductor  pollicis  ;  arises  fi-om 
the  scaphoid  and  annular  ligament;  inserted  into  the  base  of  the  first 
phalanx  of  the  thumb.  2.  Flexor  ossis  metacarpi;  arises  from  tho 
trapezium  and  annular  ligament ;  inserted  into  the  whole  length  of  the 
metacarpal  bone.     3    Flexor  brevis  pcllicis  :  its  external  portion  arisei . 


DEBP  LAYER    POSTERIOKLT. 


IvI  Y  :  L  0  G  Y. 


117 


with  the  preceding ;  its  internal  from  the  t:  apezoides  and  os  magnum ; 
both  are  inserted  into  the  base  of  the  first  phalanx  of  the  thumb,  hav- 
ing each  a  sesamoid  bone  in  the  tendon  to  protect  th-e  joint.  4.  Ad- 
ducltW  poinds ;  arises  from  the  whole  length  of  the  metacarpal  bone 
of  the  middle  finger,  and  its  converging  fibres  are  inserted  into  the  base 
of  the  first  phaJanx. 

Uses. — These  muscles,  as  their  names  import,  produce  in  the  thumb 
the  movements  of  abduction,  adduction,  and  flexion. 


Fig.  59. 


1"he  muscles  of  the  hand  are  seen  in 
Fig.  59.  1.  Annular  ligament.  2,  2.  Ori- 
gin and  insertion  of  the  abductor  pollicis, 
the  middle  portion  being  removed.  3. 
Flexor  ossis  metacarpi.  4.  One  portion 
of  the  flexor  brevis  pollicia.  5.  Its  deep 
portion.  G.  Adductor  pollicis.  7, 7.  Lum- 
bricales,  arising  from  the  deep  flexor  ten- 
dons, on  which  the  numbers  are  placed, 
the  tendons  of  the  flexor  sublirais  having 
been  removed  from  the  palm.  8.  One  of 
th'i  tendons  of  the*  deep  flexor,  passing 
b&twoen  the  two  terminal  slips  of  the 
tendon  of  the  flexor  sublimis,  to  reach  the 
last  p^ialanx.  9.  Tendon  of  the  flexor 
longus  pollicis,  passing  between  the  two 
portions  of  the  flexor  brevis  to  the  las* 
phalanx.  10.  Abductor  minimi  digiti.  11. 
Flexor  brevis  minimi  digiti;  the  edge  of 
the  flexor  ossis  metacarpi  is  seen  project- 
ing beyond  the  inner  border  of  the  flexor 
brevis.  12.  Prominence  of  the  pisiform 
bone.  13.  First  dorsal  interosseous 
muscle. 


MUSCLES    OF    THE     HAWD. 


Ulnar  Region. — Four  m.uscles  :  1.  Pahnaris  hrevis  ;  a  thin  plane, 
arising  from  the  annular  ligament  and  pabuar  fascia,  and  passing  ti'ans- 
versely  inward,  is  inseited  into  the  integuments  on  the  inner  border 
of  the  hand.  2.  Abductor  minimi  digiti  ;  a  small  taj)ering  slip,  arising 
from  the  pisiform  bone  ;  inserted  into  the  base  of  the  first  phalanx  of 
the  little  finger.  3.  Flexor  brevis  minimi  digiti ;  a  small  muscle,  am- 
ing  from  the  unciform  tone  and  annular  ligamenl  inserted  into  the 
base  of  the  irst  phalanx.  4.  Flexor  ossis  metacarpi ;  arises  with  the 
preceding ;  inserted  into  the  whole  length  of  the  metacarpal  bone  of 
the  little  finger. 

Uses. — These  muscles  are  subservient  to  the  motions  of  the  little 
finger. 

Palmar  Region. — Three  sets  of  muscles :   ?.  Lumhricales ;  four 


118  ANATOMY. 

in  number,  jrisuig  from  the  tendons  of  the  deep  flexor,  and  inserted 
into  the  aponeurotic  expansion  of  the  extensor  tendons  on  the  radial  side 
of  the  fingers.     2.  Palmar  interossei ;  three  in  number,  each  arising 
fi-om  the  base  of  the  metacarpal  bone  of  one  finger,  and  are  insertea  \ 
into  the  base  of  the  first  phalanx  and  aponeurotic  expansion  of  the  ex-  j 
tensor  tendon  of  the  same  finger,  the  middle  one  being  excepted.     3.  i 
Dorsal  interossei ;  these  are  situated  in  the  four  spaces  between  the ' 
metacarpal  bones ;  they  arise  by  two  heads  from  the  adjoining  sides  of  i 
the  base  of  the  metacai'pal  bones ;  inserted  into  the  base  of  the  first 
phalanges,  and  aponeurosis  of  the  extensor  tendons.  I 

Uses. — The  lumbricales  are  auxiliaiy  to  the  deep  flexors  ;  the ' 
palmar  interossei  are  adductors,  and  the  dorsal  interossei  abductoi*s ; 
hence  each  finger  is  furnished  with  its  proper  adductor  and  abductor,  | 
two  flexors,  and,  with  the  exception  of  the  middle  and  ring  fingers,  ' 
which  have  but  one,  two  extensors.  The  thumb  has  a  flexor  and  ex-  ! 
tensor  of  the  metacai'pal  bone  ;  and  the  little  finger  a  haetacarpal  flexor,  j 

i 

MUSCLES    or    THE    LOWER    EXTREMITY.  1 

These  have  usually  been  arranged  into  groups  corresponding  with 
the  regions  of  the  hip,  thigh,  leg,  and  foot.  1 

]MuscLES  OF  THE  Hip. — There  are  nine  muscles  of  the  hip,  which  ' 
together  constitute  the  Gluteal  Region  :  1.  Gluteus  maxiinus ; ' 
this  is  the  thick  quadrangular  mass  of  flesh  forming  the  convexity  of  j 
the  nates,  or  buttocks.  It  arises  from  the  back  part  of  the  crest  of  the  ! 
ilium,  the  posterior  surface  of  the  saciTim  and  coccyx,  and  the  great ' 
sacro-ischiatic  ligament;  passing  obliquely  outward  and  downward,  it  is  - 
inserted  into  the  rough  line  between  the  ti'ochanter  major  to  the  linea  '< 
aspera ;  by  means  of  its  tendon  it  is  continuous  with  the  fascia  lata  [ 
covering  the  outer  side  of  the  thigh.  Between  its  broad  tendon  and 
the  femur  a  large  bursa  is  situated.  2.  Gluteus  medium;  arises  from; 
the  outer  lip  of  the  crest  of  the  ilium  for  four  fifths  of  its  length,  and  ! 
from  the  dorsum  ilii  and  surrounding  fascia ;  its  fibres  converge  to  the  ] 
outer  part  of  the  ti'ochanter  major,  into  which  its  tendon  is  inserted.  ' 
3.  Gluteus  minimus;  arises  from  the  surfar  e  of  the  dorsum  ilii;  its! 
fibres  converge  to  the  anterior  border  of  the  trochanter  major,  where  ' 
they  are  inserted  by  a  rounded  tendon.  4.  Fyriformis  ;  a  pear-shaped  i 
muscle,  arising  from  the  anterior  surface  of  the  sacrum  and  ilium  ad-  ■ 
joining;  it  passes  out  of  the  pelvis  through  the  gi-eat  sacro-ischiatic  ' 
foramen ;  inserted,  by  a  rounded  tendon,  into  the  trochanteric  fossa  of  i 
the  femur.  5.  Gemellus  superior  ;  a  small  slip  arisins^  from  the  spine  { 
of  the  ischium,  and  inserted  into  the  tendon  of  the  obturator  internus,  j 
and  into  the  trochanteric  fossa.     6.   Obturator  internus  :  arises  from  I 


MYOLOGY 


119 


die  inner  surface  of  the  interior 
wall  of  the  pelvis ;  passes  out  of  the 
pelvis  through  the  lesser  sacro- 
ischiatic  foramen,  and  is  inserted 
into  the  trochanteric  fossa. 

Fig.  GO  shows  the  deep  muscles  of  the 
gluteal  region.  1.  Exteraal  surface  of  the 
ilium.  2.  Posterior  surface  of  the  sacruEC 
3.  Posterior  sacroiliac  ligaments.  4.  Tuber 
osity  of  the  ischium.  5.  Great  or  posterioi 
eacro-ischiatic  ligament.  6.  Anterior  or  less- 
er sacro-ischiatic  ligament.  7.  Trochanter 
major.  8.  Gluteus  minimus.  9.  Pyriformis. 
10.  Gemellus  superior.  11.  Obturator  inter- 
nus,  passing  out  of  the  lesser  sacro-ischiatic 
foramen.  12.  Gemellus  inferior.  13.  Quad- 
ratus  femoris.  14.  Adductor  magnus,  its 
upper  part.  15.  Vastus  exteruus.  16.  Biceps. 
17.  Gracilis.     18.  Semitendinosus. 

7.  Gemellus  inferior ;  arises  {rom 
the  anterior  point  of  the  tuberosity 
of  the  ischium ;  inserted  into  the 
trochanteric  fossa  and  tendon  of  the 
obturator   interuus.      8.    Obturator 

exteruus  ;  arises  from  the  obturator  membrane  and  suiTOunding  bone  ; 
its  tendon  passes  behind  the  neck  of  the  femur,  to  be  inserted  into  the 
trochanteric  fossa.  9.  Quadraius  femoris,  a  square  muscle  arising 
from  the  external  border  of  the  tuberosity  of  the  ischium ;  inserted 
Hito  a  rough  line,  called  linea  quadratic  on  the  posterior  border  of  the 
trochanter  major. 

Uses. — The  gkitei  are  abductors  of  the  thigh,  when  acting  from  the 
pelvis ;  when  the  thigh  is  their  fixed  point,  they  steady  the  pelvis  on 
the  head  of  the  thigh  bone,  as  in  standing ;  they  also  assist  in  carrying 
the  leg  forward  in  walking  ;  the  minimus  I'otates  the  limb  slightly  in- 
ward :  the  medius  and  maximus  rotate  it  outward.  The  other  muscles 
of  this  gi'oup  are  called  external  rotators,  their  office  being  to  rotate  the 
limb  outwardly,  everting  the  knee  and  foot. 


DEEP    GLUTEAL    MUSCLES. 


MUSCLES    OF    THE    THIGH. 

These  are  divided  into  three  regions — anterior,  internal,  and  posterior. 

Anterior  Femoral  Region. — Six  muscles :  1.  Tensor  vagina 
femoris,  a  short  fiat  muscle  on  the  outer  side  of  the  hip,  arising  from 
the  crest  of  the  ilium,  near  its  anterior  superior  spine ;  inserted  between 
two  layers  of  the  fascia  lata  at  one  fourth  down  the  thigh.   2.  Sartoriua 


120  ANATOMY.  ! 

(tailor's  muscle) ;  a  long  ribbon-like  muscle,  arising  from  the  anterior  i 

superior  spinous  process  of  the  ilium,  and  the  notch  below,  and  cross-  ] 

ing  the  upper  part  of  the  thigh  obliquely,  descends  behind  tJie  mner  ! 

Qpndyle  of  the  femur,  and  is  inserted  into  the  inner  tuberosity  of  the  \ 

tibia   by  an   aponeurotic   expansion.      3.   Rectus ;  a   straight   muscle,  \ 

arisino-  by  two  tendons,  one  from  the  anterior  inferior  spinous  process  i 

of  the  ilium,  the  other  from  the  upper  lip  of  the  acetabulum ;  insert-  ] 
ed  by  a  broad,  strong  tendon  into  the  upper  border  of  the  patella.     4. 

Vastus  e.rternus  ;  arises  from  the  inner  border  of  the  patella;  inserted  \ 
into  the  femur  and  outer  side  of  the  linea  aspera.  as  high  as  the  base 

of  the  trochanter.     5.    Vastus  internus ;  arises  from  the  inner  border  j 

of  the   patella ;   inserted  into  the  femur  and  inner  side  of  the  linea  i 

aspera  as  high  up  as  the  anterior  interti'ochanteric  line.     6.   Crureus  ;  i 

arises   from   the   upper   border  of  the    patella;  i 

inserted  into  the  front  aspect  of  the  femur,  as  i 
high  as  the  anterior  intertrochanteric  line. 

Note. — The  two  vasti  and  crureus  together 
constitute  the  triceps  extensor  cruris. 


Fig.  61  shows  the  muscles  of  the  anterior  femoral  region. 
1.  Crest  of  the  ilium.  2.  Its  anterior  superior  spinous  pro 
cess.  3.  Gluteus  medius.  4.  Tensor  raginae  femoris ;  its 
insertion  into  the  fascia  lata  is  seen  inferiorlj- .  5.  Sartorius. 
6.  Rectus.  7.  Vastus  externus.  8.  Vastus  internus.  9.  Pa- 
tella. 10.  Iliacus  internus.  11.  Psoas  magnus.  12.  Pecti- 
neus.  13.  Adductor  longus.  14.  Part  of  the  adductor  mag- 
nus.    15.  Gracilis. 


Uses. — The    tensor  vngiuce   femoris   stretches 
the  fascia  lata,  rendering  it  tense,  and  slightly  in-  ' 
verting   the    limb ;  the  sartorius  bends  the  leg  ^| 
upon  the  thigh,  and  the  thigh  upon  the  pelvis,  "' 
carrying  the  leg  across  that  of  the  opposite  side  '■ 
— tlie  tailor's  sitting  position  •  when  fixed  below  1 
it  assists  the  extensors  of  the  leg  in  supporting  the  ' 
tiTiuk.     The  four  remaining  muscles  extend  the  3 
leg  upon  the  thigh.     By  their  attachment  to  the 
patella,  which  acts  as  a  fulcrum,  they  are  advan-  ; 
tageously  disposed  for  great  power.     Wlien  their  ; 
fixed  point  is  from  the  tibia  they  steady  the  thigh  , 
upon  the  leg ;  and  the  rectus,  bj^  its  attachment 
to  the  pelvis,  serves  to  atilance  the  trunk  upon  i 


A.]TTERIOm    FEMOR.VL 


MUSCLES.  the  lower  ey^'-emity. 


MYOLOGY.  121 


Internal  Femoral  Region. — Seven  musc.fes  :  1.  Iliacus  intcrnus; 
n  Hat  radiated  muscle,  arising  from  the  inner  corcave  surface  of  the 
ilium,  and,  joining  with  the  tendon  of  the  psoas,  is  inserted  into  the 
trochanter  minor  of  the  femur.  2.  Psoas  magnus ;  arises  from  the 
intervertebral  substances,  part  of  the  bodies  and  bases  of  the  trans- 
Verse  processes  of  the  lumbar  vertebra,  and  from  tendinous  arches 
thrown  across  the  constricted  portion  of  the  last  dorsal  and  four  upper 
lumbar  vertebrae,  and,  passing  along  the  margin  of  the  brim  of  the 
pelvis  and  beneath  Poupart's  ligament,  its  tendon,  united  with  that  of 
the  iliacus  internus,  is  inserted  into  the  posterior  part  of  the  trochanter 
minor,  a  bursa  being  interposed.  3.  Pectineus ;  a  flat  quadrangular 
mwscle,  arising  from  the  pectineal  line  of  the  pubis  and  surface  of  bone 
in  front ;  inserted  into  the  femur,  between  the  anterior  intertrochan- 
teric line  and  the  Unea  aspera.  4.  Adductor  longus  ;  arises  bj^  a  round 
tendon  from  the  front  surface  of  the  pubis  below  the  angle  ;  inserted 
into  the  middle  third  of  the  linea  aspera.  5.  Adductor  hrevis ;  arises 
from  the  body  and  ramus  of  the  pubis ;  inserted  into  the  upper  third 
of  the  linea  aspera.  6.  Adductor  magnus  ;  a  broad  ti'iangular  muscle  ; 
arises  from  the  ramus  of  the  pubes  and  ischium,  and  tuber  ischii,  and, 
radiating  outward,  is  inserted  into  the  whole  length  of  the  hnea  aspera 
and  inner  condyle  of  the  femur.  7.  Gracilis  ;  a  slender  muscle,  aris- 
ing from  the  body  of  the  os  pubis,  and  ramus  of  the  pubis  and  ischium : 
inserted  into  the  inner  tuberosity  of  the  tibia. 

Uses. — The  iliacus,  psoas,  pectineus,  and  adductor  longus  bend  the 
thigh  upon  the  pelvis,  and  rotate  the  entire  limb  outward ;  the  pecti- 
neus and  adductors  move  the  limb  outward  powerfully.  The  gi-acilis 
assists  hi  adduction,  and  contributes  also  to  the  flexion  of  the  leg. 

Posterior  Femoral  Reg- "N  — ^Tliree  muscles ;  1.  Biceps  femoris ; 
double-headed,  one  head  arisih^  in  common  with  the  semi-tendinosus, 
the  other  from  the  lower  two  thirds  of  the  linea  aspera;  inserted  by  a 
strong  tendon  into  the  head  of  the  fibula ;  a  portion  of  its  tendon  is 
continued  into  the  fiiscia  of  the  leg,  and  another  is  attached  to  the 
outer  tuberosity  of  the  tibia.  2.  Semi-tendinosus ;  remarkable  for  its 
long  tendon ;  arises  from  the  tuberosity  of  the  ischium  with  the  long 
head  of  the  biceps ;  inserted  into  the  inner  tuberosity  of  the  tibia.  3. 
Semi-membranosus  ;  named  from  its  tendinous  expansion  ;  arises  fi-om 
the  tuberosity  of  the  ischium  in  front  of  the  preceding ;  inserted  into 
the  back  part  of  the  inner  tuberosity  of  the  tibia. 

]Sl"oTE. — The  biceps  forms  the  outer  hamstring;  the  tendons  of  the 
semi-tendinosus,  semi-membranosus,  gi'acilis,  and  sartorius  form  the 
inner  liamstrino;. 

i-n 


122 


A  N  A  T  0  M  y. 


Uses. — These  muscles  are  the  du-ect  flexors  of  the  leg  upon  the 
thigh;  those  fibres  which  originate  fr;  m  below  also  balance  the  pelvis  on 
the  lower  extremities.     The  biceps  everts  the  leg 
when   partially  flexed,  and   the   semi-tendinosus 
turns  it  inward  when  partially  flexed. 


Fig.  62. 


Fig.  62  exhibits  the  muscles  of  the  posterior  femoral  and 
gluteal  region.  1.  Glu».'us  medius.  2.  Gluteus  maxinus.  3. 
Vastus  externus  covered  in  by  fsscia  lata.  4.  Long  head  of 
the  biceps.  5.  Its  short  head.  6.  Semi-tendinosus.  7.  Semi- 
membranosus. 8.  Gracilis.  9.  Part  of  the  inner  border  of  thp 
adductor  magnus.  10.  Edge  of  the  sartorius.  11.  The  popli- 
teal space.     12.  Gastrocnemius ;  its  two  heads. 


MUSCLES    Ol      i'FE    LEG. 

They  are  divided  into  three  regions :  anterior 
tibial,  fibular,  and  posterior  tibial. 

Anterior  Tibial  Region. — Four  muscles:  1. 
Tibialis  anticus  ;  arises  from  the  upper  two  thirds 
of  the  tibia,  the  interosseous  membrane,  and  the 
deep  fascia;  its  tendon  passes  thi'ough  a  distinct 
sheath  in  the  annular  ligament,  and  is  inserted 
into  the  inner  side  of  the  internal  cuneiform  bone, 
and  base  of  the  metatarsal  bone  of  the  great  toe. 
2.  Extensor  longus  digitorum  ;  arises  from  the 
head  of  the  tibia,  upper  three  fourths  of  the  fibu- 
la, interosseous  membrane,  and  from  the  deep 
fascia ;  below  it  divides  into  four  tendons,  which 
pass  beneath  the  annular  ligament,  and  are  insert- 
ed into  the  second  and  third  phalanges  of  the  four 
lesser  toes.  3.  Peroneus  tertius ;  arises  from  the 
posTERiAL  FEMORAL  jgwer  fouith  of  the  tibia ;  inserted  into  the  base  of 

MUSCLE.  ,  ,       ■  <>,,.,  -n 

the  metatarsal  bone  oi  the  little  toe.  4.  ±jxtensor 
proprius  pollicis ;  arises  from  the  lower  two  thirds  of  the  fibula  and 
interosseous  memfrane ;  inserted  into  the  base  of  the  last  phalanx  of 
the  great  toe. 

Uses. — The  first  two  are  direct  flexors,  bending  the  foot  upon  the 
leg;  acting  with  the  tibialis  posticus,  they  direct  the  foot  inward,  and 
with  the  peroneus  longus  and  brevis,  outward.  They  help  to  main- 
tain the  flatness  of  the  foot  during  progi'ession.  The  extensor  longus 
digitorum  and  extensor  proprius  pollicis  are  direct  extensors  of  the 
toes  ;  they  also  assist  the  flexion  of  the  entire  foot  upon  the  leg.  When 
acting  from  beZ^w  they  ir.crense  the  firmness  of  the  ankle  joint 


MYOLOGY. 


123 


63. 


Posterior  Tibial  Region. — Seven  muscles;  the  first  three  make 
the  superficial  group;  the  last  four  the  deep  layer:  1.  Gastrocnemius ; 
arises  by  two  heads  from  the  two  condyles  of  the  femur,  which,  uniting 
to  form  tlio  bellied  part  of  the  leg,  are  inserted,  by  means  of  the  tendo 
Achillis,  into  the  lower  part  of  the  tuberosity  of  the  os  calcis,  a  synovial 
bursa  being  interposed  between  the  tendon  and  bone.  2.  Plantaris,  a 
very  small  muscle,  arising  frcm  the  outer  condyle  of  the  femur,  and 
inserted,  by  a  long,  slender  tendon,  into  the  os  calcis,  by  the  side  of  the 
tendo  Achillis.  3.  Soleus,  a  broad  muscle,  arising  fi-om  the  head  and 
upper  third  of  the  s'>ula,  and  oblique  line  and  middle  third  of  the  tibia; 
its  fibres  converge  to  the  tendo  Achillis,  by  which  it  is  inserted  into  the 
OS  calcis. 

Uses. — These  three  muscles  of  the  calf  draw 
powerfully  on  the  os  calcis,  lift  the  heel,  and  contin- 
uing then-  action,  raise  the  entire  body.  They  are 
the  principal  muscles  in  walking,  leaping,  and  danc- 
ing. When  they  are  fixed  below  they  steady  the 
leg  upon  the  foot. 

The  superficial  muscles  of  the  posterior  aspect  of  the  leg  are 
shown  in  Fig.  63.  1.  Biceps,  forming  the  outer  hamstring.  2. 
The  tendons  forming  the  inner  hamstring.  3.  Popliteal  space. 
4.  Gastrocnemius.  5,  5.  Soleus.  6.  Tendo  Achillis.  7.  Posterior 
tuberosity  of  the  os  calcis.  8.  Tendons  of  the  peroneus  longus 
and  brevis,  passing  behind  the  outer  ankle.  9.  Tendons  of  the 
tibialis  posticus  and  flexor  longus  digitorum,  passing  into  the  foot 
oehind  the  ankle. 

4.  Popliteus ;  arises  by  a  rounded  tendon  from  a 
deep  groove  on  the  outer  side  of  the  external  condyle 
of  the  femur,  beneath  the  external  lateral  ligament, 
and  spreading  obliquely  over  the  head  of  the  tibia,  is 
inserted  into  the  bone  above  its  oblique  line.  5. 
Flexor  longus  pollicis ;  arises  from  the  lower  two 
thirds  of  the  fibula,  and  passing  through  a  groove  in 
the  astragalus  and  os  calcis,  is  inserted  into  the  bone 
of  the  last  phalanx  of  the  great  toe.  6.  Flexor  longus 
digitorum ;  arises  from  the  surface  of  the  tibia,  below 
the  popliteal  line;  its  tendon  passes  through  a  sheath 
with  the  tibialis  posticus  behind  the  inner  malleolus, 
and  then  through  a  second  sheath  connected  with  a 
groove  in  the  astragalus  and  os  calcis,  into  the  sole  superficial, 
of  the  foot,  where  it  divides  into  four  tendons,  which  tibial  :mtjscles 
are  inserted  into  the  base  of  the  last  phalanx  of  the  four  lesser  toes, 
perforating  the  tendons  of  the  flexor  brevis  digitorum.     7,   Tibialis 


124  VNAro::r. 

posticus ,  arises  by  Vivc  lieads  from  the  adjacent  sides  of  the  tibia  and  j 

fibula  their  whole  length,  and  from  the  interosseous  membrane;    its  , 

tendon  i-uns  into  the  sheath  with  the  flexor  longus  digitorum.  passes  ; 

through  its  proper  sheath  over  the  deltoid  ligament,  and  is  inserted  I 
into  the  tuberosity-  of  the  scaphoid  and  internal  cuneiform  bone. 

Uses. — The  popliteus  flexes  the  leg  upon  the  thigh,  at  the  same  time  , 

carrying  it  inwai'd,  so  as  to  invert  the  leg.     The  flexors  are  connected  ; 

in  the  foot  by  a  tendinous  band,  so  that  they  act  together  in  bending  : 

the  toes.     The  tibialis  posticus  extends  the  tarsus  upon  the  leg,  antag-  | 

onizing  the  tibialis  anticus.     These  last  two  combine  in  adducting  the  ■ 

foot.  j 

Fibular  Region. — Two  muscles:  1.  Peroneus  longus;  arises  from  ' 

the  head  and  upper  third  of  the  outer  side  of  the  fibula,  and  terminates  i 
in  a  long   tendon  which  passes  behind  the  external   malleolus,  and 

obliquely  across  the  sole  of  the  foot ;   inserted  into  the  base  of  the  j 

metatai'sal  bone  of  the  great  toe.     2.  Peroneus  brevis,  lies  beneath  the  ' 

former,  arising  from  the  lower  half  of  the  fibula,  and  terminates  in  a  ! 

tendon  which  passes  behind  the   external  malleolus,  and  through  a  ' 

groove  in  the  os  calcis,  to  be  inserted  into  the  base  of  the  metatarsal  j 
bone  of  the  little  toe. 

Uses. — The  peronei  are  extensors  of  the  foot,  conjointly  with  the  j 

tibialis  posticus,  and  antagonize  the  tibialis  anticus  and  peroneus  tertius.  ; 

All  of  these  acting  together  maintain  the  foot  in  a  flat  position,  as  in  | 

walking.  j 

MUSCLES    OF    THE    FOOT. 

1 

These  may  be  arranged,  according  to  theh*  situation  above  or  below,  i 

into  those  of  the  dorsal  and  those  of  the  plantar  regions.  i 

Dorsal  Region. — Two  muscles:    1.   Extensor  brevis  digitorum; 

arises  from  the  outer  side  of  the  os  calcis,  crosses  the  foot  obliquely,  ! 

and  terminates  in  four  tendons,  one  of  which  is  inserted  into  the  first  i 

phalanx  of  the  great  toe,  and  the  others  into  the  sides  of  the  long  e^-  j 

lensor  tendons  of  the  second,  third,  and  fourth  toes.     2.  Dorsal  inter  \ 

ossei ;  these  are  placed  between  the  metatarsal  bones.  1 

Plantar  Region. — The  muscles  of  this  region  are  subdivided  into  I 

four  layers.  | 

First  Layer. — Three  muscles:  1.  Abductor  pollicis,  lies  along  the  i 
inner  border  of  the  foot,  one  head  arising  from  the  inner  tuberosity 
of  the  OS  calcis,  the  other  from  the  internal  annular  ligament  and  plantar 
fascia;  inser'ed  into  the  first  phalanx  of  the  gi'eat  toe,  and  internal  sesa- 


M  Y 0 L 0  G  x. 


125 


moid  bone.  2.  Abductor  minimi  digiti,  lies  along 
the  outer  border  of  the  foot,  arising  from  the 
outer  tuberosity  of  the  os  calcis,  and  plantar  fascia; 
inserted  into  the  base  of  the  first  phalanx  of  the 
little  toe.  3.  Flexor  hrevis  digitorum,  situated 
between  the  two  preceding;  arises  from  the  under 
surface  of  the  os  calcis,  from  the  plantar  fascia  and 
intei-muscular  septa  ;  inserted,  by  four  tendons, 
into  the  base  of  the  second  phalanx  of  the  fou'* 
lesser  toes. 

The  first  layer  of  muscles  in  the  sole  of  the  foot  is  shown  in 
Fig.  64.  1.  Os  calcis.  2.  Posterior  part  of  the  plantar  fascia 
divided  transversely.  3.  Abductor  pollicis.  4.  Abductor 
minimi  digiti.  5.  Flexor  brevis  digitorum.  6.  Tendon  of  the 
flexor  lougus  pollicis.     7,  7.  Lumbricales. 

Second  Layer. — Two  muscles :  1.  Musculus 
accessorius ;  arises  by  two  slips  from  either  side 
of  the  under  surfoce  of  the  os  calcis;  inserted  into 
the  outer  side  of  the  tendon  of  the  flexor  longus 
digitorum.  2.  Lumbricales,  four  muscular  slips, 
arising  from  the  tibial  side  of  the  tendon  of  the 
flexor  longTs  digitorum ;  inserted  into  the  expan- 
sion of  the  extensor  tendons,  and  base  of  the  first 
phalanx  of  the  four  lesser  toes. 

The  third  and  part  of  the  second  layer  of  muscles  of  the 
sole  of  the  foot  are  seen  in  Fig.  65.  1.  Divided  edge  of  the 
plantar  fascia.  2.  Musculus  accessorius.  3.  Tendon  of  the 
flexor  longus  digitorum.  4.  Tendon  of  the  flexor  Icngus  pol- 
licis. 5.  Flexor  brevis  pollicis.  6.  Adductor  pollicis.  7. 
Flexor  brei  is  mininii  digiti.  8.  Transversus  pedis.  9.  Dorsal 
and  plantar  interossei.  10.  Convex  ridge  formed  by  the  ten- 
don of  the  peroneus  longus  in  its  oblique  course  across  the 
foot. 

Third  Layer. — Four  muscles :  1.  Flexor  bre- 
vis poinds ;  arises  from  tho  side  of  the  cuboid, 
and  from  the  external  cuneiform  bone  ;  inserted 
by  two  heads  into  the  base  of  the  first  phalanx  of 
the  great  toe.  Two  sesamoid  bones  are  found  in 
these  tendons.  2.  Adductor  pollicis  ;  arises  from 
the  cuboid  bone  and  sheath  of  the  tendon  of  the 
peroneus  longus,  and  from  the  base  of  the  third 
and  fourth  metatarsal  bones ;  inserted  into  the 
base  of  the  first  phalanx  of  the  gi-eat  toe.  3. 
Flexor  hrevis  minimi  digiti;  arises  from  the  base 


Fig.  64. 


FIRST    LAYER 
PLANTAR    MUSCLES. 

Fig.  65. 


PLANTAR    MUSCLEa 


126 


ANATOMY. 


Fig.  66. 


ni 


h 


^EJlF  ITLANTAIl  MUSCLES. 

Fi?.  67. 


of  the  metacarpal  bone  of  the  little  toe,  and  sheath 
of  the  peroneal  tendon  ;  inserted  into  the  base  of 
the  first  pliiilanx  of  the  little  toe.  4.  Transversus 
pedis  ;  arises  by  fleshy  slips  from  the  heads  of  the 
metatarsal  bones  of  the  four  lesser  toes ;  inserted 
into  the  base  of  the  first  phalanx  of  the  gi'eat  toe, 
its  tendon  being  blended  with  that  of  the  adductor 
pollicis 

Fig.  66  shows  the  deep-seated  muscles  in  the  sole  of  the 
foot.  1.  Tendon  of  the  flexor  lon^s  pollicis.  2.  Tendon  of 
the  flexor  communis  digitorum  pedis.  3.  Flexor  accessorius. 
4,  4.  Lumbricales.  5.  Flexor  brevis  digitorum.  6.  Flexor 
brevis  pollicis  pedis.    7.  Flexor  breris  minimi  d'giti  pedis. 

Fourth  Layer. — One  set  of  muscles  :  Interossei 
plantares  ;  three  in  number,  placed  upon  the 
metatarsal  bones  ;  arising  by  the  base  of  the  me- 
tatarsal bones  of  the  three  outer  toes ;  inserted 
into  the  inner  side  of  the  extensor  tendon  and 
base  of  the  first  phalanx  of  the  same  toes. 

The  interossei  plantares  are  seen  in  Fig.  67.  1.  Abductor 
tertii.    2.  Abductor  quarti.    3.  Interossei  minimi  digiti. 


Uses. — All  the  muscles  of  the  foot  act  upon  the 
toes,  the  action  and  nature  and  situation  of  each 
muscle  being  expressed  by  its  name.  The  move- 
ments of  the  toes  are  flexion,  extension,  adduc- 
tion, and  abduction.  The  gi'eat  toe,  like  the 
thumb,  is  provided  with  special  muscles  for  inde- 
pendent action.  The  lumbricales  ai'e  assistants  to 
the  long  flexor ;  and  the  transvei*sus  pedis  is  placed 
across  the  foot  for  the  purpose  of  di'awing  the  toes 
together. 

The  firm  articulations  of  all  the  metacarpal 
bones,  and  the  great  strength  and  number  of  th9 
ligaments  and  tendons  of  the  leg,  ft-et,  and  toes, 
are  admirably  adapted  for  combining  power  of  en- 
durance with  facility  of  motion  ;  the  toes  genei*al]y 
have  four  flexors,  tAVO  extensors,  four  adductors, 
and  four  abductors ;  while  the  gi'eat  toe,  in  addi- 
tion, has  two  distinct  flexors,  tvvo  extensors,  one 
TLANTA*  INTEBC8SR .     adductor,  and  one  abductor. 


A.PONEUROLOGY. 


m 


CHAPTER  IV. 


OF  THE   FASCIA— APONEUROLOGY. 


The  soft  structures  and  delicate  organs  of  the  body  are  every  where 
invested  -,vith  protecting  coats,  or  bandages,  called  fascice.  They  are 
composed  of  lamina3  of  various  thickness,  and  are  divided  into  cellulo- 
fibrous  and  aponeurotic. 

The  cellulo-jihroiis  fascia  invests  the  whole  body  between  the  skin 
and  the  deeper  parts,  and  affords  a  medium  of  connection  between 
them-  It  is  composed  of  fibrous  tissue,  arranged  in  a  cellular  form, 
the  cells  containing  adipose  substance,  thus  affording  a  yielding  and 
elastic  structure,  through  which  the  minute  vessels  and  nerves  pass  to 
the  papillary  layer  of  the  skin,  without  obstruction  or  injury  from 
pressure.  By  dissection  it  may  be  separated  into  twa^layers,  between 
which  the  subcutaneous  vessels  and  nerves  fire  found.  In  some  situa- 
tions this  fascia  is  condensed  into  strong  inelastic  membrane,  as  in  the 
deep  fascia  of  the  neck  and  thorax,  and  the  sheaths  of  vessels. 

Fi-.  G8. 
Fig.  68  is  a  transverse  section  of  the  neck. 
showing  the  deep  cervical  fascia  and  its  nu- 
merous prolongations,  forming  sheaths  for 
the  ditl'erent  muscles.  1.  Platysma  myoides. 
2.  Trapezius.  3.  Ligamentum  nucha;,  from 
which  the  fascia  may  be  traced  forward 
beneath  the  trapezius,  inclosing  the  other 
muscles  of  the  neck.  4.  Division  of  the  fascia 
to  form  a  sheath  for  the  sterno-mastoid  mus- 
cle (.5).  G.  Point  of  reunion.  7.  Union  of 
the  deep  fascia  of  opposite  sides  of  the  neck. 
8.  Section  of  the  sterno-hyoid.  9.  Omo-hy- 
oid.  10.  Sterno-thyroid.  11.  Latei'al  lobe  of 
the  thyroid  glnnd.  12.  Trachea.  13.  iEso- 
phagus.  14.  Sheath  containing  the  common 
carotid  artery,  internal  jugular  vein,  and 
pneumogastric  nerve.  15.  Longus  colli;  the 
sympathetic  nerve  is  in  front.  16.  Rec- 
tus anticus  major.  17.  Scalenus  anticus.  18. 
Scalenus  posticus.  19.  Splenius  capitis.  20. 
Splenius  colli.  21.  Levator  anguli  scapulas. 
22.  Complexus.  23.  Trachleo-mastoid.  24.  Transversalis  colli.  25.  Cervicalis  ascen- 
dens.  26.  Semi-spinalis  colli.  27.  Multi.fidus  spinas.  28.  A  cervical  vertebra;  the 
transverse  processes  are  seen  to  be  traversed  by  the  vertebral  artery  and  vein. 

The  aj)oneurotic  fascia  is  strong  and  inelastic,  composed  of  parallel 
tendin»^is  fibres,  connected  by  others  passing  in  different  directions. 


DISTRIBUTION    OF    THE    FASCIA. 


128  A  ^'  A  T  0  M  Y. 

In  the  limbs  it  fci'nis  distinct  sheaths,  inclosing  all  the  muscles  and  ten 
dons,  constituting  the  deep  f;isc'a.  It  is  firmly  connected  to  the  bones, 
and  to  the  prominent  points  of  the  clavicle  «rapula,  elbow,  wi'ist,  pelvis, 
knee,  ankle,  etc.  Its  pressure  assists  the  muscular  action  and  the  cir- 
culation of  fluids.  In  the  palm  of  the  hand  and  sole  of  the  foot  it  is  a 
powerful  protection  to  the  sti-uctures. 

PP.l        IPAL    FASCIJ::. 

Temporal  Fascia. — The  fascia  of  the  temple  is  a  sti'oug  aponeurotic 
membrane  covering  the  temporal  muscle  on  each  side  of  the  head. 

Cervical  Fasclcs. — T.he  fasciae  of  the  neck  are  divided  into  the 
superficial  ^vhich  is  a  psrt  of  the  common  superficial  fliscia  of  the 
entire  body,  and  the  deep,  a  sti-ong  cellulo-fibrous  layer  which  invests 
the  muscles  of  the  neck,  and  retains  and  supports  the  vessels  and  nerves. 

Thoracic  Fascia. — The  thoracic  fascia  is  a  dense  layer  of  cellulo- 
fibrous  menibrane  stretched  horizontally  across  the  superior  opening  of 
the  thorax,  and  forming  the  upper  boundary  of  the  chest,  as  the  dia- 
phragm does  the  lower.  It  supports  the  heart  in  its  situation,  and  also 
the  large  blood-vessels,  windpipe,  and  aesophagus,  which  pass  through  it. 

Abdominal  FascicB. — The  lovrer  part  of  the  walls  of  the  abdomen, 
and  the  cavity  of  the  pelvis,  are  supported  on  their  internal  surface  with 
a  layer  of  fascia;  at  the  bottom  of  the  pelvis  it  is  reflected  inward  to 
the  sides  of  the  bladder.  In  diflerent  situations  irs  parts  are  called 
fascia  transversalis,  iliac,  and  pelvic  fascia.  The  transverse  and  iliac 
fasciae  meet  at  ihe  crest  of  the  ilium  and  Poupart's  ligament;  the  pelvic 
is  confined  to  the  cavity  of  the  true  pelvis.  These  fasciee  are  important 
in  their  relations  to 

inguinal  hernia. 

There  are  two  Kuids  of  inguinal  hernia,  oblique  and  direct.  In  the 
oblique,  the  intestine  escapes  from  the  abdominal  cavity  into  the  sperm- 
atic canal,  through  the  interned  abdominal  ring;  this  ring  is  situated  in 
the  fascia  transversalis,  about  midway  between  the  spine  of  the  pubis 
and  superior  anterior  spine  of  the  ilium,  half  an  inch  above  Poupart's 
ligament.  The  bowel  pushes  along  a  pouch  of  peritoneum  which 
forms  the  hernial  sac,  and  distends  a  process  of  the  ti-ansverse  fascia. 
After  emerging  from  the  intei-nal  ring,  it  passes  beneath  the  lower 
borders  of  the  transversalis  and  internal  oblique  muscles,  and  finally 
through  the  external  abdominal  ring  in  the  aponeurosis  of  the  external 
oblique  muscle.  While  passing  the  internal  oblique,  it  receives  tha 
cremfister  muscle  as  an  additional  investment,  and  upon  protruding 
from  tbfc   externa'  nng,  still  another  fi-om  the  intercolumnar  fascia. 


APONEUROLOGY.  129 

Hence  the  coverings  of  an  inguinal  hernia  from  the  surfoce  to  the 
bowel  are ;  1.  The  integument  2.  Superficial  fascia.  3.  Inter- 
columnar  fascia.  4.  The  cremaster  nmscie.  5.  Transversalis  fascia. 
G.  Peritoneal  sac. 

The  sjyermatic  canal  is  about  an  inch  and  a  half  in  length,  and  in  the 
normal  condition  gives  passage  to  the  spermatic  cord  in  the  male,  and 
l,he  round  ligament  of  the  uterus,  with  its  vessels,  in  the  female.  It  is 
bounded  at  its  inner  termination  by  the  internal,  and  at  its  outer  ex- 
tremity by  the  external,  abdominal  ring.  It  is  also  bounded  in  front  by 
the  aponeurosis  of  the  external  oblique ;  behind  by  the  ti'ansversalis 
fascia  and  the  conjoined  tendon  of  the  internal  oblique  and  transversalis; 
above  by  the  arched  borders  of  the  same  muscles  ;  below  by  the 
grooved  border  of  Poupart's  ligament. 

Of  oblique  inguinal  hernia  there  are  three  kinds:  1.  Coynmon  oblique; 
already  described.  2.  Congenital;  this  has  no  proper  sac,  but  is  con- 
tained vfithin  the  tunica  vaginalis;  the  other  coverings  are  the  same  as 
in  the  first  variety.  It  results  from  the  pouch  of  the  peritoneum,  which 
is  carried  downward  into  the  scrotum  by  the  descent  of  the  testicle  in 
the  foetus,  not  closing,  so  that  the  intestine  is  forced  into  the  open  canal. 
3.  Encysted ;  a  protrusion  of  the  intestine  in  which  the  pouch  of  the 
peritoneum  forming  the  tunica  vaginalis,  being  only  partially  closed, 
and  remaining  open  exte]-nally  to  the  abdomen,  admits  of  its  passing 
into  the  scrotum  behind  the  tunica  vaginalis.  The  surgeon,  in  operat- 
ing, divides  three  layers  of  serous  membrane,  the  first  and  second  being 
those  of  the  tunica  vaginalis,  and  the  third  the  peritoneal  layer,  or  ti'ue 
hernial  sac. 

Direct  inguinal  liernia  is  so  called  when  the  bowel  passes  directly 
through  the  external  ring,  forcing  before  it  the  opposing  parietes.  Its 
coverings  are  the  same  as  in  the  oblique  hernia,  except  that  the  con- 
joined tendon  of  the  internal  oblique  and  transversalis  muscles  form 
its  fourth  investment,  instead  of  the  cremaster  muscle. 

Direct  inguinal  hernia  never  attains  us  great  bulk  as  the  oblique  form; 
all  these  varieties  may  descend  into  the  cavity  of  the  scrotum,  and  afe 
then  called  scrotal  hernia. 

Iliac  Fascia. — The  iliac  fascia  invests  the  psoas  and  iliacus  muscles; 
beneath  the  femoral  arch  it  forms  a  part  of  the  sheath  of  the  femoral 
vessels. 

Pelvic  Fascia. — This  is  attached  to  the  inner  surface  of  the  os  pubis, 
and  along  the  margin  of  the  pelvis,  from  which  it  descends  into  the 
j^elvic  cavity,  where  it  divides  into  two  layers,  the  pelvic  and  ohturator. 
Tjin  pelvic  layer  is  reflected  inward  from  neai*  the  symphisis  pubis  to 
Uie  neck  of  the  bladder,  forming  the  anterior  vesical  ligaments;  au 


130 


ANATOMY. 


ascending  reflected  portion  encloses  the  sides  of  the  bladder  and  vesical 
plexus  of  veins,  and  forms  the  latei-al  ligament  of  the  bladder.  Other 
reflexions  constitute  layers  for  investing  the  lower  portion  of  the  ali- 
mentary canal.  The  obturator  layer  passes  downward,  covering  the 
obtmnitor  internus  musJe.  and  encloses  the  internal  pudic  vessels  and 
nerves. 

Perineal   Fascice. — The   svperjicial  perineal  fascia  is  a  thin  apo 
neurotic  layer  covering  the  muscles  of  the  genital  portion  of  the  peri- 
neum.    The  deep  perineal  fascia^  called  also  Canipefs,  and  triangular 
ligament,  is  sti'etched  across  the  pelvis,  so  as  to  constitute  a  defence  to 
its  outlet. 

Fig  69.  In  the  side  view  of  the  viscera 

of  the  pelvis,  Fig.  69,  is  shown 
the  distribution  of  the  perineal 
and  pelvic  fasciee.  1.  Symphisis 
pubis.  2.  Bladder.  3.  The 
recto- vesical  fold  of  peritoneum, 
passing  from  the  anterior  sur- 
face of  the  rectum  to  the  back 
part  of  the  bladder.  4.  The 
ureter.  5.  The  vas  deferens. 
6.  Right  vesicula  seminalis.  7. 
Prostate  gland  divided  by  a 
longitudinal  section.  8,  8.  Sec- 
tion of  a  i-ing  of  elastic  tissue 
encircling  the  prostatic  portion 
of  the  urethra  at  its  commence- 
ment. 9.  Prostatic  urethra. 
10.  Membranous  portion.  11. 
The  commencement  of  the  cor- 
pus spongiosum  penis,  the  bulb.  12.  Anterior  ligaments  of  the  bladder.  13.  F.dgeofthe 
pelvic  fascia  reflected  upon  tlie  rectui^.  14.  Location  of  a  plexus  of  veins,  between  the 
pelvic  and  deep  perineal  fascia.  15.  The  deep  perineal  fascia;  its  two  layers.  16 
Cowpnr's  gland  of  the  right  side.  T"'.  Superficial  perineal  fascia,  ascending  in  front  of 
flie  root  of  the  penis  to  become  continuous  with  the  dartos  of  the  scrotum  (18).  19. 
Layer  of  the  deep  fascia  prolonged  to  the  rectum  20.  Lower  part  of  the  levator  ani. 
21.  The  inferior  segment  of  the  funnel-shaped  process  givt-n  off  from  the  posterior  layer 
of  the  de«p  perineal  fascia,  which  is  continuous  with  the  recto-vesical  fascia;  the  attach- 
ment  of  this  fascia  to  the  recto-vesical  fold  of  peritoneum  is  seen  at  22. 

Fascia  of  the  Upper  Extremity. — The  superficial  contains  between 
its  layers  the  superficial  nerves,  veins,  and  lymphatics.  The  deep  is 
thick  upoii  the  dorsum  of  the  scapula,  but  thin  in  the  axillary  space 
In  the  fore-arm  it  is  very  strong  at  the  elbow  and  wi-ist  joints,  uniting 
with  the  ligamentous  structures.  In  the  latter  joint  it  forms  the  pos- 
terior annular  ligament.  The  palmar  fascia  occupies  the  middle  and 
Bide  of  the  hand,  its  centi'al  portion  spreads  over  the  heads  of  the  meta- 
carpal bones,  where  it  divides  into  slips  which  are  attached  to  the 
phalanges. 


PELVIC    FASCIA. 


A  N  G  i;  1 0  L  0  G  Y.  131 


Fascice  of  the  Lower  Extremity. — As  in  the  upper  extremity,  the 
superficial  fascia  of  the  lower  contains  between  its  layers  the  superficial 
ressels  and  nerves.  At  the  groin  these  layers  are  separated  by  the 
lymphatic  glands.  The  deepfascic  of  the  thigh  is  called,  from  its  gi-eat 
eiiXenU  fascia  lata.  It  is  sti-ongly  connected  with  tlie  prominent  points 
of  bone  around  the  hip,  knee,  a^id  ankle  joints.  The  sheath  of  the 
femoral  vessels  is  a  continuation  of  the  abdominal  fascia  down  the  thigh. 
In  this  sheath  is  an  interval  between  the  vein  and  its  inner  wall,  the 
upper  opening  of  which  is  called  the  femoral  ring.  This  ring  is 
bounded  in  front  by  Poupait's  ligament  behind  by  the  os  pubis,  inter- 
nally by  Gimbernat's  ligament,  and  externally  by  the  femoral  vein,  and 
is  closed  only  by  a  thin  layer  of  areolar  tissue,  called  septum,  crurale, 
which  retains  the  lymphatic  gland  in  position,  and  the  peritoneum. 

FEMORAL    HERNIA. 

When  violent  or  long-continued  pressure  is  made  on  the  abdominai 
viscera,  a  poi'tion  of  intestine  may  be  forced  through  the  femoral  ring 
into  the  interval  or  space  in  the  sheath  of  the  femoral  vessels,  consti- 
tuting femoral  hernia.  The  proti'uding  intestine  pushes  along  the 
peritoneum  and  septum  crurale.  If  the  causes  continue,  the  intestine 
will  be  forced  forward  through  an  opening,  called  saphenous,  in  the 
fascia  lata,  carrying  along  two  additional  coverings,  the  sheath  of  the 
'emoral  vessels,  or  fascia  proper,  and  another  investment,  called  the 
:rihriform  fascia ;  next  curving  upward  over  Poupart's  ligament,  the 
hernia  becomes  fixed  beneath  the  superficial  fascia  and  skin.  Its  direc- 
tion being  therefore  doivnward,  then  forward,  and  then  upward,  the 
efforts  to  reduce  it  must  be  directed  in  the  reverse  order. 

The  fascia  of  the  leg  is  thickened  toward  the  ankle  joint  into  naiTow 
bands,  which  form  the  annular  ligaments. 

The  plantar  fascia  forms  strong  layers,  which  invest  the  tendons 
and  joints  of  the  foot  and  toes. 


.        CHAPTER  V. 

OF   THE   ARTERIES— ANGEIOLOGY. 


The  arteries  constitute  that  pait  of  the  circulating  system  whicji 
carries  the  blood  from  the  heart  to  all  parts  of  the  body.  They  are 
d<*nse,  cylindrical  tubes,  which  form  thej'  retain  when  emptied  of 


132 


ANATOMY, 


blood,  and  even  after  death,  from  which  ch-curastance  the  ancients 

regarded  them  as  au'-vessels.* 

x^he  aorta,  which  proceeds 
from  the  left  ventricle  of  the 
heart,  and  branches,  contain 
the  pm"e  or  arterial  blood,  and, 
with  the  veins  which  return 
this  blood  ag-ain  to  the  heait, 
constitute  the  greater  or  sys- 
temic circulation.  The  puZ- 
inonary  artery,  which  conveys 
the  venous  or  impure  blood  to 
the  lungs,  with  its  correspond- 
ing veins,  is  called  the  lesser  or 
pulmonary  circulation. 


The  iS'erves 
accompany  the 
Arteries  in'eve- 
ry  pan  of  ttf. 
svslem. 


Structure  of  Arteries. 
— Arteries  are  composed  of 
thi'ee  coats  :  the  external  is 
cellular,  or  areolo-fibrous  ;  the 
middle  is  muscular,  or,  rather, 
a  mixed  tissue  of  elastic  and 
conti-actile  fibres  ;  and  the  z«- 
ternal  is  nervous,  or  a  serous 
membrane,  thi'oughout  whose 
substance  are  ramified  the 
nerves  of  organic  life.  The 
outer  coat  is  firm  and  strong ; 
the  middle  is  thick  and  soft; 
and  the  internal  thin  and  pol- 
ished. 

ARTERIAL.    SYSTEM, 

Distribution  of  Arteries. — All  the  arteries  of  the  general  sys- 
tem are  branches  of  the  aorta,  which  divide  and  subdivide  to  their  final 
ramifications  in  the  capillaiy  system.  From  the  aorta  most  of  the 
branches  pass  off  at  right  angles,  which  moderates  the  impetus  of  the 
blood  ;  but  in  the  extremities  the  branches  leave  the  main  artery  at  an 
acute  angle,  w^hich  favors  the  most  rapid  circulation.  When  an  artery 
divides,  the  area  of  its  branches  is  always  greater  than  that  of  the  sin- 

*  The  term  angeiology  has  been  applied  to  the  vascular  system  ;  it  includes  the  blood- 
reseels,  arteries,  and  veins,  and  the  lymphatics. 


A  N  G  E 1 0  L  0  G  Y.  13S 

glo  trunk ;  and  the  combined  area  of  the  ulthnate  ramifications  of  all 
the  arteries  is  vastly  greater  than  that  of  the  aortic  trunk.  This  ar- 
rangement allows  a  more  quiet  motion  of  the  vital  current  in  the  ex- 
treme vessels,  where  decomposition  and  recomposition  of  structures 
are  effected.  All  the  arteries  are  invested  with  a  fibro-cellular  sheath, 
which  also  contains  their  accompanying  veins,  and  sometimes  a  nerve. 

LxTERCOMMUMCATioN  OF  Arteries. — In  all  parts  of  the  body  the 
arterial  tubes  communicate  with  each  other  by  branches  passing  be- 
tvv^een,  called  inosculations,  or  anastomoses.  These  connections  in- 
crease in  frequency  as  the  vessels  diminish  in  size,  so  that  their  final 
distribution  is  a  complete  circle  of  inosculations.  The  advantage  of 
this  provision  against  obstructions  which  are  most  liable  to  occur  in  the 
smaller  branches  is  obvious.  When  an  artery  is  divided,  or  its  cavity 
obliterated,  the  anastomosing  branches  above  enlarge  and  make  up  the 
loss  of  blood  by  a  collateral  circulation.  The  arteries  do  not  terminate 
directly  in  veins,  but  in  an  intermediate  system,  called  the  capillary, 
an  extremely  minute  network  of  vessels  and  nerves,  from  which  the 
veins  arise. 

THE    SYSTEMIC    ARTERIES. 

Aorta. — The  aorta  arises  from  the  left  ventricle  of  the  heart,  opposite 
the  articulation  of  the  fourth  costal  cartilage  with  the  sternum,  and  arches 
backward  and  to  the  left,  and  then  descends  on  the  left  side  of  the 
spine  to  the  fourth  lumbar  vertebra.  It  is  hence  divided  into  ascend- 
ing, arch,  and  descending,  the  descending  portion  being  subdivided  into 
thoracic  and  ahdominal.  At  ite  commencement  there  are  three  dilata- 
tions, called  its  sinus,  corresponding  with  the  three  semilunar  valves. 

The  coronary  arteries  ai'e  the  only  branches  given  off  by  the  ascend- 
ing aorta;  they  arise  just  behind  the  semilunar  valves,  pass  through 
the  grooves  betvveen  the  auricles  and  ventricles,  and  are  distributed  to 
the  substance  of  the  heart. 

Arteria  Innominata. — The  arteria  innominata  arises  from  the 
arch  of  the  aorta,  is  an  inch  and  a  half  in  length,  and  ascends  obliquely 
toward  the  right  side  in  front  of  the  ti-achea  ;  behind  the  right  sterno- 
clavicular joint  it  divides  into  the  right  carotid  and  right  subclavian. 

Common  Carotid  Arteries. — The  right  common  carotid  arises 
from  the  bifiarcation  of  the  innominata,  and  ascends  the  neck  perpen- 
dicularly to  the  upper  border  of  the  thyroid  cartilage,  where  it  divides 
into  the  external  and  internal  carotids.  The  left  arises  from  the  ai-ch. 
of  the  aorta,  ascends  the  neck,  and  divides  like  the  right. 


IH 


AN/  T  0  M  Y. 


Fi-.  71. 


Fig.  71  shows  the  relations  of  tho 
large  vessels  proceeding  from  the 
root  of  the  heart,  that  viscis  being 
removed.  1.  Ascending  aorta.  2. 
Arch.  3.  Thoracic  aorta.  4.  In- 
nominata ;  this  divides,  at  5,  into 
right  carotid,  which,  at  6,  subdi- 
vides into  external  and  internal 
carotid ;  and  7,  the  right  subcla- 
vian.     8.   Axillary.      9.   Brachial 

10.  Right   pneumogastric    nerve. 

11.  Left  carotid.  12.  Left  subcla- 
vian, 13.  Pulmonary.  14.  Left 
pulmor.ary.  15.  Flight  pulmonary. 
16.  Trachea.  17.  Right  bronchus. 
13.  Left  bronchus.  19,  19.  Pul- 
racnary  veins.  20.  Bronchial  ar- 
teries.   21.  Intercostal. 

External  Carotids. — 
Each  externa]  carotid,  pass- 
ing through  the  deep  por- 
tion of  the  parotid  gland, 
ascends  nearly  perpendicu- 
larly to  the  space  between 
the  neck  of  the  lower  jaw 
and  the  meatus  auditorius, 
where  it  divides  into  the 
temporal  and  internal  maxil- 
lary. It  gives  off  nine  branches ;  the  first  three  anteriorly,  the  next  three 
superiorly,  and  the  last  Xhrce posteriorly'.  1.  Superior  thyroid;  curves 
downward  to  the  th\Toid  gland,  where  it  is  distributed.  It  sends  a  liy- 
oid  branch  to  the  mu.scles  of  the  hyoid  bone,  and  superior  and  inferior 
laryngeal,  and  muscular  branches  to  the  larynx.  2.  Linguinal ;  ascends 
obliquely  to  the  under  surface  of  the  tongue,  running  forward  in  a 
Berpentine  direction  to  its  tip,  where  it  is  called  the  ranine  artery;  it 
gives  off  the  hyoid,  dorsalis  linguce,  and  sublingual  branches.  A 
branch  of  this  latter  branch  is  often  divided  in  cutting  the  fraenum 
linguse  in  tongue-tied  children.  3.  Facial;  this  arises  above  the  os 
hyoides,  and  descends  obliquely  to  the  submaxillaiy  gland,  where  it  is 
embedded :  it  then  curves  around  the  body  of  the  lower  jaw,  ascends 
to  the  angle  of  the  mouth,  and  thence  to  the  angle  of  the  eye,  giving 
off,  below  the  jaw,  inferior  palatine,  submaxillary,  submental,  and 
pterygoid  branches,  and  on  the  face  the  masseteric,  inferior  labial, 
inferior  coronary  superior  coronary,  and  lateralis  nasi  branches.  4. 
Mastoid ;   turns  downward   to  be  distributed   to   the  sterno-mastoid 


LARGE    CARDIAC    VESSELS. 


ANGEIOLDGY. 


185 


Fig.  72. 


muscle  and  lyirphatic  glands  of  the  neck.  5.  Occipital  passes  back- 
ward a  little  below  the  tacial,  forms  a  loop  with  the  hypo-glossal  nerve, 
and  13  disti'ibuted  upon  the  occiput,  anastomosing  freely  with  the  opposite 
occipital,  the  temporal,  and  auricular  arteries.  It  gives  off  the  inferior 
meningeal  to  the  dura  mater,  and  the  princeps  cervicis,  a  large  branch 
which  descends  the  neck  betw^een  the  complexus  and  semi-spinalis 
colli,  and  inosculates  with  the  deep  cervical  branch  of  the  subclavian. 
This  branch  establishes  an  important  collateral  circulation  between  the 
branches  of  the  carotid  and  subclavian,  after  the  ligatm-e  of  the  common 
carotid.  6.  Posterior  auricular ;  ames  above  the  level  of  the  digasti-ic 
and  stylo-hyoid  muscles,  and  ascends  belov/  the  parotid  gland,  to  be 
distributed,  by  two  branches,  to  the  external  ear  and  side  of  the  head, 
anastomosing  with  the  occipital  and  temporal.  It  sends  off  the  stylo- 
mastoid branch  to  the  tympanum  and  aquaeductus  Fallopii.  The  ante- 
rior arteries  of  the  ear  are  branches  of  the  temporal.  7.  Ascending 
pharyngeal ;  arises  near  the  external  carotid  bifurcation,  and  ascends 
to  the  base  of  the  skull,  where  it  divides  into  two  branches — meningeal, 
which,  passing  through  the  foramen  lacerum  posterius,  is  distributed 
to  the  dura  mater,  and  pharyngeal,  which  supplies  the  pharynx,  tonsils, 
and  Eustachian  tube.  8. 
Parotideans;  four  or  five 
branches  distributed  to  the 
parotid  gland  and  adjacent 
integuments.  9.  Transver- 
salis  facei ;  arises  from 
the  ti'unk  within  the  parotid 
gland,  crosses  the  masseter 
muscle,  and  is  distributed 
to  the  temporo-maxillary 
articulation,  and  muscles 
and  integuments  of  the  side 
of  the  face,  inosculating  with 
the  facial  and  infi-a-orbital. 

Fig.  72  is  a  plan  of  the  common 
carotids,  with  the  branches  of  the 
external.  1.  Common  carotid.  2. 
External  carotid.  3.  Internal  ca- 
rotid. 4.  Carotid  foramen  in  the 
petrous  ijortion  of  the  tempora. 
bone.  5.  Superior  thyroid.  6 
Lingual.  7.  Facial.  8.  Mastoid 
9.  Occipital.  10.  Posterior  aurio 
ular.     11.  Transver.se  facial.     12. 

Internal  maxillary.   13.  Temooral  _ 

,.      .  ,.  ,  1  CAEOTIDS    AND    BRANCHII 

14.  Ascending  pharyngeal 


186  ANATOMY. 

The  Temporal  Artery. — This  terminal  branch  of  the  external 
carotid  ascends  over  the  root  of  the  zygoma,  where  it  divides  into  two 
branches ;  1.  Anterior  temporal ;  distributed  over  the  front  of  the 
temple  and  arch  of  the  skull,  anastomosing  witn  its  fellow,  the  frontal 
and  supra-orbital.  2.  Posterior  tenqjoral ;  curves  upward  and  back- 
vrard,  inosculating  with  its  fellow,  the  occipital  and  posterior  auricular 
It  sends  off  three  branches — the  orbitar  to  the  palpebi'al  arteries,  the 
middle  temporal  to  the  temporal  muscle,  and  the  anterior  auricular  to 
the  ear. 

The  I>"ternal  Maxillary  Artery. — The  other  terminal  branch 
of  the  external  carotid  passes  inward  behind  the  neck  of  the  lower  jaw 
to  the  deep  structm'es  of  the  face.  Its  branches  ai'e  :  1.  Tympaniticj 
disti'ibuted  to  and  around  the  drum  of  the  ear,  passing  through  the 
glenoid  fissure.  2.  Inferior  dental ;  descends  to  the  dental  foramen, 
and  enters  the  canal  of  the  lower  jaw  with  the  dental  nerve.  It  sup- 
plies the  teeth  of  the  lower  jaw,  sending  small  branches  along  the 
canals  in  their  roots.  A  branch  also  emerges  at  the  mental  foramen 
and  anastomoses  with  the  facial  arteries.  3.  Meningea  media ;  passes 
through  the  foramen  spinosum  of  the  sphenoid  bone,  and  becomes  the 
middle  artery  of  the  dura  mater,  its  branches  ramifying  through  a  part 
of  that  membrane  and  the  bones  of  the  skull.  4.  Meningea  parva ; 
enters  the  cranium  through  the  foramen  ovale,  and  is  distributed  to  the 
dura  mater,  giving  off  a  twig  to  the  nasal  fossae  and  soft  palate.  5. 
Muscular  branches ;  disti'ibuted  to  the  muscies  of  the  maxillary  region. 

6.  Superior  dental;  descending,  winds  around  the  tuberosity  of  the 
upper  jaw,  and  gives  branches  to  the  back  teeth,  gums,  and  the  anti'um 

7.  Infra-orbital ;  enters  the  orbit  of  the  eye,  and  passes  along  the  infra- 
orbital canal,  sending  branches  to  the  orbit,  anti'um,  teeth  of  the  upper 
jaw,  and  integuments.  8.  Ptery go-palatine ;  a  small  branch  sent  to 
the  upper  part  of  the  pharynx  and  Eustachian  tube.  9.  Spheno- 
palatine, or  nasal ;  enters  the  upper  meatus  of  the  nose,  and  supplies 
the  mucous  membrane  of  its  septum  and  walls,  and  sphenoid  and 
ethmoid  cells.  10.  Posterior  j^alatitie ;  descends  along  the  posterior 
palatine  canal,  and  is  disti'ibuted  to  the  palate.  A  branch  called  Vidian, 
passes  backward  to  the  sheath  of  the  Vidian  nerve  and  Eustachian  tube. 

Internal  Carotid  Arteries. — From  the  bifm*cation  of  the  com- 
mon carotid,  each  internal  carotid  curves  slightly  outward,  then  ascends 
nearly  perpendicularly  tlu'ough  the  maxillo-pharyngeal  space,  to  the 
carotid  foramen  in  the  os  petrosum.  It  nrxt  passes  irnvard  along  the 
carotid  canal,  forwcrd  by  the  sella  turcica  and  then  upward,  piercing 


ANGEIOLOGY.  137 

the  dura  tnater,  and  dividing  into  three  terminal  branches.  These  re- 
markable angular  curves  greatly  diminish  the  force  of  blood  thrown 
into  the  substance  of  the  brain.  The  cerebral  portion  of  the  artery 
gives  off  the  following  branches :  1 .  Ophthalmic ;  it  enters  the  orbit 
through  the  optic  foramen,  passes  to  the  inner  angle  of  the  eye,  and 
divides  into  two  groups  of  branches,  the  first  being  distributed  to  the 
orbit  and  surrounding  parts,  and  the  second  supplying  the  muscles  and 
globe  of  the  eye.  These  branches  are  named  from  their  distribution : 
Lachrymal,  supra-orbital,  posterior  ethmoidal,  anterior  ethmoidal,  pal- 
pebral, frontal,  nasal,  muscular,  anterior  ciliary,  short  ciliary,  long 
ciliary,  and  centralis  reiince.  2.  Tympanitic ;  this  enters  the  tym- 
panum through  a  small  foramen  in  the  carotid  canal.  3.  Anterior  me- 
ningeal ;  distributed  to  the  dvu-a  mater  and  Casserian  ganglion.  4. 
Anterior  cerebral;  passes  forward  along  the  longitudinal  fissure  be- 
tween the  two  hemispheres  of  the  brain,  and  gives  branches  to  the 
optic  and  olfactory  nerves,  anterior  lobes,  third  ventricle,  corpus  callo- 
Bum,  and  inner  surface  of  the  hemispheres.  The  two  anterior  cere- 
bral arteries  are  connected  soon  after  their  origin ;  the  anastomosing 
ti'unk  is  called  the  anterior  communicating  artery.  4.  JMiddle  cerebral; 
passes  outward  along  the  fissure  of'Sylvius,  and  divides  into  three 
branches,  which  supply  the  anterior  and  middle  lobes  of  the  brain,  and 
the  corpus  sti'iatum.  5.  Posterior  communicating ;  passes  backward, 
and  inosculates  with  the  posterior  cerebral.  6.  Choroidean ;  a  small 
branch  sent  off  to  the  choroid  plexus,  and  walls  off  the  middle  cornua. 

The  Subclavian  Arteries. — The  right  arises  from  the  innomi- 
nata,  and  the  left  from  the  arch  of  the  aorta.  Each  emerges  from  th'^ 
chest  by  passing  over  the  first  rib  between  the  anterior  and  middle 
Bcaleni  muscles.  Its  primary  branches  are  five,  most  of  which  are 
given  off  before  it  arrives  at  the  upper  rib.  The  first  three  ascend ; 
the  remaining  two  descend.  1.  Vertebral;  this  is  its  largest  branch* 
it  passes  through  the  foramina  in  the  transverse  processes  of  all  the 
cervical  vertebrae,  except  the  lower,  and  enters  the  skull  through  the 
foramen  magnum  of  the  occipitis.  At  the  lower  border  of  the  pons 
Varolii  the  two  arteries  unite  to  form  the  basilir.  The  vertebral  and 
basilir  arteries  send  off  the  following  secondary  branches :  Lateral 
spinal,  to  the  spinal  cord  and  membranes ;  posterior  meningeal,  to  the 
dura  mater,  cerebellar  fossfe,  and  falx  cerebelli ;  anterior  spinal,  to  the 
spinal  cord ;  posterior  spinal,  to  the  spinal  cord ;  inferior  cerebellar,  to 
the  lower  surface  of  the  cerebellum  ;  transverse,  to  the  pons  Varolii 
and  adjacent  parts  of  the  Drain ;  superior  cerebellar,  to  the  upper  sur- 
face of  the  cerebellum;  and  posterior  cerebral,  to  the  posterior  lobea 


'.38 


ANATOMY. 


of  the  cerebrum.  A  remarkable  connection  of  arteries  at  the  base  of 
the  brain,  formed  by  the  interior  communicating  branch,  anterior  cere« 
brals,  and  internal  carotids  in  front,  and  by  the  posterior  communicat- 
ing, posterior  cerebrals,  and  basilir  behind,  is  called  the  circle  of  Willis. 


Fig.  73. 

Fig.  73  exhibits  the  communi- 
cation of  the  arteries  constituting 
the  circle  of  Willis.  1.  Vertebral 
arteries.  2.  The  two  anterior 
spinal  branches  united  to  form  a 
single  vessel.  3.  One  of  the  pos- 
terior spinal  arteries.  4.  Poste- 
rior meningeal.  5.  Inferior  ce- 
rebellar. 6.  Basilir,  giving  ofl 
transverse  branches  to  either 
side.  7.  Superior  cerebellar.  8. 
Posterior  cerebral.  9.  Posterior 
communicating  branch  of  the 
internal  carotid.  10.  Internal  ca- 
rotid, showing  its  curvature 
within  the  skull.  11.  Ophthal- 
mic, divided  across.  12.  Middle 
cerebral.  13.  Anterior  cerebral, 
connected  by,  14.  The  anterior 
communicating  artery. 

2.  Thyroid  axis ;  this 
is  a  short  ti'unk,  dividing 
soon  affcer  its  origin  into 
four  branches :  Inferior 
thyroid,  distributed  to  the 
thjToid  gland,  and  send- 
ing twigs  to  the  ti"achea, 
CIRCLE  OF  WILLIS.  laiynx,    and    oesophagus  ; 

supra-stapular,  distributed  to  the  muscles  on  the  upper  surface  of  the 
Bhoulder  blade,  sending  a  twig  to  the  trapezius ;  posterior  scapular^ 
passing  across  the  neck,  supplying  the  muscles  beliiud  the  scapula,  and 
giving  bmnches  to  those  of  the  neck ;  with  the  branches  of  the  exter- 
nal carotid,  subclavian,  and  axillary,  it  establishes  an  important  anasto- 
motic communication  ;  superficial  cervical,  disti'ibuted  to  the  deep 
muscles  and  glands  of  the  neck,  and  sending  twigs  through  the  inter- 
vertebral foramina  to  the  spinal  cord  and  m&mbranes.  3.  Profimda 
cervicis  ;  passes  backward  below  the  lower  cervical  vertebra,  and  then 
ascends  the  back  of  the  neck,  inosculating  with  branches  of  the  occi< 
pital  and  scapular.  4.  Superior  intercostal ;  descends  behind  the 
pleura  upon  the  necks  of  the  first  two  ribs,  supplying  their  spaces,  and 
inosculating  with  the  first  aortic  intercostal. 


ANGEIOLOGY. 


139 


SUBCLAVIAN    BRANCHES. 


Fig.  74  fihows  the  branches  of  the  right  sub- 
clavian. 1.  Innorainata.  2.  Right  carotid.  3. 
First  portion  of  the  subclavian.  4.  Its  second 
portion.  5.  Its  third  portion.  6.  Vertebral  ar- 
tery. 7.  Inferior  thyroid.  8.  Thyroid  axis.  9. 
Sup'U'ficialia  cervicis.  10.  Profunda  cervicis. 
II.  Posterior  scapula!'.  12.  Supra-scapular.  13. 
Internal  mammary.     14.  Superior  intercostal. 


5.  Internal  mammary  ;  descends  by 
the  side  of  the  sternum  to  the  dia- 
phragm, where  it  enters  the  sheath  of 
the  rectus,  and  inosculates  with  the 
epigastric ;  it  sends  off  the  following 
branches :  Anterior  intercostal,  to  the 
front  intercostal  muscles  ;  mammary, 
to  the  breasts ;  comes  nervi  iihrenica, 
which  accompanies  the  phrenic  nerve ; 
mediastinal  and  pericardiac,  to  the  mediastinum,  pericardium,  and  thy- 
mus gland  ;  and  jnusculo-phrenic,  to  the  diaphragm  and  intercostal 
spaces. 

The  Axillary  Arteries. — The  axillaries  curve  gently  through  the 
middle  of  the  armpit,  where  they  become  the  brachial.  Each  axillary 
gives  off  seven  branches :  1.  Thoracica  acromialis  ;  distributed  to  the 
pectoral  muscles  and  mammary  gland,  and  inosculating  with  the  supra- 
scapular. 2.  Superior  thoracic ;  disti-ibuted  with  the  preceding,  inos- 
culating with  the  intercostal  and  mammaiy.  3.  Inferior  thoracic ;  dis- 
tributed to  the  pectoralis  minor,  serratus  magnus,  and  subscapularis 
muscles,  and  axillary  and  mammary  glands,  inosculating  with  the  su- 
perior thoracic,  intercostal,  and  mammary.  4.  Thoracica  axillaris ; 
distributed  to  the  plexus  of  nerves  and  glands  in  the  armpit.  5.  Sub- 
scapular  ;  the  largest  branch ;  supplies  the  muscles  on  the  under  sur- 
face and  lower  border  of  the  shoulder  blade,  and  the  side  of  the  chest. 
A  branch,  called  dorsalis  scapulce,  is  sent  to  the  upper  side  of  the 
Bcnpula.  6.  Circumjlex  ;  these  wind  around  the  neck  of  the  humenis, 
and  supply  the  shoulder  joint.  7.  Posterior  circumjlex ;  a  larger  branch 
disti'ibuted  to  the  joint  and  deltoid  muscle. 

Brachial  Arteries. — Each  brachial  artery  extends  down  the  arm, 
from  the  lower  border  of  the  latissimus  dorsi  to  the  elbow,  where  it 
divides  into  the  radial  and  ulnar.  Along  the  arm  it  gives  off  four 
branches  :  1.  Superior  'profunda  ;  winds  around  the  humerus  between 
the  triceps  and  bone  and  inosculates  with  the  radial  recurrent;    tsendi? 


140 


ANATOMY". 


the  j?05^f rfor  «?'fzcu?rtr  to  the  elbow  johit.  2.  Inferior  pr of unda  ;  arisea 
from  the  middle  of  the  brachial,  descends  to  the  elbow  with  the  ulnar 
nerve,  and  inosculates  with  the  posterior  ulnar  recui'rent.  3.  Anasio- 
niotica  inagna  ;  arises  two  inches  above  the  elbow,  and  inosculates 
with  both  ulnar  recurrents  and  the  inferior  profunda.  4.  Muscular 
branches  ;  distributed  to  the  muscles  along  its  course,  viz.,  coraco-bra- 
chialis,  biceps,  deltoid,  brachialis  anticus,  and  tricrus 


ARTERIES    OF    FORE-ARM. 


The  Radial  Arteri  . — The  radial  di- 
vision of  the  brachial  runs  along  the  radial 
side  of  the  fore-arm  from  the  elbow  to  the 
wrist,  -svhere  it  turns  around  the  base  of  the 
thumb  beneath  its  extensor  tendons,  and 
passes  into  the  palm  of  the  hand.  It  then 
ci'osses  the  metacarpaj  bones  to  the  ulnar 
side,  forming  the  deej)  paZmar  arch,  and 
terminates  by  inosculating  with  the  super- 
ficial palmar  arch.  This  is  the  arteiy 
which,  from  its  superficial  position  above 
the  WTist  and  base  of  the  thumb,  is  select- 
ed for  "  examining  the  pulse."  Its  branches 
are  :  1.  To  the  fore-arju ;  the  recurrent  ra- 
dial and  muscular.  2.  To  the  wi'ist ;  su~ 
perficialis  voice.,  carpalis  anterior,  carpalis 
posterior,  metacarpalis,  and  dorsales  polli- 
ds.  3.  To  the  hand ;  yrinceps  pollicis, 
radialis  indicis,  interossece,  and  j^erforantes, 
disti'ibuted  as  their  names  import. 

The  arteries  of  the  forearm  are  sho^vn  in  Fig.  75. 
1.  Biceps  muscle.  2.  Inner  condyle  of  the  humerus. 
3.  Pronator  radii  teres.  4.  Supinator  longus.  5. 
Flexor  longus  pollicis.  6.  Pronator  quadratus.  7. 
Flexor  profundus  digitorum.  8.  Flexor  carpi  ulnaris. 
9.  Annular  ligament.  10.  Brachial  artery.  11.  Anas- 
tomotica  mngna.  12.  Radial.  13.  Radial  recunent. 
14.  Superficialis  volae.  15.  Ulnar.  16.  Its  superhcial 
palmar  arch.  17.  Magna  pollicis  and  radialis.  18. 
Posterior  ulnar  recurrent.  19.  Anterior  interosseous. 
20.  Posterior  interosseous. 


The  Ulnar  Artery. — The  ulnar  division  of  the  brachial  crosses 
the  arm  obliquely,  then  runs  down  the  ulnar  side  to  the  wrist,  crossing 
the  annular  ligament,  forming  the  superficial  palmar  arch,  and  termi- 
nating hy  inosculating  with  the  superficial  volae.     Its  branches  are  :  I. 


ANGEIOLOGY.  Ul 


To  the  fore-arm ;  anterioi  and  posterior  recurrent,  anterior  and  poste- 
rior interosseous,  and  muscular.  2.  To  the  wrist;  carpialis  anterior 
and  posterior.  3.  To  the  hand ;  digitales,  distributed  as  their  names 
import. 

The  Thoracic  Aorta. — In  the  cavity  of  the  chest  the  aorta  gives 
off  three  gi-oups  of  branches :  1.  Bronchial ;  four  in  number,  distrib- 
uted to  the  bronchial  glands  and  tubes ;  they  also  send  branches  to  the 
oesophagus,  pericardium,  and  left  auricle.  They  are  the  nutritive  ves- 
sels of  the  lungs.  2.  (Esophageal ;  numerous  small  branches  distrib- 
uted to  the  oesophagus,  and  making  a  chain  of  anastomoses  along  its 
course.  3.  Intercostal ;  nine  on  each  side,  arising  from  the  posterior 
part  of  the  aoita,  and  sent  to  the  nine  lower  intercostal  spaces,  where 
each  branch  gives  off  a  dorsal  branch ;  thus  dividing  into  spinal  and 
muscular  branches,  which  supply  the  spina  cord,  and  muscles  and  in- 
teguments of  the  back. 

The  Abdominal  Aorta. — In  the  abdominal  cavity  the  aorta  gives 
off  nine  primary  branches :  1.  Phrenic ;  these  are  given  off  imme- 
diately below  the  diaphragm.,  and  soon  divide  into  an  internal  branch, 
which  inosculat(^s  with  its  fellow  in  front  of  the  oesophageal  opening, 
and  an  external,  which  is  distributed  to  the  circumference  of  the  dia- 
phragm, and  sends  branches  to  the  supra-renal  capsules.  The  phrenic 
arteries  inosculate  with  branches  of  the  internal  mammaiy,  inferior  in- 
tercostal, epigastric,  oesophageal,  gastric,  hepatic,  and  supra-renal.  2. 
The  Cceliac  axis ;  this  is  a  single  ti-unk,  arising  just  above  the  first 
lumbar  vertebrje,  about  half  an  inch  in  length ;  it  divides  into  three 
large  brandies,  the  gastric,  hepatic,  ard  splenic. 

The  Gastric  artery  is  the  smallest  branch;  it  ascends  between  the 
two  layers  of  the  lesser  omentum  to  the  cardiac  orifice  of  the  stomach, 
to  be  distributed  to  the  lower  part  of  the  oesophagus  and  lesser  curve 
of  the  stomach.  It  inosculates  with  branches  of  the  hepatic  and 
splenic. 

The  Hepatic  branch  ascends  along  the  right  border  of  the  lesser 
omentum  to  the  liver,  where  it  divides  into  right  and  left  branches 
these  are  distributed  along  the  portal  canals  to  the  right  and  left  lobes. 
It  sends  a  pyloric  branch  to  the  lesser  curve  of  the  stomach  and  duo- 
denum ;  the  gastro-duodenaUs,  dividing  into  the  gastro-ejriploi'sa  dextra 
and  pancreatico-duodenalis,  which  are  distributed  to  the  greater  curve 
of  the  stomach,  pancreas,  and  duodenum ;  and  the  cystic,  which  is  dis- 
tributed to  the  gall-bladder.     The  gastric,  pyloric,  and  splen.c  branches 


142 


ANATOMY. 


inosculate  with  each  other,  and  with  branches  of  the  pancreas,  duode- 
num, jejunum,  and  mesenteiy. 


The  abdominal  aorta  is  3ho^vn  in 
Fig-  76.  Fig.  76,  with  its  branches.     1.  Phre- 

nic arteries.  2.  Coeliac  axis.  3. 
Gastric  artery.  4.  Hepatic.  5. 
Fplenic.  6.  Right  supra-renal.  7. 
Right  renal.  8.  Lumbar.  9.  Su- 
perior mesenteric.  10.  The  two 
spermatic.  11.  Inferior  mesenteric. 
\2.  Sacra  media.  13.  Common  lil- 
acs. 14.  Right  internal  iliac.  15. 
External  iliac.  16.  Epigastric.  17 
Circumflexa  ilii.     18.  Femoral. 


The  Splenic  artery  is  the 
largest  branch  of  the  ca-liac 
axis  ;  it  passes  horizontally 
to  the  left  along  the  upper 
border  of  the  pancreas,  and 
enters  the  spleen  by  five  or 
six  divisions,  which  are  dis- 
tributed to  its  structure.  In 
its  course  it  is  tortuous  and 
serpentine,  fi-equently  mak- 
ing a  complete  turn  upon 
itself.  It  is  accompanied  by 
the  splenic  vein,  and  splenic 
plexus  of  nerves.  It  sends 
oft'  numerous  small  branch- 
es, ^awcr6ai?C(^parr<j',  to  the 
pancreas ;  the  largest  follows 
the  pancreatic  duct,  and  is 
called  pancreaiica  magna ; 
several  branches,  vasa  brevia,  to  the  great  end  of  the  stomach,  to  which 
they  are  disti'ibuted,  inosculating  with  branches  of  the  gastric ;  and  the 
gastro-cpiploica  sinistra,  which  appears  to  be  the  continuation  of  the 
splenic  artery ;  it  passes  from  left  to  right  along  the  gi-eat  curve  of  the 
stomach,  and  inosculates  with  the  gasti'o-epiploica  dexln-a;  its  distribu- 
tion is  to  the  curve  of  the  stomach  and  great  omentum. 

3.  Superior  mesenteric ;  arises  behind  the  pancreas,  and  descends 
within  the  layers  of  the  mesentery  to  the  right  iliac  fossa.  Its  branches 
are  :  Vasa  intestini  tenuis ;  fifteen  or  twenty  branches,  distributed  to 
the  small  intestines.     Between  the  layers  of  the  mesentery  the  larger 


ABDOMINAL    BRANCHES. 


ANvJElOLOGT. 


148 


branches  inosculate  so  as  to  form  series  of  arches  ;  from  these  second- 
ary arches  ai*e  similarly  formed,  and  from  the  latter  a  third  series,  from 
which  branches  are  distributed  to  the  intestinal  coats.  Sometimes  a 
fourth  or  even  fifth  series  of  arches  is  produced.  lieo-colic  ;  descends 
to  the  right  iliac  fossa,  where  it  divides  into  branches,  which  form 
arches,  and  are  finally  distributed  to  the  ilium,  cascum,  and  colon. 
Colica  dextra ;  forms  arches,  from  which  branches  are  distributed  to 
the  ascending  colon.  Colica  media ;  distributed,  like  the  preceding,  to 
the  ti'ansverse  part  of  the  colon.  All  the  branches  of  the  superior 
mesenteric  inosculate  fi-eely  with  each  other. 


Fig.  77, 


Fig.  77  shows  the  course 
and  distribution  of  the  su- 
perior   mesenteric    artery. 

I.  Duodenum.  2.  Its  trans- 
verse portion.  3.  Pancreas. 
4.  Jejunum.  5.  Ileum.  6. 
CsBoum,  with  its  vermiform 
appendix.  7.  Ascending  co- 
lon. 8.  Its  transverse  por- 
tion. 9.  Commencement  of 
the  descending  colon.  10. 
Superior  mesenteric  artery. 

II.  Colica  media.  12.  The 
branch  inosculating  with  the 
colica  sinistra  13.  Branch 
of  the  superior  mesenteric 
inosculating  wi'.h  the  pan- 
creatico-duodenalis.  14.  Co- 
lica dextra.  15.  Ileo-coiica. 
16,  If).  Branches  from  the 
convexity  of  the  superior 
mesenteric  to  the  small  in- 
testines. 


4.  Sjyennatic ;  the 
spermatic  arteries  are 
two  small  vessels  aris- 
ing from  the  aorta  be- 
low the  mesenteric, 
and,  passing  obliquely 
outward,  accompany  the  uretei^s  along  the  front  of  the  psoas  muscle  to 
the  border  of  the  pelvis.  Each  spermatic  artery  is  then  directed  out- 
ward to  the  internal  abdominal  ring,  following  the  spermatic  cord,  with 
its  corresponding  veins  and  plexus  of  nerves,  through  the  scrotum  to 
the  testicle,  to  which  it  is  distributed.  In  the  female  they  descend 
iuto  the  pelvis,  and  pass  between  two  layers  of  the  broad  ligaments  of 


MESENTFRIC    DISTRIBUTION. 


144  ANATOMY. 


the  uterus,  to  be  disti'ibuted  to  the  ovaries,  Fallopian  tubes,  and  round 
ligaments,  inosculating  with  the  uterine  aiteries.  5.  Inferior  mesen- 
teric ;  arises  two  inches  below  the  superior  mesenteric,  and  descends 
to  the  left  iliac  fossa,  when  it  divides  into  the  colica  sinistra,  which  is 
distributed  to  the  descending  colon;  the  sigmoide-e,  several  branches 
sent  to  the  sigmoil  flexure  of  the  colon;  and  the  superior  hcemorrhoid- 
cdy  which  descends  to  the  rectum,  and  is  there  disti'ibuted.  6.  Supra- 
renal;  two  small  vessels  sent  to  the  supra-renal  capsules.  7.  Renal; 
two  large  trunks  given  otf  iramediatel}  below  the  superior  mesenteric ; 
they  divide  into  several  large  branches,  which  ai'e  minutely  ramified  in 
the  substance  of  the  kidneys.  8.  Lumbar;  four  or  five  branches 
curving  around  the  lumbar  vertebrae,  then,  dividing  into  branches,  dis- 
tributed to  the  vertebrae,  spinal  cord,  dorsal  and  abdominal  muscles. 
9.  Sacra  media  ;  arises  at  the  bifhrcation  of  the  aorta,  and,  descend- 
ing, inosculates  with  the  lateral  sacral  arteries,  sending  branches  to  the 
rectum  and  auterior  sacral  nerves. 

The  Common  Iliac  Arteries. — The  abdominal  aorta  divides  into 
the  two  common  iliacs  opposite  the  fourth  lumbar  vertebra.  They  are 
about  two  and  a  half  inches  long,  and  opposite  the  sacro-iliac  symphasia 
divide  into  the  internal  and  external  iliac. 

The  Internal  Iliac  Artery. — This  is  a  short  trunk,  from  one  to 
two  inches  in  length,  dividing  opposite  the  great  sacro-ischiatic  foram^ 
into  an  anterior  and  posterior  ti"unk.  The  branches  of  the  anterior 
trunk  are:  1.  Umbilical;  this  is  the  commencement  of  the  fibrous 
cord,  into  which  the  umbilical  artery  of  tlie  foetus  is  converted  after 
birth.  In  after  life  the  cord  remains  pervious  a  short  distance,  consti- 
tuting the  umbilical  artery  of  the  adult;  it  give.s  olf  the  superior  and 
middle  vesical,  and  middle  hoemorrhoidal  arteries  to  the  bladder,  vesi- 
culae  seminales,  prostate  gland,  and  rectum.  2.  Ischiatic ;  presses 
downward  to  the  lower  border  of  the  great  ischiatic  notch,  where  it 
emerges  from  the  pelvis,  then  passes  down  between  the  trochanter 
major  and  tuberosity  of  the  ischium,  in  company  with  the  ischiatic 
nerves,  where  it  divides  into  the  hoemorrhoidal,  distributed  to  the  rec- 
tum; inferior  vesical,  to  the  base  and  neck  of  the  bladder,  vesiculae 
seminales,  and  prostate  gland ;  coccygeal,  to  the  integuments  and  mus- 
cles  around  the  anus  and  coccyx ;  inferior  gluteal,  to  the  gluteus  maxi- 
mus ;  comes  nervi  ischiatici,  to  the  lower  part  of  the  thigh;  and  jnus- 
cuZar  branches,  which  supply  the  posterior  part  of  the  hip  and  thigh. 
2.  Internal  pudic  ;  passes  down  in  front  of  the  ischiatic,  emerges  from 
the  pelvis  through  the  gi-eat  sacio-ischiatic  foramen,  crosses  the  spine 


ANCtEIOLOGY.  J45 


of  the  ischium,  and  re-enters  the  pelvis  through  the  lesser  sacro-ischi- 
Rtic  foramen ;  it  then  crosses  the  internal  obturator  muscle  to  the  ramus 
of  the  ischium,  ascends  the  ramus,  and  at  the  symphysis  enters  the 
deep  perineal  fascia,  finally  reaching  the  dorsum  of  the  penis,  along 
which  it  runs,  much  diminished  in  size,  supplying  that  organ  under  the 
name  of  dorsalis  penis.  Within  the  pelvis  it  sends  branches  to  the 
bladder,  vesiculse  seminales,  prostate  gland,  and  rectum.  Externally  to 
the  pelvis  it  gives  off  the  external  hcemorrlioidal  to  the  muscles  and  in- 
teguments of  the  anus  and  perineum ;  sivperjicialis  perinei,  to  the 
scrotum  and  perineum  ;  bulbosa,  to  the  corpus  spongiosum  of  the 
penis;  corposis  cavernosi,  to  the  corpus  cavernosum;  and  f/or,9a^,  dis- 
tributed to  the  body  of  the  penis. 

In  the  female  the  internal  pudic  is  smaller ;  its  distribution  is  the 
same  in  principle  to  the  corresponding  organs.  The  uterine  and  vaginal 
arteries  are  derived  from  the  internal  iliac,  umbilical,  internal  pudic,  and 
ischiatic  arteries. 

The  branches  of  the  posterior  trunk  are :  J .  Ueo-lumbar ;  distrib- 
uted to  the  abdominal  muscles.  2.  Obturator ;  this  passes  from  the 
pelvis  through  the  obturator  foramen,  and  divides  into  internal  and  ex- 
ternal branches,  which  are  disti-ibuted  to  the  muscles  around  the  hip 
joint.  3.  Lateral  sacral;  two  in  number;  the  snj:)  erior  pnsses  through 
the  posterior  sacral  foramen,  and  is  distributed  to  the  spinal  canal  and 
sacral  integuments ;  the  inferior  supplies  the  sacral  nerves.  4.  Glu- 
teal ;  this  is  the  continuation  of  the  main  trunk ;  it  passes  through  the 
great  sacro-ischiatic  foramen,  and  divides  into  a  sujierjicial  branch, 
which  ramifies  in  the  gluteus  maximus  and  adjacent  integuments ;  a 
deep  superior  branch,  which  inosculates  with  the  circumflex  arteries ; 
and  deep  inferior  branches,  which  are  sent  to  the  gluteus  minimus  and 
capsule  of  the  hip  joint. 

The  External  Iliac. — The  external  iliac  of  each  s'de  passes 
obliquely  downward  along  the  inner  border  of  the  psoas  muscle,  from 
opposite  the  sacro-iliac  symphysis  to  the  femoral  arch,  where  it  be- 
comes the  femoral  artery.  It  is  surrounded  b}'  lymphatic  vessels  and 
glands  throughout  its  whole  course.  Its  branches  are  :  1.  Epigastric ; 
arises  near  Poupart's  ligament,  passes  forward  between  the  peritoneum 
and  transversalis  fascia,  ascends  obliquely  to  the  sheath  of  the  rectus, 
which  it  enters  and  passes  upward  behind  that  muscle.  It  is  disti'ib- 
uted  to  the  rectus,  inosculating  in  its  substance  with  the  internal  mam- 
mary. It  sends  a  cremasteric  branch  to  the  muscle  of  that  name,  and 
inosculating  branches  to  the  obturator  artery.  The  epigastric  artery 
fbiins  the  prominence  of  the  peritoneum,  which  divides  the  iliac  fossa 
T— 13 


146         •  ANATOMY. 


into  internal  and  external  portions,  from  the  former  of  which  direct 
inguinal  hernia  issues,  and  from  the  latter  oblique  inguinal  hernia.  2. 
Circumjlexa  ilii ;  arises  nearly  opposite  the  epigastric.  It  is  distrib- 
uted to  the  abdominal  muscles,  inosculating  with  the  inferior  intercostal 
and  lumbar. 

The  Femoral  Artery. — After  emerging  from  Poupart's  ligament 
the  external  iliac  enters  the  thigh,  and  takes  the  name  of  femoral.  It 
passes  down  the  inner  sid«  of  the  thigh  midway  between  the  anterior 
superior  spine  of  the  iliurL  and  the  symphysis  pubis,  to  the  opening  in 
the  adductor  magnus,  which  is  about  two  thirds  the  distance  to  the 
knee,  where  it  takes  the  name  of  popliteal.  Its  branches  are  :  1  Su- 
'perjicial  circumjlexa  ilii ;  to  the  integuments  of  the  groin  and  inguinal 
glands.  2.  Superficial  ejngastric ;  distributes  branches  to  the  groin, 
and  ascends  toward  the  umbilicus,  to  inosculate  with  branches  of  the 
epigastric  and  internal  mammary.  3.  Superficial  external  pudic ;  to 
the  penis  and  scrotum  in  the  male,  and  the  labia  in  the  female.  4 
Deep  external  pudic ;  to  the  scrotal  integuments  and  perineum.  5. 
Profunda ;  to  the  flexor  muscle  on  the  back  of  the  leg.  This  ariery 
which  arises  two  inches  below  Poupart's  ligament,  divides  into  the  ex- 
ternal circumflex,  which  supplies  the  muscles  on  the  front  and  outer 
side  of  the  thigh,  and  inosculates  with  the  gluteal  and  ischiatic ;  the 
internal  circumflex,  which  winds  around  the  inner  side  of  the  neck  of 
the  femur,  supplying  the  muscles  on  the  upper  and  inner  side  of  the 
thigh,  anastomosing  with  the  adjacent  vessels ;  and  the  perforating  ar- 
teries ;  three  branches,  distributed  to  the  posterior,  anterior,  and  flexo) 
muscles  of  the  thigh,  and  inosculating  fi-eely  with  the  surrounding 
branches  of  other  arteries.  These  anastomoses  maintain  the  cojlatera 
circulation  of  the  limb  after  ligature  of  the  femoral  arteiy.  6.  Mus- 
cular ;  given  oif  to  all  tl.e  suirounding  muscles.  7.  Anastomotica 
magna ;  this  runs  along  the  tendon  of  the  adductor  magnus  to  the 
inner  condy'e,  and  inosculates  with  the  arteries  ai'ound  the  knee  joint; 
some  of  the  branches  are  distributed  to  the  vastus  internus. 

The  Popliteal  Artery.—  This  continuation  of  the  femoral  passes 
obliquely  outward  to  the  lower  border  of  the  popliteal  muscle,  where 
it  divides  into  the  anterior  and  postoior  tibial.  Its  branches  are:  1 
Superior  articular ;  two  branches,  external  and  internal,  which  wino 
around  the  femur,  supplying  the  knee  joint  and  lower  part  of  ihe  fe- 
mur, anastomosing  with  each  other  and  the  adjacent  arteries.  2.  Azy- 
gos  articular ;  one  or  more  sent  to  the  interior  of  the  syno'v  ial  mem- 
.«rane.     3.  Inferior  articular ;  two   branches,   external  and  internal, 


ANGEIOLOGY.  147 


which  wind  around  the  head  of  the  tibia,  supply  the  knee  joint,  heads 
of  the  tibia  and  fibula,  and  anastomose  with  each  other  and  the  adjacent 
arteries.  4.  Crural ;  two  large  muscular  branches,  distributed  to  the 
two  heads  of  the  gasti'ocnemius. 

The  Anterior  Tibial  Artery. — This  runs  down  the  front  aspect 
of  the  leg  to  the  ankle  joint,  where  it  becomes  the  dorsalis  pedis.  Its 
branches  are:  1.  Recurrent;  disti'ibuted  to  the  knee  joint,  and  anasto- 
mosing with  the  articulai*.  2.  Muscular ;  numerous  branches  disti'ib 
uted  to  the  anterior  tibial  region.  3.  Malleolar ;  two  brandies,  ex 
ternal  and  internal,  distributed  to  the  ankle  joint,  and  anastomosing 
extensively  with  adjacent  arteries. 

The  Dorsalis  Pedis. — This  continuation  of  the  anterior  tibial  mns 
forward  along  the  tibial  side  of  the  upper  surface  of  the  foot,  from  the 
ankle  to  the  base  of  the  metatarsal  bone  of  the  great  toe,  where,  after 
sending  off  the  tarsea  branches  to  the  tarsal  articulations,  and  the  me- 
tatarsea,  which  form  an  arch  across  the  base  of  the  foot  and  bones, 
and  also  giving  off  the  interossea,  which  ai-e  distributed  to  tlie  dorsal 
interossei  muscles  and  toes,  it  divides  into  the  dorsalis  pollicis,  dis- 
ti'ibuted to  the  gi'eat  and  second  toes,  and  the  communicating,  which 
passes  to  the  sole  of  the  foot,  inosculating  with  the  external  plantar. 

The  Posterior  Tibial  Artery, — This  division  of  the  popliteal  pass 
es  obliquely  down  the  tibial  side  of  the  leg  to  the  concavity  of  the  os  cal 
cis,  where  it  divides  into  the  internal  and  exteriaal  plantar.  Its  brancher 
are :  1.  Peroneal ;  a  large  branch  ^iven  off  two  inches  below  the 
lower  border  of  the  popliteal  muscle ;  it  runs  downward  along  the 
inner  border  of  the  fibula  to  its  lower  third,  where  it  divides  into  an 
anterior  branch,  distributed  around  the  outer  malleolus,  and  a  posterior^ 
to  the  tarsus.  2.  Nutritious ;  to  the  nutritive  canal  of  the  tibia.  3. 
Muscular;  numerous  branches  sent  to  the  deep  muscles  of  the  leg. 
A  recurrent  branch  passes  up  and  anastomoses  with  the  articular  arte- 
ries. 4.  Internal  calcancan  ;  several  branches  sent  to  the  os  calcis  and 
integuments,  and  anastomosing  with  the  neighboring  arteries. 

The  Plantar  Arteries. — The  internal  proceeds  from  the  bifur- 
cation of  the  posterior  tibial,  along  the  inner  border  of  the  foot,  sup- 
plying that  part  and  the  gi'eat  toe.  The  external,  the  largest  division, 
passes  outward  to  the  fifth  metatarsal  space,  then  turns  horizontally 
inward  between  the  layeis  of  muscles  to  the  first  metatarsal  space, 
where  it  inosculates  with  the  communicating  branch  of  the  dorsalis 


148  ANATOMY. 

pedis.  It  sends  oft'  branches,  named  after  their  manner  of  distribution, 
muscular,  articular,  digital,  anterior  and  posterior  perforating,  which 
supply  the  various  structures  and  parts  of  the  foot,  and  form  numerous 
inosculating  connections  with  each  other 

THE    PULMONARY    ARTERY. 

The  pulmonary  artery  arises  from  the  left;  side  of  the  right  venti'icle 
in  front  of  the  origin  of  tlie  aorta ;  it  ascends  obliquely  to  the  under 
surface  of  the  aorta,  where  it  divides  into  the  right  and  left  puhnonary. 
In  its  course  upward  and  backward  it  crosses  the  commencement  of 
the  aorta,  to  which  it  is  connected  by  a  thick,  impervious  cord,  the  re- 
mains of  the  ductus  arteriosus. 

The  Right  Pulmonary  passes  beneath  the  ai'ch  and  behind  the 
ascending  aorta  to  the  root  of  the  lungs,  where  it  divides  into  three 
branches,  which  are  disti'ibuted  to  the  three  lobes  of  the  right  lung. 

The  Left  Pulmonary,  the  largest  division,  passes  in  front  of  the 
descending  aorta  to  the  root  of  the  left  lung,  to  which  it  is  disti'ibuted. 

These  arteries  divide  and  subdivide  in  the  substance  of  the  lungs, 
and  finauy  terminate  in  a  network  of  capillary  vessels  around  the  air 
ceUs  and  intercellular  passages. 


CHAPTER  VI. 

OF   THE   VEINS— ANGEIOLOGY. 


The  veins  are  the  vessels  which  return  the  blood  to  the  heart,  after 
it  has  been  circulated  thi'ough  the  vai'ious  stnictures  of  the  body  by 
the  arteries.  They  are  thinner  than  the  arteries,  and  collapse  and  flat- 
ten on  becoming  empty. 

In  tRe  systemic  circulation  the  veins  convey  the  dark-colored  blood 
fi'om  the  capillaries  to  the  right  auricle  of  the  heart.  The  veins  of  the 
pulmonary  circulation  correspond  to  the  arteries  of  the  systemic  circu- 
lation, as  they  convey  the  pure  red  blood  from  the  capillaries  of  tho 
lungs  to  the  left  auricle. 

Veins  originate  bj''  minute  radicles  in  all  the  textures  of  the  body, 
and  converge  to  larger  ti'unks,  the  sum  of  the  radicles  being  larger 
than  tliat  of  the  main  ti-unk ;  hence  the  blood,  in  returning  to  the 
heart,  pjisses  from  a  larger  to  a  smaller  channel,  which  increases  its 
rapidity  of  motion. 


ANGEIOLOGY. 


149 


Structure   or  Veiiss. — Like  the  arteries,  the  veins  have  three 
coats.     The  external  is  cellular,  or  areolar ;  the  middle  is  fibrous,  or 

Fig.  78. 


muscular  ;  and  the  internal  is  nervo- 
serous.  The  tniddle  coat  consists 
of  an  outer  layer  of  circular  fibres., 
am  an  inner  layer  of  longitudinal 
organic  muscular  fibres.  The  inner 
coat  is  probably  a  continuation  of  the 
inner  coats  of  arteries.  The  differ- 
ences between  the  structures  of  ar- 
teries and  veins  is  the  thinness  and 
inelasticity  of  the  veins,  and  the  ex- 
istence of  valves  in  them.  These 
valves  are  generally  semilunar  fibrous 
flaps,  arranged  in  pairs,  one  on  each 
side  of  the  vessel ;  sometimes,  how- 
ever, there  is  a  single  spiral  flap,  and 
occasionally  three.  The  free  border 
of  the  valvular  flaps  is  concave,  and 
directed  forward,  allowing  a  free 
current  toward  the  heart,  but  pre- 
venting a  reti-ograde  motion.  The 
valves  are  most  numerous  in  the 
veins  of  the  extremities ;  they  are 
generally  absent  in  very  small  veins, 
in  the  portal  and  cerebral  veins,  and 
those  of  the  viscera ;  they  are  also 
absent  in  the  large  ti'unks,  as  the 
cavsB,  azygos,  innominata,  and  iliac. 

Veins  are  divided  into  superficial, 
deep,  and  sinuses.  The  sinuses  are 
excavations  in  the  structure  of  an 
grgan,  and  lined  by  the  internal  coat 
of  the  veins.  The  principal  are 
those  of  the  dura  mater,  the  diploe,  the  canalous  structure  of  bones, 
and  the  uterus. 


THE    VENOUS    SYSTEM. 


Veins  of  the  Head. — The  venous  blood  from  the  face  and  exterior 
of  the  head  is  principally  collected  by  veins  which  accompany  the  ar- 
teries, and    have   the   same    names.      The    principal   trunks   are :    1 
Facial ;  descends  along  the  middle  of  the  forehead,  passes  downward 
by  the  side  of  the  root  of  the  nose,  and  continues  beneath  the  zj'-go- 


150  ANATOMY. 


matic  muscles,  receiving  the  supra-orbital,  nasal,  ophthalmic,  alveolar^ 
and  palj^ebral  branches,  and  finally  terminating  in  the  internal  jugular. 
2.  Internal  maxillary ;  receives  the  branches  from  the  zygomatic  and 
pterygoid  fossae,  and  joins  with  the  temporal  behind  the  neck  of  the 
lower  jaw,  constituting  the  temporo-maxillary.  2.  Teynporo-maxillary ; 
passes  down  through  the  parotid  gland,  at  the  lower  border  of  which 
it  becomes  the  external  jugular,  receiving  in  its  com-se  the  anterior 
auricular,  masseteric,  transverse  facial^  and  parotid.  3.  Temporal ; 
descends  between  the  meatus  auditorius  externus  and  the  condyle  of 
the  lower  jaw,  and  unites  with  the  internal  maxillary.  4.  Occipital ; 
follows  the  occipital  artery,  and  terminates  in  the  internal  jugular. 

Veins  or  the  Diploe. — The  venous  blood  of  the  bones  of  the 
head  is  received  from  the  cellular  capillaries,  which  terminate  exter- 
nally in  the  veins  of  the  pericranium,  and  internally  in  the  veins  and 
sinuses  of  the  dura  mater. 

Veins  of  the  Cerebrum  and  Cerebellum. — The  superficial 
cerebral  are  situated  on  the  surface  of  the  hemispheres,  lying  in 
grooves  formed  by  the  convexities  of  their  convolutions.  The  superior 
terminate  in  the  superior  longitudinal  sinus.  The  deep  commence 
within  the  lateral  ventricles,  and  unite  to  form  the  venee  galeni,  which, 
escaping  through  an  opening,  called  the  fissure  of  Bichat,  terminates 
in  the  straight  sinus. 

The  cerebellar  are  disposed  like  the  cerebral,  and  terminate  in  the 
lateral  and  peti'osal  sinuses. 

Sinuses  of  the  Dura  Mater. — These  are  irregular  channels, 
formed  by  a  splitting  of  the  layers  of  the  membrane,  which  are  lined 
by  a  continuation  of  the  inner  coat  of  the  veins.  The  principal  are : 
1.  Superior  longitudinal ;  attached  to  the  falx  cerebri ;  it  extends 
along  the  middle  line  of  the  arch  of  the  skull  to  the  occipital  bone, 
where  it  divides  into  the  lateral  sinuses.  Its  termination  forms  a  dila- 
tation, called  torcular  Herophili,  which  is  the  point  of  communication 
of  the  six  sinuses,  the  superior  longitudinal,  two  lateral,  two  occipital, 
and  the  straight.  2.  Inferior  longitudinal ;  situated  in  the  lower  free 
mai'gin  of  the  falx  cerebri,  terminating  in  the  straight  sinus.  3. 
Straight :  extends  across  the  tentorium,  from  the  inferior  longitudinal 
to  the  torcular  Herophili.  4.  Occipiial  ;  two  canals  commencing 
around  the  foramen  magnum,  and  terminating  in  the  torcular  Hero- 
phili. 5.  Lateral ;  these  commence  at  the  torcular  Herophi  i,  and 
terminate  in  the  internal  jugulars. 


ANGEIOLOGY. 


15' 


Fig.  79. 


Fig.  79  represents  a  part  of 
the  sinuses  of  the  dura  mater. 
1.  Superior  longitudinal  si- 
nus. 2,  2.  Entrance  of  veins 
of  the  pia  mater.  3.  Falx 
cerebri.  4.  Inferior  longitu- 
dinal sinus.  5.  Straight  or 
fourth  sinus.  6.  Vense  Ga- 
leni.  7.  Torcular  Herophili. 
8.  Lateral  sinuses.  9.  Infe- 
rior petrosal  sinus.  10,  11. 
[nternal  jugular  veins. 


Sinuses  of  the  Base 
OF  THE  Skull. — These 
are  five  iu  number :  1. 
Cavernous ;  situated  on 
each  side  of  the  sella 
turcica,  receiving  the 
ophthalmic    veins,    and  «^^^«^«  °^  ^"^  ^^^^^'- 

terminating  in  the  inferior  petrosal.  2.  Inferior  j^ietrosal ;  terminates  in 
the  internal  jugular  with  the  lateral.  3.  Circular  ;  surrounds  the  pitu- 
itary gland  in  the  sella  turcica,  communicating  on  each  side  with  the 
cavernous.  4.  Superior  petrosal ;  this  establishes  a  communication  be- 
tween the  cavernous  and  lateral  on  each  side.  5.  Transverse  ;  passes 
across  the  basilir  process  of  the  occipital,  forming  a  communication  with 
the  two  inferior  petrosal. 

Veins  of  the  Neck. — The  veins  which  return  the  blood  from  the 
head  are :  1.  External  jugular ;  descends  the  neck  fi-om  the  parotid 
gland,  in  a  line  drawn  from  the  angle  of  the  lower  jaw  to  the  middle 
of  the  clavicle,  crosses  the  sterno-m.astoid  muscle,  and  terminates  in  the 
subclavian.  2.  Anterior  jugular ;  this  collects  the  blood  from  the  su- 
perficial structures  of  the  neck,  and  opens  into  the  subclavian,  near  the 
preceding.  3.  Internal  jugular  ;  commences  at  the  foramen  lacerum 
posterius  on  each  side  of  the  base  of  the  skull,  and  descends  near  the 
carotids  to  the  root  of  the  neck,  where  it  unites  with  the  subclavian  to 
form  the  vena  innominata.  It  receives  facial,  lingual,  pharyngeal, 
occipital,  and  thyroid  branches.  4.  Vertehral ;  descends  by  the  side 
of  the  vertebral  artery  in  the  canal  of  the  ti'ansverse  cervical  processes, 
and  terminates  at  the  commencement  of  the  vena  innominata. 

Veins  of  the  Upper  Extremities. — These  are  divided  into  the 
deep,  which  accompany  the  arteries,  and  are  called  vents  comites,  and 
*Ae  superficial,  the  principal  branches  of  which  are  :  1.  Anterior  ulnar  • 


152  A  X  A  r  0  M  Y. 

running  up  the  inside  of  the  fore-arm  to  the  elbow,  where  it  becomes  tha 
basilic.  2.  Posterior  ulnar ,  ascends  the  back  of  the  hand  and  fore-arm, 
and  terminates  in  the  anterior  ulnai-  at  the  inner  condyle.  3.  Basilic  ; 
ascends  fi'om  tlie  common  ulnar  formed  by  the  t^vo  preceding,  along 
the  inner  side  of  the  arm  to  the  axilla,  where  it  becomes  the  axillaiy 
vein.  4.  Radial;  commences  in  the  large  vein  of  the  thumb,  ascends 
the  outer  border  of  the  fore-arm  to  the  elbow,  becoming  there  the 
cephalic.  5.  Cepnalic ;  ascends  t.ie  outer  side  of  the  ai'm,  and  ter- 
minates hi  the  subclavian  beneath  the  clavicle.  6.  ?ilediati ;  passes 
up  between  the  anterior  ulnar  and  radial :  at  the  elbow  it  receives  a 
branch  from  the  deep  veins,  and  divides  into  the  median  cephalic  and 
median  basilic.  7.  Median  cephalic ;  passes  outward  in  the  groove 
between  the  biceps  and  supinator  lougus  to  jo«in  the  cephalic.  8. 
Median  basilic;  passes  inward,  and  terminates  in  the  basilic.  The 
median  cephalic  and  median  basilic  branches  are  comraonly  selected 
for  the  operation  of  venesection,  or  bleeding,  by  which  that  "  minute 
insti-ument  of  mightj'  mischief" — ^the  lancet  of  the  surgeon — has  shed 
more  blood  in  the  civilized  world  than  has  the  sword  of  the  wai'rior ; 
in  both  cases  unfortunately  for  science  and  humanity. 

The  Axillary  Vein. — The  vens  comites  of  the  brachial  artery  and 
the  basilic  vein  unile  to  form  the  axiEaiy  vein,  which  becomes  the  sub- 
clavian at  the  lower  border  of  the  first  rib.  It  lies  in  front  of  the  axillary 
artery. 

Tke  Subclavian  Vein. — This  crosses  over  the  first  rib  beneath  the 
clavicle,  and  unites  with  the  internal  jugular  to  form  the  vena  innomi- 
nata.     It  lies  in  front  of  the  subclavian  artery. 

Veins  of  the  Lower  Extremities. — The  deep  veins  accompany 
the  arteries  in  pairs.  Near  the  knee  joint  the  anterior  and  j^osterio?- 
tibial  and  peroneal  veins  unite  to  form  the  popliteal,  which,  as  it 
ascends,  becomes  the  femoral,  and  then  the  external  iliac. 

iVie  Popliteal  Vein. — Ascending  through  the  popliteal  region  t 
receives  several  muscular  and  articiiar  branches,  and  the  exter7iau 
saphenous. 

The  Femoral  Vein. — This  vein  ascends  the  thigh  in  the  sheath  with 
the  artery,  and  on  entering  the  pelvis  becomes  the  external  iliac.  It 
receives  muscular  veins — the  profunda,  and  internal  saphenous. 

The  sapheno-^i  veins  collect  the  blood  from  the  foot  and  leg. 

Veins  of  'i^e  Trunk. — Of  these  there  are  seven  divisions:    1. 

Superior  vena  cava  and  its  fonnatii-e  oranchcs.  The  superior  cava  is 
a  short  trunk,  about  three  inches  in  length,  forived  by  the  junction  of 


ANGEIOLO  JY. 


153 


the  venae  innominatae.  It  descends  on  the  right  side  of  the  mediastinum, 
and  entering  the  pericardium,  terminates  in  the  upper  part  of  the  rio^ht 
auricle.  Its  branches  are  :  the  vence  innominatcs,  two  large  tiunka 
formed  by  the  union  of  the  internal  jugular  and  subclavian  at  each  side 
of  the  root  of  the  neck ;  the  right  vena  innominata  lies  externally  t^ 
ihe  arteria  innominata,  and  receives  the  right  lymphatic  duct,  right 
vertebral,  right  internal  mammary,  and  right  inferior  thyroid  veins;  the 
left  vena  innominata,  much  the  longest,  extends  across  the  roots  of  the 
tln-ee  gi-eat  arteries  arising  from  the  arch  of  the  aorta  \vhere  it  unites 
with  the  right  to  constitute  t^ie  superior  cava. 


Fig.  80  is  a  repi'esentation  of  the  principal  veins  of 
the  trunk  and  neck.  1.  Superior  cava.  2.  Left  in- 
nominata. 3.  Right  innominata.  4.  Pught  subclavian. 
5.  Interaal  jugular.  6.  External  jugular.  7.  Anterior 
jugular.  8.  Inferior  cava.  9.  External  iliac.  10.  In- 
ternal iliac.  11.  Common  iliac ;  the  small  vein  be- 
tween is  the  sacra  media.  12,  12.  Lumbar  veins.  13. 
Right  spermatic^l4.  Left  spermatic.  15.  Right  renal, 
IG.  Trunk  of  the  hepatic  veins.  17.  Greater  azygos 
18.  Lesser  azygos.  19.  A  branch  communicating  witL 
the  left  renal.  20.  Termination  of  the  lesser  in  the 
greater  azygos.  21.  Superior  intercostal,  communi- 
cating below  with  the  lesser  azj'gos,  and  above  in  the 
left  innomrnata. 


2.  Inferior  vena  cava,  and  its  formative 
branches.  The  inferior  cava  is  formed  by 
the  union  of  the  common  iliac  veins  between 
the  fourth  and  fifth  lumbar  vertebrae,  ascends 
along  the  front  of  the  spine,  on  the  right 
of  the  aorta,  passes  through  the  fissm'e  in 
the  back  side  of  the  liver,  and  the  opening 
in  the  middle  of  the  diaplu'agm,  to  the  right 
auricle.  It  receives  as  branches :  1.  The 
iliac  veins,  external  and  internal,  which 
commence  in  the  pelvic  cavity,  and  passing 
upward  along  its  brim,  terminate  opposite 
the  sacro-iliac  symphisis,  by  uniting  together 
to  form  the  common  iliac  vein.  2.  The  com- 
mon  iliac  receives  the  epigastric  and  circuni- 
jiexa  ilii  immediately  above  Poupart's  liga- 
ment; the  lionbar  veins  from  the  loins  ;  the 
ri/xht  spermatic  from  the  venous  plexus  ni 
the    spermat'c    cord — in    the    female   the 


Fig.  80. 


OF    THE    TRUNK    ANB 
NKCK 


154  ANATOMY. 

ovarian^  from  the  ovai'ies,  round  ligaments,  and  Fallopian  tubes ;  the 
renal,  or  emulgent,  from  the  kidneys — the  left  spermatic  vein  is  re- 
ceived by  the  left  renal — and  the  supra-renal,  phrenic,  and  hepatic  from 
the  ramifications  of  the  renal  and  phrenic  aiteries  and  the  liver.  3. 
Azygos  veins ;  these  comprise  the  rena  azygos  major,  vena  azygos  mi- 
nor, and  superior  intercostal  vein,  which  form  a  communicating  system 
between  the  superior  and  inferior  cava,  and  return  the  blood  from  that 
part  of  the  ti-unk  in  which  the«e  vessels  are  deficient  on  account  of 
then-  connection  with  the  heart.  The  azygos  majc  commences  in  the 
lumbar  region,  passes  up  thi'ough  the  aortic  opening  in  the  diaphi-agm, 
and,  receiving  all  the  right  intercostal  veins,  terminates  in  the  superior 
cava.  The  azygos  minor  commences  on  the  left  side  of  the  lumbar 
region,  passes  beneath  the  border  of  the  diaphi-agm,  and  receiving  the 
SIX  or  seven  lower  left  intercostal  veins,  terminates  in  the  azygos  major. 
The  superior  intercostal  is  the  trunk  formed  by  the  union  of  the  five  or  six 
upper  mtercostal  veins  of  the  left  side.  4.  Vertebral  and  spinal  veins. 
The  plexuses  of  the  veins  of  the  vertebral  column  and  spjpal  cord  ai-e 
numerous,  and  may  be  gi'ouped  into  the  dorsi-spinal,  which  receive 
the  returning  blood  from  the  doi*sal  muscles  and  surrounding  structures ; 
the  meningeo-rachidian,  which  form  two  longitudinal  trunks  extending 
the  whole  length  of  the  vertebral  column,  pouring  their  blood  into  the 
sacral,  lumbar,  vertebral,  and  intercostal  veins ;  and  the  medulli-spinal. 
which  receive  the  blood  from  the  membranes  of  the  spinal  maiTOw. 
5.  Cardiac  veins.  The  veins  returning  the  blood  fr-om  the  substance 
of  the  heart  are  named,  according  to  their  situation  and  size,  the  grea 
cardiac,  or  coronary,  anterior  and  posterior  cardiac,  and  verne  Thehesii. 

The  Portal  System. — The  veins  which  retm'n  the  blood  from  the 
chylopoietic  viscera  constitute  the  portal  system.  There  are  four  of 
them :  1.  Inferior  mesenteric ;  this  receives  the  blood  from  the  rectum 
by  means  of  the  hemorrhoidal  veins,  fi*om  the  sigmoid  flexm'e  and  de- 
scending colon,  and  terminates  in  the  splenic.  2.  Superior  mesenteric ; 
formed  by  branches,  which  collect  the  blood  from  the  ramifications  of 
the  superior  mesenteric  artery  ;  it  unites  with  the  splenic  in  the  forma- 
tion of  the  portal  vein.  3.  Splenic ;  arises  fr-om  the  spleen  in  several 
large  tranks,  passes  horizontally  behind  the  pancreas,  and  unites  with 
the  superior  mesenteric,  receiving  in  its  course  the  gastric,  pancreatic, 
and  inferior  mesenteric  veins.  4.  Gastric ;  the  gastric  veins  con'es- 
pond  with  the  gasti'ic,  gasti-o-epiploic,  and  vasa  brevia  arteries,  and  ter- 
minate in  the  splenic  vein. 

The  Vena  Pori^. — The  portal  vein  '3  formed  by  tJie  union  of  the 


ANGEIOLOGY. 


155 


splenic  and  superior  mesenteric  veins  behind  the  pancreas,  ascends  to 
the  transverse  fissure  of  the  liver,  where  it  divides  into  two  branches, 
one  of  which  is  sent  to  each  lateral  lobe  of  that  viscus ;  each  prim- 
ary branch   then   di-  Pig  g^^ 
vides   into    numerous 
secondary    branches. 
Within  the  liver  the 
portal    vein    receives 
the  venous  blood  from 
the  capillaries  of  the 
hepatic  artery. 

Fig.  81  shows  the  rela- 
tions of  the  vena  portae.  1. 
Inferior  mesenteric  vein  ; 
the  dotted  lines  trace  its 
course  behind  the  pancreas 
(2),  to  terminate  in  the 
splenic  vein  (3).  4.  The 
spleen.  5.  Gastric  veins 
opening  into  the  splenic. 
6.  Superior  mesenteric.  7. 
Descending  portion  of  the 
duodenum.  8  Its  trans- 
verse portion.  9.  Portal 
vein.  10.  Hepatic  artery. 
11.  The  ductus  communis 
choledochus.  12.  The  di- 
vision of  the  duct  and  ves- 
sels at  the  transverse  fis- 
sure of  the  liver.  13.  The 
cystic  duct  leading  to  the 
gall  bladder. 


THE    PORTAL    VEIN. 


Pulmonary  Veins. — The  veins  which  return  the  arterial  blood 
from  the  lungs  to  the  left  am'icle  of  the  heart  are  four  in  number. 
They  differ  from  veins  in  general,  in  being  but  little  larger  than  their 
corresponding  arteries,  and  in  accompanying  singly  each  branch  of  the 
pulmonaiy  artery.  The  right  pubnonary  veins  pass  behind  the  supe- 
rior cava,  and  the  left  behind  the  pulmonary  artery,  to  the  left  auricle. 


CHAPTER  VIL 

OF  THE   LYMPHATICS— ANGEIOLOGY. 

The  lymphatic  vessels  constitute  what  is  called  the  absorbent  system. 
They  are  named  from  the  lymph,  or  watsr-like  fluid,  which  they  coeu 


156 


ANATOMY. 


vey.     They  are  minute  transparent  vessels,  uniform  in  size,  having 
numerous  valves,  which  give  t^^em  a  knotted  appearance,  and  before 


Fig.  82. 


CYMPHATi:    SYSTEM 


entering  a  gland  di- 
vide into  several 
branches.  Their  of- 
fice is  to  collect  the 
nutritive  products  of 
digestion  from  the 
alimentary  canal, and 
the  effete,  disorgan- 
ized matter  from  all 
parts  of  the  body, 
and  convey  them  in- 
to the  venous  blood 
near  the  heart. 

Lymphatic  vessels 
originate  in  a  deli- 
cate network  distrib- 
uted throughout  the 
skin,  the  various  sur 
faces  and  interna) 
structures  of  organs, 
and  proceed  in  near- 
ly straight  lines  to 
ward  the  root  of  the 
neck.  They  are  in 
tercepted  in  their 
course  by  numerous 
oblong,  flattened  bo- 
dies, called  b/mjjJia- 
tic  glands,  The  ves- 
sels entering  these 
glands  are  called  va- 
sa  infer  en  fia,  and 
those  which  leave 
them  vasa  effercn- 
tia.  These  divisions 
of  the  lymphatics 
subdivide  just  before 
entering  and  just 
after  leaving  th® 
fflands. 


vNGElOLOGF.  167 

Though  lymphatic  vessels  are  generally  distributed  throughout  the 
tissues — probably  all  the  tissues — yet  they  have  never  been  detected  m 
the  brain,  spinal  cord,  eye,  bones,  cartilages,  tendons,  membranes  of 
the  ovum,  umbilical  cord,  and  placenta. 

Like  arteries  and  veins,  they  are  composed  of  three  coats.  Vi.as- 
tomoses  between  them  occur,  though  less  frequently  than  w^ith  arteries 
and  veins.  They  are  smallest  in  the  neck,  lai'ger  in  the  upper,  and 
still  larger  in  the  lower  extremities. 

The  valves  of  lymphatic  vessels  give  them  a  knotty  or  consti-icted 
appearance  similar  to  that  of  the  veins ;  near  the  ghands  the  valves 
are  most  numerous.  The  presence  of  valves  is  marked  by  two  small 
dilatations,  or  pouches,  analogous  to  the  valvular  sinuses  of  the  veins. 
These  sinuses  are  always  on  the  side  of  the  valves  toward  the 
heart. 

Lymphatic  glands  are  composed  of  a  minute  plexus  of  lymphatic 
vessels,  intimately  connected  with  a  plexus  of  blood-vessels,  and  en- 
closed in  a  thin  capsule  of  cellulai*  tissue.  In  their  internal  substance 
numerous  convolutions  are  formed  by  the  lymphatic  vessels.  In  form 
they  are  small,  oval,  somewhat  flattened  or  rounded  bodies,  termed 
conglobate,  or  absorbent,  presenting^a  lobulated  appearance  on  the  sur- 
face, while  the  face  of  a  section  appears  cellular,  from  the  division  of 
the  numberless  convolutions  which  are  formgd  by  the  lymphatic  vessels 
within  its  substance.  These  glands  are  larger  in  young  persons  than 
m  the  adult,  and  smallest  in  old  age. 

The  lacteals  are  the  lymphatic  vessels  of  the  small  intestines,  which 
convey  the  milk-like  fluid,  caDed  chyle,  to  the  thoracic  duct.  These 
are  the  nutritive  absorbents,  and  in  their  course  pass  through  the  nu- 
merous glands  of- the  mesentery. 

The  siqjerjicial  lymjyhatlc  vessels  follow  the  course  of  the  veins, 
passing  through  the  deep  fascia  in  convenient  situations  to  join  the 
deep  lymphatics. 

The  superficial  lymphatic  glands  are  placed  in  the  most  protected 
situations  of  the  superficial  fascia,  as  in  the  hollow  of  the  ham  and 
groin,  and  on  the  inner  side  of  the  arm. 

The  deep  lymphatics  accompany  the  deep  veins ;  those  from  the 
lower  part  of  the  body  converging  to  the  glands  around  the  inferior 
vena  cava,  and  terminating  in  the  thoracic  duct.  From  the  upper 
part  of  the  trunk  of  the  body  on  the  left  side,  and  from  the  left  side  of 
the  head  and  neck,  they  also  proceed  to  the  thoracic  duct.  But  tbos«» 
on  the  right  side  of  the  head  and  neck,  right  arm,  and  right  side  of  the 
thorax,  form  a  distinct  duct,  which  terminates  at  the  junction  of  the 
right  subclavian  and  internal  jugulai  vems 


IfiB 


ANATOMY. 


Fig.  S3. 


Fig.  SS  exhibits  the  coerss  and  termin&tion  of  the 
tharacie  dact,  "L  Arck  of  the  aorta.  2.  Thoradc 
eorta.  3.  Abdam:;^  aorta  and  its  branches.  4. 
ArterJi  WynominAta,  tiividing  into  right  carotid  and 
right  gnbs^a-riazi.  S.  Left  carotid.  6.  Left  eubclarian. 
7.  Superior  cava,  formed  by  the  union  of  e,  the  tomb 
ismoniicatis?;  ssa-i  then  by  the  juncticn  (9)  of  the  inter- 
nal jugular  asd  Enbclavian  at  each  ride  10.  Greater 
azycos  Ttin.  11.  Termination  of  the  lesser  azy§os  in 
the  greater.  12.  Receptacuiiun  chyli ;  several  iymph- 
etic  tnmki'  are  seen  opeiing  into  it  13.  Thoracic 
"duct,  divided  opposite  the  middle  of  the  dorsal  verte- 
bras into  two  branches,  which  soon  reunite ;  the  cours« 
of  the  duct  behind  the  arch  of  the  aorta  and  left  sub- 
clavian artery  is  shown  by  a  dotted  line.  14.  The 
duct,  making  its  tnm  at  the  root  of  the  neck,  and 
receiving  several  lymphatic  trunks  before  terminaticg 
in  the  venous  circulation.  15.  Termination  of  the 
trank  cf  the  right  lymphatic  ducL 


The  Thoracic  Duct. — This  is  the 
centre  of  the  lymphatic  system.  It  com- 
mences in  the  abdomen  by  a  triangular 
dilatation,  called  receptaculum  chyli,  which 
is  situated  on  the  front  of  the  body  of  the 
second  lumbar  vertebra.  From  this  it  as- 
cends through  the  aortic  opening  of  the 
diaphragm  to  the  fourth  dorsal  vertebra, 
whf»re  it  inclines  to  the  left,  passes  behind 
the  arch  of  the  aorta,  ascends  by  the  side 
ot  the  aesophagus  to  tiie  root  of  the  neck» 
and  cuning  forward  and  downward  pwurs 
its  contents  into  the  venous  blood  at  the 
junction  of  the  left  subclavian  with  the  left 
mtemal  jugular  vein.  In  size  it  is  about  equal  to  the  diameter  of  a 
goose-quHl.  Its  termination  is  provided  with  valves  to  prevent  the 
admission  of  venous  blood.  It  receives  as  branches  four  or  five  large 
trunks,  which  unite  to  form  the  chylous  receptacle,  the  trunks  of  the 
lacteals.  a  larz?  trunk  from  the  liver :  also  branches  from  the  thoracic 
viscera  and  parieties,  and  trunks  from  t}ie  left  side  of  the  head,  neck, 
and  upi>er  extremity. 


If 


y 


A.1MPHATIC    CENTRE. 


The  Ductus  Ltmphaticus  Dexter. — This  is  a  short  trunk 
which  receives  the  lymphatic  vessels  from  the  right  side  of  the  head, 
neck,  right  arm,  right  lung,  right  side  of  the  chest,  and  some  branche» 
from  the  liver.     Like  the  thoracic  duct,  it  is  prorki&d  with  valves. 


ANGEIOLOGY  158 


where  it  discharges  its  contents  into  the  veins,  at  the  point  before 
mentioned. 

Lymphatics  of  the  Head  and  Neck. — The  principal  superficial 
glands  are  the  occipital,  posterior  auricular,  parotid,  zygomatic,  buccal, 
and  submaxillary,  situated  as  their  names  indicate,  and  the  cervical, 
extending  along  the  course  of  the  external  jngular  vein.  The  deep 
glands  are  numerous  and  large  around  the  internal  jugular  veins  and 
carotid  arteries,  extending  from  the  base  of  the  skull  to  the  root  of  the 
neck. 

The  superjicicd  vessels  are  disposed  in  occipital,  temporal  and  facial 
groups,  which  converge  to  the  deep  cervical,  parotid,  and  submaxillary 
glands.  The  deep  vessels  are  the  meningeal  and  cerebral,  which  pasa 
through  foramina  at  the  base  of  the  skull  to  terminate  in  the  deep 
cervical  glands. 

Lymphatics  of  the  Upper  Extremity. — The  superficial  glands 
are  few  and  small  in  the  arm  and  fore-arm.  The  principal  chain  of 
deep  glands  accompanies  the  brachial  artery.  The  axillary  glands 
are  large  and  numerous ;  a  small  chain  of  them  extends  along  the  lower 
border  of  the  large  pectoral  muscle  to  the  mammary  gland.  They  re- 
ceive the  lymphatics  of  the  integuments  of  the  chest  and  the  mam- 
mary gland. 

The  superfi^cial  vessels  commence  upon  the  fingers,  and  course  along 
the  fore-arm  to  the  elbow,  where  they  are  arranged  in  two  gi-oups, 
which  extend  upward  to  the  axillary  glands  of  the  armpit. 

The  deep  vessels  accompany  the  blood-vessels,  communicate  occa- 
sionally with  the  superficial,  and  enter  the  axillary  and  subclavian  glands 

Lymphatics  of  the  Lower  Extremity. — The  superficial  in- 
guinal glands  are  those  of  the  groin;  the  smallest  gi-oup  extends  along 
the  course  of  Poupart's  ligament,  and  receives  vessels  of  the  walls  of 
the  abdomen,  gluteal  'egion,  perineum,  and  genital  organs;  the  largest 
group  clusters  around  the  termination  of  the  internal  saphenous  vein, 
and  receives  the  vessels  of  the  lower  extremities.  The  deep  glands 
are  the  anterior  tibial,  popliteal,  deep  inguinal,  gluteal,  and  ischiatic, 
situated  in  the  regions  after  which  they  are  named. 

The  superfi.cial  vessels  are  divisible  into  an  internal  group,  commenc- 
ing on  the  dorsum  of  the  foot,  and  ascending  the  leg  along  the  interna) 
saphenous  vein  to  the  glands  oi'the  gi'oin,  and  an  external  gi'oup,  which 
commences  on  the  outer  side  of  the  foot  and  back  part  of  the  ankle, 
and  accompanies  the  external  saphenous  vein  to  the  popliteal  glands* 


160  ANATOMY. 


The  deep  vessels  follow  the  deep  veins  and  arteries,  and,  after  joining 
the  deep  inguinal  glands,  communicate  with  the  numerous  glands 
ai'ound  the  iliac  vessels. 

Most  of  the  efferent  lymphatics  from  the  superficial  inguinal  glands 
communicate  \vith  the  large  gland  in  the  femoral  ring,  by  which  a 
communication  is  established  between  the  lympliatics  of  the  trunk  and 
those  of  the  lower  exti'emity. 

Lymphatics  of  the  Trunk. — These  may  be  arranged  into  three 
groups  :  1.  Superficial ;  the  superficial  vessels  of  the  upper  part  of  the 
ti'unk  converge  to  the  axillary  glands,  and  to  those  at  the  root  of  the 
neck.  Those  of  the  lower  half  of  the  trunk,  gluteal  region,  perineum, 
and  external  organs  of  generation,  converge  to  the  upper  gi'oup  of  su- 
perficial inguinal  glands.  2.  Deep  ;  the  deep  glands  are  the  intercos- 
tal, situated  on  each  side  of  the  vertebral  column,  the  internal  mam- 
mary, in  the  intercostal  spaces  beside  the  internal  mammary  ai'teries, 
and  the  anterior  and  posterior  mediastiyial,  situated  about  the  large 
vessels  at  the  root  of  the  heart,  and  extending  along  the  course  of  the 
aorta  and  oesophagus  in  the  mediastinum,  communicating  with  the  deep 
cervical,  intercostal,  and  abdominal  glands ;  the  lumbar,  numerously  situ- 
ated around  the  common  iliac  vessels,  aorta,  and  vena  cava;  the  external 
iliac,  placed  around  the  external  iliac  vessels ;  the  internal  iliac,  located 
along  the  coui-se  of  the  internal  iliac  vessels,  and  the  sacral,  placed  on 
the  concave  surface  of  the  sacrum.  The  deep  vessels  of  the  thorax 
are  the  intercostal,  following  the  course  of  the  intercostal  arteries ; 
the  internal  mammary,  -which  commence  in  the  w^lls  of  the  abdo- 
men, and,  communicating  with  the  epigasti'ic,  ascend  to  the  root  of 
the  neck  ;  the  diaphragmatic,  which  pui-sue  the  direction  of  their  cor- 
responding veins.  The  deep  vessels  of  the  ahdomen  are  continued  up- 
ward from  the  thigh,  beneath  Poupart's  hgament,  and  along  the  exter- 
nal iliac  vessels  to  the  lumbar  glands,  receiving  in  their  course  the 
epigasti'ic,  circumflexa  ilii,  and  ilio-lumbar  vessels.  Those  fr")m  the 
walls  of  the  pelvis  and  from  the  gluteal,  ischiatic,  and  obturator  vessels, 
follow  the  coui-se  of  the  internal  iliac  arteries,  and  unite  with  the  lum- 
bar lymphatics ;  and  the  lumbal*  vessels,  after  receiving  all  the  lymph- 
atics from  the  lower  extremities,  pelvis,  and  loins,  terminate  by  several 
large  tiTinks  of  the  receptaculum  chyli.  3.  Visceral ;  the  lymphatic 
vessels  of  the  lungs  are  of  large  size,  distributed  thi-oughout  their 
textures  and  surfaces,  and  converge  to  the  numerous  glands  around 
the  roots  of  the  lungs  and  bifurcation  of  the  trachea.  These  bronchial 
glands  in  the  adult  are  3f  a  variable  brownish  tint,  and  in  old  ago  pre' 
sent  a  deep  blacR  v,oIor 


NEUROLOGY  161 


Those  of  Llie  heart  follow  the  course  of  its  blood-vessels  to  the  gknds 
around  the  arch  of  the  aorta,  and  to  the  bronchial  glands.  The  lymph.  - 
atic  vessels  of  the  liver  proceed  from  its  different  parts  to  the  glands, 
along  the  course  of  the  hepatic  artery  and  lesser  curve  of  the  stom- 
ach, mediastinal  glands,  to  those  situated  around  the  inferior  cava,  and 
to  the  lumbar  glands  ;  those  from  the  gall-bladder,  which  are  large,  n-nd 
form  a  remarkable  plexus,  enter  the  glands  in  the  right  border  of  the 
lesser  omentum. 

Those  of  the  spleen  and  pancreas  pass  through  the  splenic  glands, 
and  those  along  the  course  of  the  splenic  vein,  and  join  the  aortic  glands 
before  entering  the  thoracic  due'. 

Those  of  the  stomach  proceed  variously  to  the  glands  along  its  lesser 
and  gi'eater  curves,  and  to  the  splenic,  pyloric,  and  aortic  glands. 

The  lymphatics  of  the  small  intestines  are  of  two  kinds  :  those  which 
run  upon  the  surface  and  belong  to  their  structure,  and  those  Avhich 
commence  in  the  substance  of  the  mucous  membrane,  and  are  called 
'acteals.  Both  enter  the  mesenteric  glands.  Those  glands  are  situ- 
ated between  the  layers  of  the  mesentery,  in  the  meshes  formed  by 
the  superior  mesenteric  artery.  They  are  most  numerous  and  largest 
near  the  duodenum,  and  near  the  termination  of  the  ileum. 

The  lacteals  commence  by  tubular  mouths,  which  open  into  a  fine 
network,  situated  in  the  sub-mucous  tissue,  from  whence  they  proceed 
to  the  mesenteric  glands,  and  thence  to  the  thoracic  duct. 

Those  of  the  large  intestines  proceed  in  two  different  directions  :  the 
vessels  of  the  cascum,  ascending  and  transverse  colon,  traverse  their 
own  proper  glands,  and  then  enter  the  mesenteric,  and  those  of  the 
descending  colon  and  rectum  proceed  to  the  lumbar  glands. 

Those  of  the  kidneys  follow  the  blood-vessels  to  the  lumbar  glands, 
situated  around  the  aorta  and  inferior  cava ;  those  of  the  supra-rena! 
capsules,  which  are  very  large  and  numerous,  terminate  in  the  renal. 

Those  of  the  pelvic  viscera  terminate  in  the  sacral  and  lumbar 
glands. 


CHAPTER  VIIL 

OF   THE  NERVES— NEUROLOGY. 


The  nervous  system  may  be  divided  into  two  sub-systems — the 
cerebrospinal  and  the  organic.  Ths  former  comprises  th<3  brain, 
spinal  marrow,  the  nerves  of  sensation    and  the  nerves  of  motion;  the 


162 


ANATOMY. 


latter  embraces  the  nerves  and  ganglions  which  preside  over  the  de- 
rclopraent  and  functional  changes  of  the   body ;   this  division  of  the 
Pi„  g4  nervous  sti'ucture  has  been  called 

the  sympathetic,  ganglionic,  and, 
more  properly,  the  organic  sys- 
tem. This  system  is  essential  tt> 
animal  existence  ;  the  lowest  ani  • 
mals  are  destitute  of  the  cerebro- 
spinal sti'ucture. 

The  nervous  tissue  is  enclosed 
in  membranes,  or  sheaths,  and 
consists  of  two  pulpy  materials, 
one  of  which  is  of  a  white  color 
— the  medullary  substance,  and 
the  other  gray-colored- — ^the  cine- 
ritious  substance.  The  medul- 
lary structure  is  fibrous,  the  fibres 
being  looped  at  their  termina- 
tions, and  containing  a  centi'al 
stripe,  called  the  cylinder  axis  of 
Purkinje.  The  ciiieritious  ig 
more  vascular,  and  composed  of 
kidney-shaped  globules,  contain- 
ing a  vesicular  nucleus  with  a 
nucleolus.  These  globules  are 
soft,  and  of  a  yellow  or  brow^nish 
color. 

The  ganglions  iand  nervous 
centres  consist  of  a  mixture  of 
white  fibres  and  gray  globules. 
The  sheath  of  the  nerves  is  call- 
ed neurilemma,  and  the  enclosed 
matter  neurine.  The  trunks  of  nerves  frequently  interchange  ti-unks 
or  fasciculi,  forming  anastomoses ;  and  a  combination  of  these  anasto- 
moses into  a  network  forms  a  plexus. 

N'jmerous  small  elliptical  bodies,  attached  to  the  ulnar  and  digital 
nerves,  ai'e  called  Pacinian  corpuscles ;  these  have  no  terminal  loops, 
being  the  only  exception  to  the  general  rule. 

Microscopic  observation  makes  out  the  elements  of  the  nervous  sys- 
tem to  be,  white  nerve-fibros;  gray  nerve-fibres,  n^rve-cells,  and  nerve* 
granules. 


NERVOITS    SYSTEM. 


NEUROLOGY. 


lez 


Fig.  85  represents  the  microscopic  elements  of  the 
nervous  structure.  1.  Mode  of  termination  of  white 
nerve-fibres  in  loops  ;  three  ui  these  loops  are  simple, 
the  fourth  is  convoluted.  The  latter  is  i'ound  in  situ- 
ations where  a  high  degree  of  sensation  exists.  2.  A 
white  nerve-fibre  from  the  brain,  showing  the  vari- 
cose or  knotty  appearance  produced  by  traction  or 
pressure.  3.  A  white  nerve-fibre  enlarged  to  show 
its  structure,  a  tubular  envelope  and  a  contained  sub- 
stance— neurilemma  and  neurine.  4.  A  nerve-cell, 
showing  its  composition  of  a  granular-looking  cap- 
sule and  granular  contents.  5.  Its  nucleus  containing 
a  nucleolus.  6.  A  nerve-cell,  from  which  several 
processes  are  given  off;  it  contains  also  a  nucleated 
nucleus.     7.  Nerve-granules. 


Fig.  85, 


MINUTE   NEKVOUS   STRUCTURE. 


White  nerve-fibres  compose  most  of  the  brain,  spinal  cord,  and  cere- 
bro-spinal  nerves,  and  enter  into  the  structure  of  the  organic  system. 
They  terminate  in  the  various  internal  organs,  at  the  surface  of  the 
body,  and  in  the  substance  of  the  cerebro-spinal  axis,  by  forming  loops. 
In  size  they  vaiy  from  — -  to  — -  of  an  inch  in  diameter. 

''  -^  2000  1-4000 

Gray  nerve-fibres  are  smaller  in  diameter,  and  less  transparent. 
They  constitute  the  principal  part  of  the  organic  system,  and  are  also 
p'3isent  in  the  cerebro-spinal  nerves,  most  abundantly  in  those  of 
sensation. 

The  nerve-ceUs  vary  from  —^  to  -—  of  an  inch  in  diameter.     They 

•^  300  1250  *' 

are  composed  of  a  capsular  sheath,  containing  a  reddish-gray  gi'anular 
substance,  and  one  or  more  nuclei  and  nucleoli,  the  nucleus  being 
attached  to  the  sheath.  Nerve-cells  are  found  in  the  gray  substance 
of  the  brain  and  spinal  cord,  in  the  ganglions  of  the  cerebro-spinal 
nerves,  and  in  the  organic  nerves  and  their  ganglia.  From  the  circum- 
ference of  the  nerve-cells  arise  one  or  more  delicate  thread-like  pro- 
cesses, from  -^  to  j^^  of  an  inch  in  diameter,  which  are  the  origins 
of  the  gray  nerve-fibres. 

The  nerve-granules  exist  in  the  forms  of  minute  homogeneous  parti- 
cles, aggi-egated  particles,  and  nucleated  corpuscles,  varying  in  diameter 
between  —^  and  ^^^  of  an  inch.  They  serve  as  a  bond  of  connection 
between  the  fibres  and  cells  of  the  brain  and  spinal  cord,  and  enter  into 
the  various  ganglia. 

A  nerve  is  a  collection  of  nerve-fibres  into  small  bundles,  or  fascicuL 
each  fasciculus  being  invested  by  a  distinct  neurilemma.  Several  of 
these  fasciculi  are  again  collected  into  larger  bundles,  which  are  also 
enclosed  ni  a  separate  neurilemma ;  then  again  the  larger  fasciculi  are 
collected  into  a  grand  bundle,  which  is  enclosed  in  a  general  neurilem- 
ma, or  sheatb-  of  white  fibrous  tissue 


164  A  N'  A  T  0  M  Y. 


THE    BRAi:*f. 

The  braia  is  the  mass  of  nervous  substance  contained  within  the 
cranium.  It  is  divided  into  cerebrum,  cerehellum,  and  medulla  oblongata. 
Its  investing  membranes  are  called  dura  mater ^  arachnoid,  and  pia 
mater.    The  brain  and  its  membranes  together  constitute  the  cncephalon. 

Membranes  of  the  Brain. — The  external  covering  is  the  dura 
mater,  a  strong,  whitish  fibrous  membrane  which  adheres  to  the  inter- 
nal surface  of  the  cranium,  and  is  prolonged  into  the  spinal  column 
under  the  name  of  tlieca  vertebralis ;  but  there  it  is  not  adherent  to 
the  bones.  From  its  internal  surface  processes  extend  inward  to 
support  and  protect  different  parts  of  the  brain,  and  externally  other 
processes  for  sheaths  for  the  nerves  passing  out  of  the  skull  and  spinal 
column.  Its  internal  processes  are  the  falx  cerebri,  which  extends  ver- 
tically across  the  median  line  from  the  crista  galli  of  the  ethmoid  bone 
to  the  tentorium,  dividing  the  cerebrum  into  righ*  and  left  hemispheres  ; 
the  tentoriwn,  which  stretches  horizontally  across  the  cranium,  separat- 
ing the  cerebrum  fi"om  the  cerebellum ;  and  the  falx  cerebelli,  which 
divides  the  cerebellum  into  t^^o  lobes  or  hemispheres. 

The  arachnoid  membrane  is  the  middle  covering  and  the  serous 
membrane  of  the  cerebro-spinal  centre.  It  is  very  thin  and  transparent. 
It  surrounds  the  nerves  until  their  exit  fi'om  the  brain,  v\'here  it  is  re- 
flected back  upon  the  dura  mater.   It  does  not  enter  into  the  ventricles. 

The  pja  mater  s  the  internal  covering,  vascular,  consisting  of  innu- 
merable blood-vessels  held  together  by  a  thin  layer  of  cellular  tissue. 
It  invests  the  whole  brain  and  each  of  its  convolutions  by  extending 
thiough  all  the  fissures  between  them.  It  contains  usually  a  number 
of  small  gi-anulai*  bodies,  called  the  glandules  Pacchioni ;  these  are 
•arger  in  old  persons,  and  are  considered  by  some  anatomists  to  be  of 
morbid  origin.     The  pia  mater  is  the  nutiient  membrane  of  the  brain. 

The  Cerebrum. — The  cerebral  portion  of  the  brain  is  an  oval  mass 
divided  superiorly  into  two  hemispheres  by  the  great  longitudinal  fis- 
sure. Each  hemisphere  is  divided  on  its  under  surface  into  anterior, 
middle,  and  p>ostcrior  lobes.  The  anterior  rests  upon  the  roof  of  the 
orbit,  the  middle  is  received  into  the  middle  fossa  at  the  base  of  the 
skull,  and  the  posterior  is  supported  by  the  tentorium.  The  surface 
of  the  cerebrum  presents  a  number  of  slightly  convex  elevations,  con- 
stituting the  convolutions,  called  gyri,  which  are  separated  from  each 
other  by  sulci  or  fissures  of  various  depths.  The  interior  cerebral  sub- 
stance is  medullary,  and  the  exterior  cineritious  to  the  depth  of  one  of 
two  Imes 


NEUROLOGY. 


165 


Fig.  86. 


THE    BRAIX    EXPOSED. 


The  externa]  surface  of  the  oerebrum 
is  seen  in  Fig.  86.  a  a.  The  scalp  turned 
down,  b  b.  Cut  edges  of  the  skull 
bones.  3.  The  dura  mater  suspended 
by  a  hook.     4,  The  left  hemisphere. 

The  anatomical  distinctions 
of  the  cerebnam  are  the  fol- 
lowing : 

Crura  cerehri  ;  two  thick 
white  coi'ds  diverging  from  the 
anterior  border  of  the  pons  va- 
rolii, their  fibres  terminating  iii 
the  hemispheres.  A  layer  of 
meduUarj^  matter  occupies  a 
triangular  space  between  them, 
which  is  called  the  locus  per- 
foratus. 

Eminentice  mammillarcs ; 
two  white  globular  bodies,  near 
the  size  of  a  pea,  between  the 
crura  and  in  front  of  the  locus  perforatus. 

Tuber  cinereum;  a  soft  gray  mass  in  front  of  the  eminentise  mammil- 
lares,  and  behind  the  chiasm  of  the  optic  nerves. 

Infundihulum ;  a  hollow,  conical,  reddish  body  resting  on  the  tuber 
cinereum,  and  attached  by  its  apex  to  the  pituitary  gland. 

Pituitary  gland ;  a  vascular  mass,  consisting  of  two  lobes,  which 
occupies  the  sella  turcica. 

Longitudinal  fissure;  the  sulci  which  separates  the  hemispheres 
laterally,  and  contains  the  falx  cerebri. 

Corpus  calloswn ;  a  v/hite  arched  band,  forming  the  great  comriiissure 
between  the  two  hemispheres  at  the  bottom  of  the  longitudinal  fissure. 
It  is  about  an  inch  broad  and  three  and  a  half  inches  long.  Its  fibres 
are  mostly  medullary  matter ;  a  few,  however,  are  cineritious ;  these 
pass  longitudinally,  and  are  called  the  raphe. 

Septum  lucidum ;  a  vertical  partition  separating  the  lateral  ventricle?. 
It  is  in  contact  superiorly  with  the  corpus  callosum,  and  below  witl 
the  fornix. 

Fornix ;  a  ti'iangular  arch,  the  base  of  which  is  continuous  with  the 
corpus  callosum  behind ;  its  apex  divides  into  two  crura,  which  termi- 
nate in  the  eminentia  mammillares ;  its  under  surface  is  called  Lyra. 
Under  these  crura  is  the  foramen  of  Munro,  which  communicates  be- 
tween the  third  and  the  two  lateral  ventricles. 


166  ANATOMY 

Felum  interpositum ;  a  triangular  process  of  pia  mater  under  the 
fornix,  containing  in  its  edges  a  plexus  of  veins,  called  plexus  choroides. 

Pineal  gland  ;  a  small,  reddish- gray,  conical  body,  situated  upon  the 
tubercula  quadi'igemina,  and  connected  with  the  optic  tubercles  by  tv\'^o 
crura.  This  little  thing  is  mejnorable  fi'om  having  been  regarded  by 
the  ancients  as  the  seat  of  the  soul. 

Tubercula  quadrigemina ;  four  prominences  over  the  junction  of 
the  pons  and  crm*a  cerebri.  Under  them  is  a  passage  betw^een  the 
third  and  fourth  venti'icles,  called  the  aqueduct  of  Sylvius,  or  iter  a 
tertio  ad  ventriculum  quartum. 

Corpus  striatum ;  a  gray  oblong  mass  medullary  within,  situated  in 
each  lateral  ventricle. 

Thalamus  opticus  ;  an  oval  body  behind  the  corpus  striatum  on  eacb 
side.  It  is  a  mixed  mass  of  medullary  and  cineritious  matter,  and  has 
three  prominences,  called  corpora  geniculata.  It  is  connected  with  it.« 
fellow  by  a  gray  substance,  which  is  called  the  soft  commissure. 

Tenia  striata  ;  a  thin  slip  of  medullaiy  matter  occupying  the  groove 
between  the  corpus  sti'iatum  and  thalamus  opticus. 

Hippocampus  major ;  a  scroll  extending  into  the  inferior  cornu  of 
the  lateral  ventricle  ;  its  extremity  resembles  a  foot,  and  is  called  the 
pes  hippocampi. 

Corpus  jimhriatum  ;  a  thin  edge  of  medullary  matter  on  the  concave 
side  of  the  hippocampus  major;  beneath  it  is  a  layer  of  cineritious 
substance,  having  a  seiTated  ajipearance,  called  the  fascia  dentata. 

Hippocampus  minor ;  a  conical  elevation,  resembling  the  spur  of  a 
cock,  pointing  backward  into  the  posterior  cornu. 

Ventricles ;  five  in  number.  The  lateral  exist  in  each  hemisphere, 
and  contain  the  corpus  striatum  and  thalamus  opticus ;  the  roof  is 
formed  by  the  corpus  callosum.  In  each  are  three  angular  depressions, 
called  cornua ;  the  posterior  contains  the  hippocampus  minor,  the  in- 
ferior the  hippocampus  major,  the  anterior  is  vacant.  They  are  par- 
tially separated  by  the  septum  lucidum,  but  communicate  with  each 
other  and  with  the  third  by  the  foramen  of  Munro.  The  third  ven^ 
tricle  is  the  space  between  the  thalami  optici.  Its  roof  is  formed  of  the 
velum  interpositum  and  fornix,  and  its  floor  by  the  locus  perforatus  and 
the  tuber  cinereum.  Its  front  is  traversed  by  the  anterior  commissure, 
a  medullary  cord  extending  between  the  corpora  sti'iata,  and  by  the 
posterior  commissure,  which  extends  ti-ansversely  between  the  thalami 
optici.  It  communicates  with  the  fourth  by  the  aqueduct  of  Sylvius, 
and  with  the  lateral  by  the  foramen  of  Munro.  The  fourth  ventricle 
is  situated  between  the  pons  Varolii,  cerebellum,  and  medulla  oblongata. 
Its  floor  is  the  calamus  scriptorius,  and  its  roof  is  the  valve  of  the  brain 


NEUROLOGY. 


167 


tt  communicates  only  with  the  third  Laterally  it  is  limited  by  the  pia 
mater  and  arachnoid.  T\\g  fifth  veKiricle  is  situated  between  the  lara- 
inas  of  the  septum  lucidum,  and  has  no  communication  with  the  others. 

Fig.  87  represents  the 
taesial  surface  of  a  longi- 
tudinal section  of  the  brain. 
1.  Inner  surface  of  left 
hemisphere.  2.  Divided 
centre  of  the  cerebellum, 
showing  the  arbor  vitse.  3. 
Medulla  oblongata.  4.  Cor- 
pus callosum,  5.  Fornix. 
6.  One  of  the  crura  of  the 
fornix.  7.  One  of  the  cor- 
pora albicantia,  pea-shaped 
bodies  between  the  crura 
cerebri.  8.  Septum  luci- 
dum. 9.  Velum  interposi- 
tum.  10.  Section  of  the 
middle  commissure  in  the 
third  ventricle.  11.  Section 
of  the  anterior  commissure. 
12.  Section  of  the  posterior  commissure.  13.  Corpora  quadrigemina.  14.  Pineal  gland. 
15.  Aqueduct  of  Sylvius.  16.  Fourth  ventricle.  17.  Pons  Varolii,  through  which  are 
Been  passing  the  diverging  fibres  of  the  corpora  pyramidalia.  18.  Cnis  cerebri  of  the 
left  side;  the  third  nerve  arising  from  it.  19.  Tuber  cinereum,  from  which  projects  the 
mfundibulum,  having  the  pituitary  gland  appended  to  its  extremity.  20.  One  of  the 
optic  nerves.    21.  The  left  olfactory  nerve  terminating  anteriorly  in  a  rounded  bulb. 


MESIAL,    SURFACE    OF   THE    BRAIIV 


The  Cerebellum. — The  cerebellar  portion  constitutes  one  sixth  or 
one  seventh  of  the  brain.  It  is  an  oblong,  flattened  body,  situated  be- 
tween the  occiput  and  tentorium.  Its  external  substance  is  cineritious, 
and  the  internal  medullary.  It  is  divided  by  a  longitudinal  fissure  into 
two  hemispheres ;  in  the  upper  part  of  this  fissm'e  is  a  ridge,  called 
vermis  superior ;  in  front  of  this  is  an  elevation,  called  nionticulus  ;  in 
the  lower  part  of  the  fissure  is  a  smaller  ridge,  called  vermis  inferior. 
Two  small  protuberances  are  seen  at  the  root  of  the  crura  cerebelli, 
the  lower  of  which  is  called  lohulus  amygdaloides,  and  the  upper  lo- 
hulus  nervi  pneumogastrici.  Extending  from  the  lower  surface  of  the 
cerebellum  to  the  corpora  restiformia  is  a  thin  gray  plate,  called  the 
valve  of  the  brain.  The  substance  of  the  cerebellum,  on  a  section 
being  made  in  either  lobe,  presents  an  arborescent  arrangement  of 
medullary  matter,  called  arhor  vitce.  A  gray  mass  in  the  trunk  of  this 
medullary  tree,  with  sen-ated  edges,  is  called  corpus  dentatum.  The 
cerebellum  is  associated  with  the  rest  of  the  encephalon  by  means  of 
three  pairs  of  rounded  cords,  called  sujjerior,  7niddle,  and  inferior  pe- 
fivncles.     Its  two  hemispheres  are  united  by  the  commissure  called 


163  ANATOMY. 

pons  Varolii ;  this  consists  of  transverse  fibres,  separated  into  two 
!ayei-3  by  the  fosciculi  of  riie  corpora  pyramidalia  and  corpora  olivaria. 
These  two  layers,  the  upper  and  lower  on  each  side,  are  collected  to- 
gether to  form  the  crura  cerebelli. 

The  Medulla  Oblongata. — This  is  the  upper  enlarged  pai't  of 
the  spinal  cord,  about  an  inch  in  length,  conical  in  shape,  extending 
from  the  pons  Varolii  to  the  atlas.  It  is  separated  anteriorly  and  pos- 
teriorly  by  vertical  fissures  into  two  symraeti'ical  Literal  cords,  or  col- 
umns, eac'"  column  being  subdivided  by  small  grooves  into  tlu-ee  smaller 
cords ;  these  ai"e  the  corpora  ^''yramidalia,  two  naiTow  tapering  cords 
on  either  side  of  the  anterior  fissure,  whose  fibres  decussate  freely 
about  an  inch  below  the  pons ;  the  corpora  olivaria,  two  oblong  convex 
bodies,  half  an  inch  in  length,  behind  the  corpora  pyramidalia,  from 
which  they  are  sepai-ated  by  a  fissure — a  section  of  them  exhibits  an 
arrangement  of  cineritious  matter,  called  corpus  fimbriatum ;  and  the 
corpora  restiformia,  which  comprehend  the  posterior  half  of  each  late- 
ral column.  That  part  of  the  postenor  fissm-e  between  them  is  ciilled 
calamus  scriptorius,  across  which  pass  ti-ansverse  fibres  of  medullary 
matter.  Two  slightly  convex  columns  of  the  medulla  oblongata,  v/hich 
enter  into  the  formation  of  the  floor  of  the  fourth  venti'icle,  are  cailc'l 
funiculi  teretes,  or  posterior  pyramids. 

The  fibres  composing  the  columns  of  the  medulla  oblongata  have  a 
peculiar  arrangement  on  its  upper  part ;  those  of  the  coi-pora  pyramid- 
alia and  olivaria  enter  the  pons  Varolii,  and  are  prolonged  through  the 
crura  cerebri,  thalarai  optici,  and  corpora  sti'iata  to  the  hemispheres  of 
the  cerebrum ;  while  those  of  the  corpora  restiformia  are  reflected 
backward  into  the  cerebellum,  and  form  its  inferior  peduncles.  These 
fibres  were  termed  by  Gall  the  diver ffing  fibres.  They  constitute  both 
the  cerebrum  and  cerebellum ;  while  another  set  of  fibres,  called  co/i- 
verging,  associate  their  symmetrical  halves  and  distant  parts  of  the 
same  hemispheres.  These  converging  fibres  constitute  the  commis- 
sures of  the  brain  already  mentioned.  The  corpus  caliosum  is  the 
commissure  of  the  hemispheres ;  'he  fornix,  septum  lucidum,  the  bo- 
dies called  anterior,  middle,  and  {/«Dsterior  commissures,  and  the  pe- 
duncles of  the  pineal  gland,  connect  different  parts  of  the  cerebrmn, 
while  the  pons  Varolii  connects  the  hemispheres  of  the  cerebellum. 

The  gray  matter  which  is  intermixed  with  the  white  fibres  of  the 
medulla  oblongata  was  regarded  by  Gall  and  Spui-zheim  as  the  channels 
of  nutrition :  this  supposition  is  strengthened  by  the  gi-eat  vasculai'ity 
of  the  former  substance,  which  enables  it  to  conve;*  a  large  proportion 
of  the  elements  of  gi-owth  and  development. 


NEUROLOGY. 


169 


In  Fig.  88  are  seen  several  sections 
Df  the  base  of  the  '-vrain,  the  distri- 
bution of  the  diverging  fibres.  1. 
Medulla  oblongata.  2.  Half  of  the 
pons  Varolii.  3.  Crus  cerebri,  cross- 
ed by  the  optic  nerve  (4),  and  spread- 
ing out  into  the  hemisphere,  where  it 
is  called  corona  radiata.  5.  Optic 
nerve.  6.  Olfactory  nerve.  7.  Cor- 
pora albicantia.  8.  Fibres  of  the 
corpus  pyramidale  passing  through 
the  pons.  9,  The  fibres  passing 
through  the  thalamus  opticus.  10. 
The  fibres  passing  through  the  cor- 
pus striatum.  11.  Their  distribu- 
tion to  the  hemisphere.  12.  Fifth 
nerve.  13.  Fibres  of  the  corpus 
pyramidale,  which  pass  outward 
with  the  corpus  restiforme  into  the 
cerebellum.  14.  Section  through 
one  of  the  hemispheres  of  the  cere- 
bellum, showing  a  body  called  cor- 
pus rhomboideum  in  the  centre  of 
Its  white  substance,  and  the  arbor 
VitSB.    15.  The  opposite  hemisphere. 


Fig.  88. 


BASE    OF   THE    BRAIN. 


The  Spinal  Cord. — The  spinal  column  contains  the  spinal  cord^ 
medulla  spinalis,  its  membranes.,  and  the  roots  of  the  spinal  nerves. 
[ts  outer  membrane  is  the  tlieca  vertebralis,  continuous  with  the  dura 
mater  of  the  skull;  the  central  is  the  arachnoid,  a  continuation  of  the 
serous  membrane  of  the  brain,  and  the  internal  is  the  prolongation  of 
the  pia  rnater,  which  is  more  firm  and  fibrous,  and  less  vascular,  than 
in  the  brain.  The  anterior  are  separated  from  the  posterior  roots  of 
the  spinal  nerves  thi'oughout  the  entire  length  of  the  cord,  by  their 
processes  of  pia  mater,  called  memhrana  dentata.  A  transverse  sec- 
tion of  the  spinal  marrow  exhibits  an  arrangement  of  gray  matter  in- 
ternally and  medullary  externally.  It  extends  from  the  pons  Varolii 
to  the  fir^t  or  second  lumbar  vertebra,  where  it  terminates  in  a  rounded 
point,  lis  diameter  varies  in  different  parts,  and  exhibits  three  enlarge- 
ments, the  uppermost  being  the  medulla  oblongata,  the  middle  corres- 
ponding with  the  origin  of  the  nerves  of  the  upper  exti'emities,  and  the 
lower  corresponding  with  the  origin  of  nerves  that  supply  the  lower 
extremities.  It  is  divided  into  lateral  halves  by  anterior  and  posterior 
longitudinal  fissures,  which  extend  deeply  into  its  substance.  Eacxi 
lateral  half  is  divided  by  a  lateral  sulcus,  or  fissure,  into  anterior  and 
posterior  columns,  the  anterior  giving  origin  to  the  nerves  of  motion, 
and  the  posterior  to  those  of  sensation.  Another  slight  fissm*e  indicates 
[-15 


170 


ANATOMY 


a  middle  lateral  column,  which  Sir  Charles  BeB 
supposed  to  pertain  to  the  respiratory  nerves, 
though  such  functional  aiTangement  has  not  yet 
been  demonstrated. 

Ill  Fig.  69  ai-e  seen  the  relations  of  the  spinal  marrow  to  the 
medulla  oblongata,  pons  Varolii,  and  cerebellum,  as  well  as  the 
sereral  c-nlargeuients  in  its  course. 

The  Cranial  Nerves. — These  are  so  called 
from  then-  emerging  through  the  foramina  at  the 
base  of  the  cranium.  There  are  nine  pairs  of  them, 
all  of  which  are  named  numerically  and  functionally. 

Fig.  SO. 


IS 


6    I^TAL    CORD. 


THE    XERVES    CO.XNECTED    WITH    THE    BRAIN. 

Fig.  90  ehows  the  origin  of  the  cranial  nerves.  The  numbers 
are  p'aced  against  tbs  corresponding  pairs  of  nerves.  11  and 
12  aif  spinal  nerves,  a  a  a.  Cerebrum,  b.  Cerebellum,  s. 
Meduiia  oblongjtta.    d.  Medulla  spinalis.    /.  Corpus  callosam. 


i\rst  Pair — Olfacl^-y;  the  nerves  of  srrelling.  Each  arises  by 
three  roots,  which  unite  in  the  fissure  of  Syvius :  passing  forward  it 
enlarges  into  a  bulbous  mass  of  white  and  gray  substance,  which  rests 
on  the  cribriform  plate  of  the  ethmoid  bone.  From  this  bulbous  olfac- 
torius  the  nerves  are  given  off  which  are  distributed  upon  the  mucouj 
membrane  of  the  nose. 


NEUROLOGY. 


171 


Second  Pair — Optic;  the  nerves  of  seeing.  Each  is  a  large  cord 
arising  from  the  thalamus  opticus  and  tubercula  quadrigemina,  winding 
around  the  crus  cerebri  as  a  flattened  band,  under  the  name  of  tractus 
opticus,  joining  its  fellow  in  front  of  the  tuber  cinereum,  forming  a 
chiasm  called  the  optic  commissure,  then  proceeding  forward  it  diverges 
from  its  fellow,  and  passes  through  the  optic  foramen  to  the  eyeball, 
pierces  the  sclerotic  and  choroid  coats,  and  expands  into  the  nervous 
membrane  called  the  retina. 

Third  Pair — Motores  oculorum ;  nerves  of  motion.  They  arise 
from  the  crus  cerebri,  pass  forward  between  the  posterior  cerebral  and 
superior  cerebellar  artery,  and  through  the  sphenoidal  foramen  to  be 
disti-ibuted  to  all  the  muscles  of  the  eyeball  except  the  external  rectus 
and  superior  oblique.  Each  sends  a  branch  to  the  ophthalmic  ganglion, 
from  which  proceed  the  ciliary  nerves  that  supply  the  iris. 

Fourth  Pair — Pathetici;  nerves  of  motion,  and  the  smallest  of  the 
cerebral.  Each  patheticus  arises  from  the  valve  of  the  brain  (valve  of 
Viessens),  winds  around  the  crus  cerebri,  passes  along  the  cavernous 
sinus,  and  entering  the  orbit  at  the  sphenoidal  fissure,  is  disti'ibuted  to 
the  superior  oblique  muscle.  In  the  sinus  it  gives  off  a  recurrent  branch 
to  the  lining  membrane. 


In  Fig.  91  is  seen  the  distribution  of  the 
fifth  pair  of  nerves.  I.  Orbit.  2.  Antrum 
of  the  upper  jaw.  3.  Tongue.  4.  Lower 
jaw.  5.  Root  of  the  fifth  pair,  forming 
the  ganglion  of  Casser.  6.  Ophthalmic 
branch.  7.  Superior  maxillary.  8.  Infe- 
rior maxillary.  9.  Frontal  branch.  30. 
Lachrymal.  11.  Nasal.  12.  Internal  nasal. 
13.  External  nasal.  14.  External  and  in- 
ternal frontal.  15.  lufraorbitary.  16. 
Posterior  dentals.  17.  Middle  dental.  18. 
Anterior  dental.  19.  Labial  and  palpebral 
branches  of  the  infra-orbital.  20.  Orbitar. 
21.  Pterygoid.  22.  Masseter,  temporal, 
pterygoid,  and  buccal  branches.  23.  Lin- 
gual branch,  joined  at  an  acute  angle  by 
the  chorda  tympani.  24.  Inferior  dental, 
terminating  in  25.  Mental  branckes.  26. 
Superficial    temporal.  2'J.    Auricular 

branches.    28.  Mylo-hyoid  branch. 

Fifth  Pair — Trifacial;  the 
largest  cranial  nerves,  and  the 
principal  nerves  of  sensation  of 
the  head  and  face,  arise,  like  the 
spinal    nerves,    from    two   roots. 


Fig.  91. 


TRIFACIAL    NEP-VES. 


172  ANATOMY. 


Each  trifticiiil  commences  in  a  tract  of  yellowish  matter  in  front  of  the 
floor  of  the  fomth  venti'icie,  and  passing  fonvard  through  an  opening 
in  the  border  of  the  tentorium,  near  the  exti'emity  of  the  petrous  bone, 
spreads  out  into  a  large  semilunar  ganghon,  called  Casserian,  the  an- 
terior root,  which  is  much  the  smallest,  merely  lying  against  the  under 
surface,  but  not  forming  a  part,  of  the  ganglion.  This  ganglion  divides 
into  the  ophthalmic,  superior  maxillary,  and  inferior  maxillary  branches. 

The  ophthalmic  nerve  is  a  short  trunk,  three  fourths  of  an  inch  long; 
it  pusses  out  at  the  sphenoidal  foramen,  and  divides  into  thi'ee  branches ; 
the  frontal  passes  through  the  supra-orbiter  foramen  to  the  integument 
of  the  forehead,  supplying  also  the  conjunctiva  and  upper  eyelid ;  it 
gives  off  a  supra-trachlear  branch  to  the  inner  angle  of  the  eye  and 
root  of  the  nose.  The  lachrymal  is  the  smallest  branch,  and  is  dis- 
ti'ibuted  to  the  lachrymal  gland,  temple,  cheek,  and  inner  portions  of 
the  orbit.  The  nasal  passes  forward  between  the  two  heads  of  the 
externa]  rectus  muscle,  and  enters  the  nose  by  the  opening  at  the  side 
of  the  crista  galJi,  where  it  divides  into  an  i?iternal  branch,  supplying 
the  anterior  part  of  the  mucous  membrane,  and  an  external,  distributed 
to  integuments  at  the  exti'emity  of  the  nose.  Within  the  orbit  the 
nasal  nerve  gives  off  a  ganglionic  branch,  which  forms  the  superior 
long  root  of  the  ciliary  ganglion,  ciliary  branches  to  the  iris,  and  an 
infra-trochlear  to  the  lachrymal  sac,  caruncula  lachrymalis,  conjunc- 
tiva, and  inner  angle  of  the  orbit. 

The  superior  maxillary  nerve  passes  through  the  foramen  rotundura, 
crosses  the  spheno-maxillary  fossa,  enters  the  canal  in  the  floor  of  the 
orbit,  emerges  on  the  face  through  the  infi-a-orbital  foramen,  wher<j  it 
divides  into  several  branches,  distributed  to  the  lower  eyelid  and  con- 
junctiva, muscles,  and  integument  af  the  upper  lip,  nose,  and  cheek, 
forming  a  plexus  with  the  facial  nerves.  The  orbital  branch  ti'averses 
the  infra-orbital  canal,  and  enters  the  orbit  at  the  infra-orbital  foramen, 
where  it  divides  into  a  temporal  branch,  which  passes  through  a  canal 
in  the  malar  bone  to  supply  the  integuments  of  the  temple  region,  and  a 
malar  branch,  which  emerges  upon  the  cheek  through  an  opening  in 
the  malar  bone,  to  communicate  with  branches  of  the  infi-a-orbital  p>nd 
facial  nerves.  Two  branches  ascend  from  Meckel's  ganglion,  and  join 
the  orbital  nerve  as  it  crosses  the  spheno-maxillary  fossa,  called  pterygo- 
palatine. The  posterior  dental  branches  pass  through  small  foramina 
in  the  back  surface  of  the  upper  jaw,  and  nin  forward  to  the  base  of 
the  alveolus,  supplying  the  back  teeth  and  gums.  The  middle  and  an- 
terior dental  branches  descend  to  the  corresponding  teeth  and  gums ; 
previously  to  their  distribution  the  dental  nerves  form  a  plexus  in  the 
outer  wall  of  the  upper  maxj)lary  bone,  above  the  alveolus,  from  which 


NEUROLOGY.  173 


filaments  are  given  off  to  the  pulps  of  the  teeth,  gums,  mucous  mem- 
brane of  the  nose,  and  palate. 

The  Inferior  Maxillary  Nerve  is  the  largest  division  of  the  fifth  pair; 
it  emerges  at  the  foramen  ovale,  and  divides  into  external  and  internal 
trunks.  The  external  divides  into  five  branches — the  masseteric,  two 
temjJoral,  buccal,  and  internal  iJierygoicI,  all  of  which  are  distributed 
to  the  muscles  of  the  temporal  and  maxillary  regions ;  the  last-named 
branch  is  connected  by  filaments  with  tlie  otic  ganglion.  The  internal 
trunk  divides  into  three  branches ;  the  gustatory,  which  is  distributed 
by  numerous  filaments  to  the  papillae  and  mucous  membrane  of  the 
tongue ;  the  inferior  dental,  which  proceeds  to  the  dental  foramen, 
which  it  enters,  and  runs  along  the  canal  of  the  lower  javf,  supplying 
the  teeth  and  gums,  and  terminating  in  two  branches ;  incisive,  which 
goes  to  the  front  teeth ;  and  mental,  which  passes  out  at  the  mental 
foramen,  to  be  distributed  to  the  muscles  and  integuments  of  the  chin 
and  lower  lip ;  the  inferior  dental  gives  off  a  mylo-liyoidean  branch  to 
the  mylo-hyoid  and  digasti'ic  muscles ;  and  the  anterior  auricular,  which 
originates  by  two  roots,  passes  backward  behind  the  articulation  of  the 
lower  jaw,  where  it  forms  a  plexus,  from  which  an  ascending  or  tem- 
poral branch  is  given  off  to  the  temporal  region,  and  a  descending 
branch,  which  supplies  the  parotid  gland  and  external  parts  of  the  ear, 
suppl^'ing  a  few  filaments  to  the  tympanum. 

Sixth  Pair — Ahducentes  ;  nerves  of  motion ;  each  arises  from  the 
corpus  pyramidale,  proceeds  forward  parallel  with  the  basilir  artery, 
and,  ascending,  passes  through  the  cavernous  sinus  ;  entering  the  orbit 
through  the  sphenoidal  fissure  to  be  distributed  to  the  external  rectus 
muscle.     A  palsy  of  this  nerve  produces  internal  squinting. 

Seventh  Pair — Facial  and  Auditory ;  nerves  of  motion ;  the  sev- 
enth pair  consists  of  two  nerves ;  the  smaller  and  internal  is  the  facial, 
or  portio  dura,  arising  from  the  corpus  restiforme  ;  the  larger  and  ex- 
ternal is  the  auditory,  or  j^ortio  mollis,  arising  from  the  calamus  scrip- 
torius.  The  facial  7ierve  enters  the  meatus  auditorius  internus  along 
witn  the  auditory,  passes  through  the  canal  called  aqueduct  of  Fallo- 
pius,  and  emerges  at  the  stylo-mastoid  foramen,  then  penetrates  the 
parotid  gland,  and  at  the  ramus  of  the  lower  jaw  divides  into  f.ejnporo- 
facia.l  and  cervico-facial  trunks,  Avhich  split  into  numerous  branches, 
forming  looped  communications,  called  p)es  anserinus,  to  be  distributed 
upon  the  side  of  the  fece  from  the  temple  to  the  neck ;  in  its  course  it 
communicates  extensively  with  the  neighboring  branches  of  nerves ;  it 
also  sends  off  the  following  branches :  tympanitic,  to  the  stapedius 
muscle  ;  chorda  tympani,  to  the  tympanum,  which  it  crosses,  and,  pass- 
in?   trough  the  fissura  Giasseri  joins  the  gustatory  nei-ve  between  the 


174  ANATOMY 


pteiygoid  muscles,  with  which  it  descends  to  the  submaxillary  gm- 
glion ;  the  'posterior  auricular,  to  the  muscles  of  the  ear ;  the  stylo-hy- 
-'icl  and  digastric,  to  those  muscles.  The  auditory  nerve  divides  at  the 
DOttom  of  the  meatus  into  cochlear  and  vestibular  branches,  which  are 
distributed  to  the  internal  ear. 

Eighth  Pair  ;  consists  of  three  nerves;  glosso-pharyngeal,  pneumo- 
gasti'ic,  and  spinal  accessory,  which  some  authors  reckon  as  the  ninth, 
tenth,  and  eleventh  paii-s. 

The  glosso-pharyngeal  nerve  arises  from  the  groove  between  the 
corpus  olivare  and  restiforme,  emerges  at  the  foramen  lacerum  poste- 
rius,  and  curves  forward  to  be  disti-ibuted  to  the  mucous  membrane  of 
the  base  of  the  tongue  and  fauces,  tonsils,  and  mucous  glands  of  the 
mouth.  Within  the  jugular  fossa  it  presents  a  p-angliouic  enlarge- 
ment, called  ganglion  jugulare ;  near  its  origin  is  also  a  small  gan- 
glion, called  petrosal,  or  Anderschian.  Its  branches  are  :  Communicat- 
ing, which  proceed  from  the  peti-osal  ganglionic  plexus,  and,  in  com- 
mon with  those  of  the  facial  and  sympathetic,  form  a  complicated 
plexus  at  the  base  of  the  skull;  tympanitic  (Jacobson's  nerve),  which 
proceeds  from  the  petrosal  ganglion,  and,  entering  the  bony  canal  in 
the  jugular  fossa,  divides  into  six  branches,  disti'ibuted  upon  the  inner 
wall  of  the  tympanum,  forming  a  plexiform  communication  (tympanic 
plexus)  with  the  sympathetic  and  fifth  pair ;  it  sends  branches  of  dis- 
tribution to  supply  the  fenesti'a  rotunda,  fenestra  ovalis,  and  Eustachian 
tube,  and  communicating  branches  to  the  carotid  plexus,  otic  ganglion, 
and  petrosal  branch  of  the  Vidian  nerve  ;  the  muscular,  which  are  sent 
to  the  stylo-pharjmgeas,  stylo-hyoid,  and  digastric  muscles ;  the  pha- 
ryngeal, which  are  distributed  to  the  pharynx ;  the  lingual,  which  go 
to  the  base  of  the  tongue,  fauces,  and  epiglottis ;  and  the  tonsillitic, 
which  form  a  plexus  around  the  base  of  the  tonsils,  and  supply  filaments 
to  the  fauces  and  soft  palate. 

The  pneumogastric  nerve  arises  immediately  below  the  former,  and 
emerges  from  the  skull  through  the  same  foramen ;  soon  after  passing 
from  the  skull  it  enlarges  into  a  ganglion,  plexus  gangliformis,  nearly 
an  inch  in  length,  surrounded  by  an  irregular  plexus  of  white  nerves 
which  communicate  with  each  other,  with  other  divisions  of  the  eighth 
pair,  and  with  the  ti-unk  of  the  pneumogastric  below.  Descending  to 
the  root  of  the  neck,  the  right  pneumogastric  passes  between  the  sub- 
clavian artery  and  vein  to  the  posterior  mediastinum,  then  behind  tha 
root  of  the  lung  to  the  oesophagus,  which  it  accompanies  to  the  stoit- 
ach.  The  left  enters  the  chest  parallel  with  the  left  subclavian  artery, 
crosses  the  arch  of  the  aorta,  and  descends  behind  the  root  of  the  lung, 
and  along  the  anterior  sui'face  of  the  oesophagus  to  the  stomach. 


N  E  U  R  0  L  0  G  y 


175 


In  Fig.  92  is  seen  a  representation  of  the  origin  and  pj^,  gg 

iistribiition  of  the  eighth  pair.  1,  3,  4.  Medulla  ob- 
longata. 1  is  the  corpus  pyramidale  of  one  side.  '3.  / 
Corpus  olivare.  4.  Corpus  restiforme.  2.  Pons  Va-  ^ 
rolii.  5.  Facial  nerve.  6.  Origin  of  the  glosso-pha- 
ryngeal.  7.  Ganglion  of  Andersch.  8.  Trunk  of  the 
nerve.  9.  Spinal  accessory  nerve.  10.  Ganglion  of 
the  pneumogastric.  11.  Its  plexiform  ganglion.  12. 
Its  trunk.  13.  Its  pharyngeal  branch  forming  the 
pharyngeal  plexus  (14),  assisted  by  a  branch  from  the 
glossopharyngeal  (8),  and  one  from  the  superior 
laryngeal  (15).  15.  Cardiac  branches.  17.  Recurrent 
laryngeal  branch.  18.  Anterior  pulmonary  branches. 
19.  Posterior  pulmonary  branches.  20.  CEsophageal 
plexus.  21.  Gastric  branches.  22.  Origin  of  the 
spinal  accessory.  23.  Its  branches  distributed  to  the 
BtiJino-mastoid  muscle.  24.  Its  branches  to  the  tra- 
''8z'us  muscle. 


The  branches  of  the  pneumogastric  ai'e  : 
Communicating,  which  connect  with  the 
facial,  glosso-pharyngeal,  spinal  accessory, 
hypo-glossal,  and  sympathetic ;  auricular^ 
which  passes  through  a  small  canal  in  the 
petrous  portion  of  the  temporal  bone  to  the 
pinna,  sending  filaments  to  the  facial ;  pha- 
ryngeal, which  assists  to  form,  on  the  mid- 
dle constrictor  muscle,  the  pharyngeal 
plexus,  which  is  distributed  to  the  muscles 
and  mucous  membrane  of  the  phaiynx; 
the  superior  laryngeal,  disti'ibuted  to  the 
arj'^tenoideus  muscle  and  mucous  membrane 
of  the  larynx,  communicating  behind  the 
cricoid  cartilage  with  the  recurrent  laryn- 
geal, and  giving  off  the  external  laryngeal, 
which  sends  a  twig  to  the  pharyngeal  plex- 
us, and  supplies  the  inferior  consti'ictor  and 
circo -thyroid  muscles  and  thyroid  gland ; 
cardiac,  two  or  three  branches  which  cross 
the  lower  part  of  the  common  carotid,  to 
communicate  with  the  cardiac  branches  of 
the  sympathetic,  and  with  the  gi-eat  cardiac  plexus ;  recurrent  laryn- 
geal, which  passes  upward  from  near  the  pulmonary  branches  to  the 
larynx,  giving  off  branches  to  the  heart,  lungs,  oesophagus,  and  trachea, 
and  is  distributed  to  all  the  muscles  of  the  larynx,  except  the  circo- 
hyroid,  communicating  with  the  superior  and  external  laryngeal  and 


EIGHTH    PAIR    OF   NERVES 


176  ANATOMY. 


sympathetic  nei-ves ;  anteriyr  pulmonary,  disti'ibiited  to  the  anterior 
aspect  of  the  root  of  the  lungs,  and  forming,  with  the  branches  of  the 
gi'eat  cai'diac  plexus,  the  anterior  p)uliionary  plexus ;  posterior  pulmo- 
nary, which  supply  the  posterior  aspect  of  the  root  of  the  lungs,  and 
forming,  with  branches  from  the  great  cardiac  plexus,  the  posterior 
jmlmonary  plexus ;  and  the  gastric,  which  are  the  terminal  filaments 
of  the  two  pneumogastric  nerves,  spread  out  upon  the  anterior  and 
posterior  surfaces  of  the  stomach,  and  also  distributed  to  the  omentum, 
spleen,  pancreas,  liver,  and  gall-bladde  •,  communicating  with  the  solar 
plexus. 

Note. — The  superior  '  iryngeal  nerve  is  regarded  by  some  anatomists 
as  the  nerve  of  sensation  to  the  larynx,  being  distributed  mainly  to  its 
mucous  membrane.  The  recuiTent  is  the  proper  motor  nerve  of  the 
larynx,  being  distributed  to  its  muscles.  The  two  pneumogastric  nerves 
divide  into  numerous  branches  upon  the  oesophagus,  which  communicate 
with  each  other,  and  form  the  cesophagal  plexus. 

The  spinal  accessory  nerve  arises  from  the  spinal  cord  as  low  down 
as  the  fourth  cervical  nerve,  escapes  at  the  jugular  foramen,  and  divides 
into  two  branches,  one  of  which  sends  filaments  to  the  superior  phaiyn- 
geal  nerve,  and  the  other,  which  is  the  proper  continuation  of  the  nerve, 
descends  obliquely  backward,  and  piercing  the  sterno-mastoid  muscle, 
is  disti'ibuted  to  the  trapezius,  communicating  with  the  upper  cervical 
nerves. 

Ninth  Pair — Hypoglossal ;  nerves  of  motion ;  each  arises  fi-om  the 
gi'oove  between  the  corpus  pyramidale  and  corpus  olivare,  by  numerous 
filaments  which  unite  into  two  bundles,  and  emerge  from  the  cranium 
at  the  anterior  condyloid  foramen ;  then  passing  between  the  internal 
carotid  aitery  and  internal  carotid  vein,  and  curving  around  the  occipital 
artery,  sends  branches  to  the  muscles  of  the  tongue,  being  distributed 
principally  to  the  genio-hyo-glossus.  Its  branches  ai'e  :  communicating, 
which  connect  with  the  pneumogastric  spinal  accessory,  cervical  and 
sympathetic ;  descendens  noni,  a  long,  slender  twig  which  descends 
upon  the  sheath  of  the  cai'otid  vessels,  forming  a  loop  with  a  long 
branch  from  the  second  and  third  cen'ical,  from  the  convexity  of  which 
branches  are  sent  off  to  the  stei-no-hyoid,  sterno-thyroid,  and  omo- 
hyoid muscles  ;  and  thyro-hyoidean,  disti-ibuted  to  the  thyro-hyoid 
muscle. 

The  Spinal  Nerves. — Of  these  there  are  thirty-one  pairs,  each 
arising  by  two  roots,  an  anterior  motor  and  a  posterior  sensitive  ;  the 
posterior  are  lai'ger,  and  have  moro  numerous  filaments  than  the  ante- 
vior.     In  the  intenertebral  foram-^j  the  posterior  roots  enlarge  into  a 


NEUROLOGY.  177 


ganglion,  after  which  both  roots  unite  nnd  form  a  spinal  nerve,  which 
passes  out  of  the  foramen,  and  then  divides  into  an  anterior  branch, 
which  supplies  the  front,  portion  of  the  bod/,  communicating  with  the 
ganglions  of  the  sympathetic,  and  forming  plexuses  which  give  off  the 
principal  nerves  to  the  muscles  of  the  trunk  and  extremities,  and  a  pos- 
terior, which  supplies  the  muscles  of  the  back.  The  spinal  nerves  aro 
divided  into  cervical,  dorsal,  lumbar,  and  sacrc.l 

Cervical  Nerves. — Eight  pairs:  the  first  is  called  sub-occipital; 
it  passes  out  of  the  spinal  canal,  between  the  occiput  and  atlas;  and  the 
last  passes  out  between  the  last  cervical  and  first  dorsal  vertebra.  The 
anterior  branches  of  the  four  upper  form  the  cervical  jdexus  ;  the  pos- 
terior branches,  posterior  cervical  plexus.  The  anterior  branches  of  the 
fcur  lower  cervical,  with  the  first  dorsal,  form  the  brachial  plexus. 

The  cervical  plexus  sends  off  the  following  :  superjicialis  colli,  which 
divides  into  a  descending  branch,  distributed  to  the  integument  on  the 
side  and  front  of  the  neck,  and  an  ascending  branch,  which  supplies  the 
integument  of  the  chin  and  lower  parts  of  the  face ;  auricularis  mag- 
nus,  the  largest  of  the  ascending  branches,  which  divides  at  the  parotid 
gland  into  an  anterior  branch,  distributed  to  the  gland,  adjacent  integu- 
ment, and  external  ear,  and  a  posterior,  which  pierces  the  parotid 
gland,  crosses  the  mastoid  process,  and  is  then  divided  into  branches  to 
supply  the  integument  of  the  side  of  the  head  and  back  part  of  the  pinna, 
sending  off  several  fticial  branches  to  the  cheek ;  occipitalis  minor^ 
which  arises  from  the  second  cervical,  and  is  distributed  to  the  muscles 
and  integument  of  the  external  ear  and  occipital  region ;  acromiales 
and  claviculares,  two  or  three  large  branches  distributed  to  the  integu- 
ment of  the  upper  and  front  part  of  the  chest ;  communicating,  fila- 
ments which  comiect  with  the  sympathetic,  pneumogastric,  and  hypo- 
glossal ;  muscular,  distributed  to  the  trapezius,  levator  anguli,  scapula?, 
and  rhomboidei  muscles ;  communicans  noni,  a  long,  slender  branch 
forming  a  loop  with  the  descendens  noni  over  the  sheath  of  the  carotid 
vessels ;  and  phrenic  (the  internal  respiratory  of  Charles  Bell),  which 
descends  to  the  root  of  the  neck,  crosses  the  subclavian  artery,  and 
enters  the  chest  between  it  and  the  subclavian  vein,  passes  through  the 
middle  mediastinum  and  in  front  of  the  root  of  the  lung  to  the  dia- 
phragm, to  which  it  is  distributed,  its  filaments  communicating  with 
the  phrenic,  solar,  and  hepatic  plexuses. 

The  posterior  cervical  plexus  gives  off  musculo-cutaneous  branches  to 
the  ligamentum  nuchas,  integument  of  the  back  part  of  the  neck,  and 
posterior  region  of  the  scalp ;  and  the  occipitalis  major,  which  is  diS' 
liibutod  to  the  mus-'les  of  the  no,ck  and  integument  of  the  scalp. 


178  ANATOMY. 

The  brachial  plexus  is  broad  in  the  neck,  naiTOwing  as  it  descends 
into  the  axilla,  enlai-ging  again  at  its  lower  part,  where  it  divides  into 
six  terminal  branches,  which  are  distributed  to  the  upper  extremity 
and  chest.  From  the  plexus  are  sent  off  superior  muscular  branches  to 
the  subclavius  and  rhonAoidei  muscles,  short  thoracic  to  the  two  pectoral 
and  deltoid  muscles,  long  thoracic  (external  respiratory  of  Bell)  to  the 
serratus  rangnns  muscle,  supra-scapular  to  the  supra-spinatis  and  infi-a- 
spinatis  muscles,  subscapular  to  the  subscapularis  muscle,  and  inferior 
muscular  to  the  latissimus  dorsi  and  teres  major.  The  terminal 
brandies  are :  the  external  cutaneous,  which,  piercing  the  coraco- 
brachialis  muscle,  passes  between  the  biceps  and  brachialis  anticus  to 
the  outer  side  of  the  elbow,  where  it  perforates  the  fascia,  and  divides 
into  two  branches ;  the  external  follows  the  course  of  the  radial  vein, 
communicating  with  branches  of  the  radial  nerve  on  the  back  of  the 
hand,  and  supplying  the  coraco-brachialis,  biceps,  brachialis  anticus, 
and  integuments  on  the  outer  side  of  the  fore-arm;  the  internal  cuta- 
neous, which  passes  down  the  inner  side  of  the  arm  with  the  basilic 
vein,  piercing  the  deep  fascia  about  the  middle  of  the  upper  arm,  and 
dividiug  into  two  branches ;  the  anterior  descends  along  the  palmarus 
longus  to  the  wi'ist,  supplying  the  integument  in  its  course ;  the  poste- 
rior supplies  the  integument  over  the  olecranon  and  inner  condyle,  and 
descends  the  fore-arm  along  the  ulnar  vein  to  the  wrist,  supplying  the 
integument  on  the  inner  side  of  the  fore-arm  ;  the  lesser  internal  cuta- 
neous, a  long,  slender  branch  which  descends  on  the  inner  side  of  the 
external  cutaneous  to  be  distributed  to  the  integument  of  the  elbow ; 
the  median,  which  arises  by  two  heads,  embracing  the  axillary  arteiy, 
crosses  the  brachial  aitery  at  its  middle,  descends  to  the  inner  bend 
of  the  elbow,  runs  down  the  fore-arm  between  the  flexor  sublimis  and 
profundus,  and  beneath  the  annular  ligament  into  the  palm  of  the  hand, 
where  it  divides  into  muscular,  anterior  interosseous,  superficial  palmar, 
and  digital  branches,  to  be  distributed  to  the  structures  of  the  fore- 
ai-m,  wrist,  and  fingers  :  the  ulnar,  Vf\i\c\i  arises  with  the  internal  head 
of  the  median,  runs  down  the  inside  of  the  arm  to  the  gi'oove  between 
the  internal  condyle  and  olecranon,  where  it  is  superficial  and  easil}^ 
compressed — giving  rise  to  the  painfully  thrilling  sensation  along  the 
inside  of  the  fore-arm  and  little  finger  when  a  blow  is  made  on  it 
against  the  inner  condyle — after  which  it  descends  along  the  inner  side 
of  the  fore-arm,  crosses  the  annular  ligament,  and  divides  into  super- 
ficial palmar  and  deep  palmar  branches,  which,  with  muscular,  artic- 
ular, and  anastomotic  branches  given  off  along  its  course,  are  disti'ibuted 
to  the  structures  of  the  arm,  fore-arm,  wrist,  and  hand,  and  communicate 
with  the  othe'   surrounding  branches  of  nerves:    the   muscido-spircu 


NEUROLOGY.  179 


nerve,  the  largest  branch  of  the  brachial  plexu*?,  which  descends  in 
front  of  the  tendons  of  the  latissimus  dorsi  and  teres  major  muscles, 
winds  around  the  humerus  in  the  spiral  groove,  and  passes  to  the 
elbow,  where,  after  sending  off  muscular  branches,  and  the  spiral  cuta- 
neous to  the  nerves,  muscles,  and  integument  in  its  course,  it  divides  into 
the  posterior  interosseous  and  radial  branches ;  the  radial  runs  along 
the  radial  side  of  the  fore-arm,  and  about  two  inches  above  the  wrist 
penetrates  the  deep  fascia,  and  divides  into  external  and  internal 
branches,  which  are  distributed  to  the  hands  and  fingers ;  the  inter- 
osseous supplies  all  the  muscles  on  the  posterioA*  aspect  of  the  fore-arm, 
and  a  descending  branch  of  it  forms  a  large  gangliform  swelling  on  the 
back  of  the  wrist,  from  which  branches  an<  distributed  to  the  joint; 
and  the  circumflex  nerve,  which  arises  with  t-ie  former,  winds  around 
the  neck  of  the  humerus  with  the  posterior  circumflex  artery,  and 
terminates  in  numerous  branches,  distributed  to  the  deltoid  muscle, 
after  sending  off  muscular  and  cutaneous  branches  to  the  muscles  and 
integuments  of  the  shoulder  and  arm. 


'S)' 


The  Dorsal  Nerves. — There  are  twelve  pairs  of  dorsal  nerves. 
Each  nerve,  as  it  emerges  from  the  intervertebral  foramen,  divides  into 
dorsal  and  intercostal  branches.  The  dorsal  pass  backward  between 
the  transverse  processes  of  the  vertebrae,  where  each  divides  into  a 
muscular  and  a  musculo-cutaneous  branch,  distributed  to  the  muscles 
and  integument  of  the  back ;  the  intercostal  branches,  which  are  the 
true  intercostal  nerves,  receive  filaments  from  the  adjoining  ganglia  of 
the  sj^mpathetic,  and  pass  forward  with  the  intercostal  vessels  in  the 
intercostal  spaces,  supplying  the  intercostal  muscles  in  their  course ; 
near  the  sternum  they  pierce  the  intercostal  and  pectoral  muscles,  sup- 
l)ly  the  mammary  glands,  and  are  finally  distributed  to  the  muscles 
and  integument  in  front  of  the  chest  and  abdomen. 

The  Lumbar  Nerves. — Of  these  there  are  five  pairs ;  the  first 
passes  out  between  the  first  and  second  lumbar  vertebrae,  and  the  last 
between  the  lower  lumbar  vertebra  and  sacrum.  At  their  origin  the 
anterior  branches  communicate  with  the  lumbar  ganglia  of  the  sym- 
]nithetic,  and  pass  obliquely  outward  behind  the  i)soas  magnus  muscle, 
where  they  intercommunicate  and  anastomose  to  form  the  lumbar 
j)lexus.  The  posterior  branches  divide  into  internal  branches,  which 
are  distributed  to  the  adjacent  muscles  and  integuments,  and  external, 
which  intercommunicate,  and,  after  supplying  the  deep  muscles,  are 
distributed  to  the  integument  of  the  gluteal  region.  The  lumbar 
plexus  gives  off  the  following  branches:  1    Mnsculo-cntaneous  \  which 


180  ANATOMY. 


divides  into  a  superior  biancb,  and  this,  after  winding  around  the  crest 
of  the  ilium,  divides  into  abdominal  and  scrotal  branches,  the  former 
of  which  is  disti'ibuted  to  the  integument  of  the  groin  and  around  the 
pubis,  and  the  latter  accompanies  the  spermatic  cord  in  the  male,  and 
round  ligament  in  the  female,  to  supply  the  integument  of  the  scrotum 
and  internal  labium ;  and  an  inferior  branch,  which  passes  along  the 
spermatic  cord,  to  be  distributed  to  the  genital  organs.  2.  External 
cutaneous ;  which  passes  into  the  thigh  beneath  Poupart's  ligament, 
and  divides  into  a  posterior  branch,  which  supplies  the  integument  of 
the  thigh,  and  an  anterior  bi*anch,  which  is  distributed  to  the  integu- 
ment on  the  outer  border  of  the  thigh  and  to  the  articulation  of  the 
knee.  3.  Genito-crural ;  which  runs  on  the  anterior  surface  of  the 
psoas  magnus  muscle  to  near  Poupart's  ligament,  where  it  divides  into 
a  genital  branch,  which  descends  along  the  spermatic  canal,  to  be  dis- 
ti'ibuted to  the  spermatic  cord  and  cremaster  muscle  in  the  male,  and 
the  round  ligament  and  external  labium  in  the  female,  and  a  crural 
branch,  which  enters  the  sheath  of  the  femoral  vessels,  and  is  distrib- 
uted to  the  anterior  aspect  of  the  thigh.  4.  Crural,  or  femoral ;  the 
•argest  division  of  the  lumbar  plexus  is  formed  by  the  union  of  branches 
from  the  second,  third,  and  fourth  lumbar  nerves,  passes  into  the  thigh 
beneath  Poupart's  ligament,  then  spreads  out  and  divides  into  numerous 
branches  :  a.  cutaneous,  two  nerves  which  perforate  the  sartorius  mus- 
cle, and  are  distributed  to  the  integument  of  the  middle  and  lower  part 
of  the  thigh  and  kneo  ;  b.  muscular,  round,  lai'ge  twigs,  disti'ibuted  to 
the  muscles  of  the  anterior  aspect  of  the  thigh,  sending  filaments  to  the 
periosteum  and  knee  joint ;  c.  aponeurotic,  to  the  sheath  of  the  femoral 
vessels  and  adjacent  muscles ;  d.  short  saphenous,  which  divides  at  the 
sheath  of  the  fem.oral  vessels  into  a  superficial  branch,  which  runs 
down  to  the  knee  joint,  and  terminates  by  communicating  with  the  long 
saphenous  nerve,  and  a  deep  branch,  which  divides  at  the  termination 
of  the  femoral  arteiy  into  sevend  filaments,  which  communicate  with 
other  nerves  to  form  a  plexus,  some  of  whose  filaments  are  distributed 
to  the  integument  on  the  posterior  part  of  the  thigh;  e.long  sapheyious, 
which  enters  the  femoral  sheath,  and  descends  along  the  inside  of  the 
leg  with  the  internal  saphenous  vein,  crosses  in  front  of  the  inner  ankle, 
and  is  disti'ibuted  to  the  integument  on  the  inner  side  of  the  foot.  In 
its  course  it  receives  a  communicafmg  branch  from  the  obturator,  near 
the  division  of  the  femoral  nrteiy,  find  another  at  the  internal  condyle, 
and  gives  of^  a  femoral  cutaneous  branch,  a  tibial  cutaneous  hronch,  and 
an  articular  branch,  to  the  integument  of  the  inner  and  back  part  of 
the  thigh,  the  inner  aspect  of  the  leg,  around  the  knee  joint,  the  front 
anc  cute?"  aspect  of  the  leg,  and  the  ankle  joint.    5.  Obturator  ;  formed 


NEUROLOGY.  181 

by  a  branch  from  the  third  and  another  from  the  fourth  lumbar 
nerve,  passes  through  the  angle  of  bifurcation  of  the  common  iliacs, 
and  along  the  brim  of  the  pelvis  to  the  obturator  foramen,  where  it 
joins  the  obturator  artery.  After  emerging  from  the  pelvis  it  gives  oif 
twigs  to  the  obturator  externus  muscle,  and  divides  into  four  branches ; 
three  anterior,  which  supply  the  adductor  brevis,  pectineus,  adductor 
longus,  and  gracilis  muscles,  and  a  posterior  which  ramifies  in  the  adduc- 
tor magnus ;  from  the  anterior  branches  a  communicating  filament  pro- 
ceeds to  unite  with  the  long  saphenous,  and  a  long  cutaneous  branch 
descends  to  the  inner  side  of  the  knee,  where  it  communicates  with 
the  long  saphenous ;  and  from  the  posterior  branch  an  articular  branch 
is  given  ofif,  which  accompanies  the  popliteal  artery,  to  be  distributed 
to  the  back  part  of  the  synovial  membrane  of  the  knee  joint.  6. 
Lumbar  sacral ;  descends  over  the  base  of  the  sacrum  into  the  pelvis, 
and  forms  a  part  of  the  sacral  plexus. 

The  Sacral  Nerves. — There  are  six  pairs  of  sacral  nerves ;  the 
first  pass  out  of  the  vertebral  canal  through  the  first  sacral  foramina, 
and  the  two  last  between  the  sacrum  and  coccyx.  The  posterior  are 
very  small,  and  are  distributed  to  the  integument  over  the  sacrum  and 
coccyx  and  gluteal  region.  The  anterior  diminish  in  size  from  above 
downward  ;  they  are  distributed  to  the  muscles  and  integuments  around 
the  coccyx  and  anus ;  many  of  their  branches  are  connected  in  the 
formation  of  the  sacral  plexus ;  they  send  communicating  branches  to 
the  hypogastric  plexus,  and  receive  branches  from  the  sacral  ganglia  of 
the  sympathetic. 

The  Sacral  Plexus. — The  sacral  plexus  is  formed  by  the  lumbo- 
sacral and  anterior  branches  of  the  four  upper  sacral  nerves.  It  is 
triangular  in  form,  its  base  corresponding  to  the  sacrum,  and  its  apex  to 
the  lower  part  of  the  great  ischiatic  foramen.  Its  branches  are  :  1. 
Visceral ;  three  or  four  branches,  which  ascend  by  the  rectum  and 
bladder  in  the  male,  and  in  the  female  upon  the  side  of  the  rectum,  the 
vagina,  and  bladder,  supplying  those  viscera,  and  communicating  with 
the  hypogastric  plexus.  2.  Internal  muscular ;  given  off  within  the 
Tjelvis ;  an  obturator  branch  to  the  obturatus  internus,  a  coccygeal 
branch,  and  a  hemorrhoidal  nerve,  which  descends  to  the  rectum, 
supplying  the  spiucter  and  integument.  3.  External  muscular ;  sev- 
eral branches,  di.stributed  to  the  capsule  of  the  hip  joint  and  suri'ound- 
mg  nmscles.  4.  Gluteal ;  passes  out  of  the  pelvis  with  the  gluteal 
irtery,  and  divides  into  a  superior  branch,  which  goes  to  the  gluteus 
Giedius  and  minimus,  and  an  inferior,  which  is  distributed  v/ith  th« 
15 


182  ANATOxMY. 


above,  and  also  to  the  tensor  vaginie  femoris.  5.  Internal  jpudic , 
passes  out  of  the  pelvis  with  the  foroer,  and  divides,  beneath  the  ob- 
turator fascia,  into  a  superior  branch  (dorsalis  penis),  which  accom- 
panies the  dorsal  artery  of  the  penis  to  the  glans,  and  is  there  distrib- 
uted, supplying  filaments  to  the  corpus  cavernosum,  integument,  and 
prepuce,  and  an  inferior  branch  (perineal  nerve),  which  supplies  the 
scrotum,  and  sends  branches  to  the  integuments  of  the  under  part  of 
the  penis,  prepuce,  sphincter  ani,  ti-ap<«ve.'6us  perinei,  and  accelerator 
urina%  and  terminates  by  ramifying  in  the  corpus  spongiosum.  In  the 
female  the  internal  pudic  is  disti'ibuted  to  the  parts  analogous  to  those 
of  the  male ;  the  superior  branch  supplies  the  clitoris,  alid  the  inferior 
the  vulva  and  parts  in  the  perineum.  6.  Lesser  isckiatic ;  passes  out 
of  the  pelvis  through  the  gi-eat  iscliiatic  foramen,  and  divides  into  mus- 
cular branches  (inferior  gluteal),  which  are  disti'ibuted  to  the  gluteus 
maximus  ;  and  cutaneous,  which  send  ascending  filaments  to  the  gluteal 
integument;  the  perineal  cutaneous  nerve,  down  the  inside  of  the  testis 
to  the  scrotum  and  integument  on  the  under  side  of  the  penis ;  and 
the  middle  posterior  cutaneous,  which  is  distributed  to  the  integuments 
of  the  thigh  and  leg  at  the  middle  of  the  calf.  7.  Great  iscliiatic ; 
this  is  the  largest  nervous  cord  in  the  whole  body.  It  is  a  prolongation 
of  the  sacral  {ylexus,  and  measures,  at  its  exit  from  the  gi-eat  sacro- 
ischiatic  foramen,  three  fourths  of  an  inch  in  breadth.  It  descends  be- 
t>veen  the  ti'ochanter  major  and  tuberosity  of  the  ischium,  and  along 
the  back  part  of  the  thigh  to  its  lower  thh'd,  where  it  divides  into  ter- 
minal branches,  called  popliteal  and  p>eroneal.  Previous  to  its  division 
it  sends  oflf  muscular  branches  to  the  semi-tendinous,  semi-membrano- 
sus,  and  adductor  magnus,  and  articular  branches,  which  descend  to  be 
distributed  to  the  capsule  and  synovial  membrane  of  the  knee  joint. 

The  popliteal  nerve  passes  down  externally  to  the  vein  and  artery, 
and  after  sending  off  muscular  branches  to  the  gastrocnemius,  soleus, 
plantaris,  and  popliteus,  an  articular  to  the  interior  of  the  knee  joint, 
and  a  communicating,  a  large  "^erve  descending  between  the  heads  of  the 
gastrocnemius,  and  forming  Lelow  the  knee,  with  a  connecting  branch 
from  the  peroneal  nerve,  the  external  saphenous  neiTe,  it  becomes  the 
posterior  tibial.  The  external  saphenous  peneti-ates  the  deep  fascia  below 
the  fleshy  part  of  the  gastrocnemius,  and  passes  down  the  leg  along  the 
outer  border  of  the  tendo-Achillis,  winds  around  the  outer  malleolus, 
and  is  disti'ibuted  to  the  outer  side  of  the  foot  and  little  toe,  sending 
numerous  filaments  to  the  integument  of  the  heel  and  sole  of  the  foot. 

The  posterior  tibial  nerve  continues  along  the  back  of  the  leg  from 
trie  lower  border  of  the  popliteus  ir.uscle  to  the  back  of  the  inner  ankle, 
where  it  divides  into  fc:3  interns^   inc  external  plantar  nerve ;   in  its 


NEUROLOGY.  183 


course  it  sends  nmscular  branches  to  the  deep  muscles,  one  or  two 
filaments  which  entwine  around  the  fibular  artery,  and  then  terminate 
in  the  integument,  and  plantar  cutaneous  branches,  which  pass  down 
the  inner  side  of  the  os  calcis,  to  be  distributed  to  the  integument  of 
^he  heel. 

The  internal  plantar  mrve  crosses  the  posterior  tibial  vessels,  to 
enter  the  sole  of  the  foot,  and  is  distributed  to  the  toes,  integument, 
and  tarsal  and  metatarsal  articulations. 

The  external  plantar  nerve  is  smaller  than  the  former,  and  is  dis- 
ribul.ed  to  the  outer  side  of  the  foot,  the  little  toe,  and  outer  side  of 
the  second. 

The  peroneal  nerve  passes  dowm  by  the  tendon  of  the  biceps,  crosses 
the  head  of  the  gasti'ocnemius  to  the  neck  of  the  fibula,  where  it  divides 
into  the  anterior  tibial  and  musculo-cutaneous. 

The  anterior  tibial  nerve  descends  the  anterior  aspect  of  the  leg 
with  the  artery  to  the  ankle,  where  it  passes  beneath  the  annular  liga- 
ment, and  accompanies  the  dorsalis  pedis  artery  to  supply  the  adjoining 
sides  of  the  great  and  second  toes,  distribating,  in  its  course,  filaments 
to  the  muscles  and  articulations  of  the  tarsus  and  metatarsus. 

The  inusculo-culaneous  nerve  passes  dow^nward  in  the  direction  of 
the  fibula,  and  at  the  lower  third  of  the  leg,  where  it  pierces  the  deep 
fascia,  and  divides  into  two  peroneal  cutaneous  branches,  which  pass  in 
front  of  the  ankle  joint,  to  be  distributed  to  the  integument  of  the  foot 
and  toes,  after  sending  filaments  to  adjacent  muscles,  and  communicat- 
ing branches  to  the  saphenous  and  anterior  tibial  nerves. 

THE    ORGANIC    NERVES. 

The  organic  nerves,  commonly  called  the  sympathetic  or  ganglionic 
system,  consist  of  a  series  of  ganglia  extending  along  both  sides  of  the 
rertebral  column,  which  disti'ibute  branches  to  all  the  internal  organs 
and  viscera,  and  communicate  with  all  the  other  nerves  of  the  body. 

The  branches  of  distribution  accompany  the  arteries  which  supply 
the  different  organs,  and  form  communications  around  them  called 
j)lexuses,  which  are  named  after  the  arteries,  as  mesenteric,  hepatic, 
ispienic,  etc.,  plexuses. 

Cranial  Ganglia. — There  are  five  ganglia  in  the  head  :  1.  Gan- 
glion  of  Ribes,  situated  upon  the  anterior  communicating  artery ;  it  is 
the  superior  point  of  union  between  the  chains  of  opposite  sides  of  the 
body.  2.  Ciliary  ganglion,  a  small,  flattened  body  within  the  orbit, 
between  the  optic  nerve  and  external  rectus  muscle  ;  its  branches  of 
distribution  supply  the  coats  of  the  eye. 


184 


A  NATO  M  Y. 


CRAjriAL    GAXGLIA. 


Fie.  93.  Fig.  93  is  a  repre- 

Bentation  of  cranjal 
ganglia  of  tne  organ- 
ic system.  1.  Gan- 
glion of  Ki>^«>9  2.  A 
filament  by  which  it 
commumcates  with 
the  carotid  plexua 
(3).  4.  Ciliary  or 
lenticular  ganglion, 
giving  off  ciliary 
branches  to  the 
globe  of  the  era.  5. 
Part  of  the  inferior 
division  of  the  third 
nerve,  receiving  a 
short,  tliick  branch 
(the  short  root)  from 
the  ganglion.  6.  Part 
of  the  nasal  nerve, 
receiving  a  longer 
branch  (the  long 
root)  from  the  gan- 
glion. 7.  A  slender 
filament  (the  sympa- 
thetic root),  sent  directly  backward  from  the  ganglion  of  the  carotid  plexus.  8.  Part 
of  the  sixth  nerve  in  the  cavernous  sinus,  receiving  two  branches  from  the  carotid 
plexus.  9.  Meckel's  g;inglion  (spheno-palatine).  iJ.  Its  ascending  brancnes,  communi- 
cating with  the  superior  maxillary  nerve.  11.  Its  descending,  or  palatine  brancnes.  12. 
Its  internal  branches,  spheno-palatine,  or  nasal.  13  The  nasopalatine  branch.  OTie  of  the 
nasal  branches.  14.  Posterior  branch  of  the  ganglion,  the  A'idian  nerve.  15.  Its  carotid 
branch  communicating  with  the  carotid  plexus,  id.  Its  petrosal  orancn,  jommg  liia 
inrumescentia  ^'anghformis  of  the  facial  nerve.  17.  Facial  nerve.  18.  Ctiorda  t)'n:;:ani, 
■which  descends  to  join  the  gustatory.  19.  Gustatory  nerve.  20.  Submaxillary  ganglion, 
receiving  the  corda  tympani  and  other  filaments  from  the  gustatory.  21.  Superior  cer- 
vical ganglion  of  the  sympathetic. 

3.  Spheno-palatine  ganglion  (Meckel's),  the  lai'sest  of  the  crania] 
ganglia,  situated  in  the  spheno-maxillary  fossa-  Its  branches  of  disti-i- 
bution  are :  nasal,  or  splieno-palallne,  four  or  five  in  number,  wli'-'h 
enter  the  nasal  fossa  through  the  spheno-palatine  foramen,  and  supply 
the  raucous  membrane  and  spongy  bones  of  the  nose,  and  the  upper 
pait  of  the  phaiynx  and  the  Eustachian  tube;  the  naso-palatine  to  the 
septum  of  the  nose  and  palate;  the  anterior  paiotine  to  the  hard  palate, 
bones  of  the  nose,  and  the  anti'um;  the  middle  palatine  to  the  tonsil, 
soft  palate,  and  uvulva ;  and  the  posterior  palatine  to  the  hard  palate, 
gums,  tonsil,  and  soft  palate.  Its  communicating  branches  join  the 
superior  maxillary,  abducens,  and  optic  nerves,  and  the  ciliary  gHnglion. 
The  posterior  branch  is  the  Vidian  or  pterygoid  nerve,  which  passes 
to  the  foramen  lacerum.  and  divides  into  carotid  and  petrosal  branches 
to  the  carotid  plexus  and  the  gangliform  enlargement  of  the  facial  nei've, 


NEUROLOGY.  185 


It  also  sends  a  filament  to  the  otic  ganglion.  4.  Otic  ganglion  (Arnold's), 
is  u  small,  oval  ganglion,  situated  on  the  inferior  maxillary  nerve,  im- 
mediately below  the  foramen  ovale.  It  sends  off  two  branches  of  dis- 
tribution, one  to  the  tensor  palati  muscle,  and  one  to  the  tensor  tjan- 
pani,  and  branches  of  communication  to  the  auricular,  chorda  tympani, 
nervi  molles,  facial,  and  Vidian  nerves,  and  the  focial  and  Casserian 
ganglions.  5.  Suhmaxillary  ganglion,  a  small,  triangular  ganglion  upon 
the  submaxillary  gland ;  it  sends  branches  of  disti'ibution  to  the  gland 
and  Wharton's  duct,  and  communicating  branches  to  the  gustatory, 
facial,  and  nervi  molles. 

The  Carotid  Plexus. — The  carotid  plexus  is  formed  of  the  divi- 
sions of  the  ascending  branch  of  the  superior  cervical  ganglion  in  the 
carotid  canal,  where  they  form  several  loops  with  each  other  around 
the  artery,  together  with  branches  derived  from  the  petrosal  branch 
of  the  Vidian.  The  continuation  of  this  plexus  onward  by  the  side  of 
the  sella  turcica  is  called  the  cavernous  plexus.  It  is  the  centime  of 
communication  between  all  the  cranial  ganglia,  and  being  derived  from 
the  superior  cervical  ganglion,  between  the  cranial  ganglia  and  those 
of  the  ti'unk,  it  also  communicates  with  most  of  the  cerebral  nerves, 
and  distributes  filaments  with  each  of  the  branches  of  the  internal  caro- 
tid, Vv'hich  accompany  those  branches  in  all  their  ramifications. 

Cervical  Ganglia. — The  cervical  ganglia  are  three  in  number  on 
each  side.  1.  Superior  cervical ;  along,  grayish-colored  ganglion,  ex- 
tending from  within  an  inch  of  the  carotid  foramen  in  the  petrous  bone 
to  the  third  cervical  vertebra.  It  sends  a  superior  branch  to  the  carotid 
canal,  whose  divisions  and  intercommunications  with  each  other,  and 
with  the  petrosal  branch  of  the  Vidian,  constitute  the  carotid  plexus 
before  described ;  an  inferior  or  descending  branch  to  the  middle  cer- 
vical ;  numerous  external  branches  to  the  glosso-pharyngeal,  pneumo- 
gastric,  hypoglossal,  and  the  first  three  cervical  nerves ;  three  internal 
branches,  to  the  pharyngeal  plexus,  superior  laryngeal  nerve,  and  su- 
perior cardiac  nerve  ;  and  anterior  branches,  called  from  their  softness 
nervi  molles,  which  accompany  the  carotid  artery  with  its  branches, 
around  which  they  form  intricate  plexuses,  and  occasional^  small  gan- 
glia. 2.  Middle  cervical  (thyroid  ganglion) ;  of  small  size,  situated 
opposite  the  fifth  cervical  vertebra,  and  resting  on  the  inferior  thyroid 
artery.  It  sends  a  superior  branch  to  the  superior  cervical  ganglion ; 
infe  'ior  branches  to  the  inferior  cervical  ganglion ;  external  branches  tc 
the  third,  fourth,  and  fifth  cervical  nerves;  and  internal  branches  to 
the    inferior   thyroid   plexus  and   artoiy,   and    middle  cardiai:    nerve. 


188 


ANATOMY. 


Fig.  94. 


GANGLIONIC    SYSTEM. 


In  Fig.  94  is  presented 
a  view  of  the  organic  or 
synipathetx  sysUm.  A 
AAA.  Semilunar  gan- 
glion and  solar  plex- 
us. B.  Small  splanch- 
nic nerve.  C.  Great 
splanchnic  nerve.  D 
D  D.  Thoracic  ganglion. 

E.  Internal    branches- 

F.  External    brancheH. 

G.  Right  coronarj'  plex- 
us. H.  Left  coronary 
plexus.  I.  Inferior  cer 
vical  ganglion.  J.  In 
ferior  twigs.  K.  Exter 
nal  threads.  L.  Inter* 
nal  twigs.  M.  Anterior 
threads.  N.  Middle  cer- 
vical ganglion.  O.  In- 
terior twigs.  P.  Exter- 
nal twigs.  Q.  Superior 
cervical  ganglion.  IL 
Superior  branches.  S. 
Inferior  branch.  T.  Ex- 
ternal branches.  U. 
Submaxillary  gland.  V. 
Vidian  nerve.  \V.  Na- 
so-palatine  branch.  X. 
Spheno-palatine  gangli- 
on. Y.  Ophthalmic  gan- 
glion.  Z.  Auditory 
nerve.  1.  Renal  plex- 
uses. 2.  Lumbar  gan- 
glia. 3.  Internal  branch- 
es. 4.  External  branch- 
es.   5.  Aortic  plexus 

3.  Inferior  cervi- 
cal ;  of  a  semilunar 
form,  situated  upon 
the  base  of  the 
transverse  process 
of  the  seventh  cer- 
vical vertebra,  ami 
hence  called  ^^ver- 
tebral ganglion. " 
It  sends  superior 
branches  to  the 
midile  cervical 
ganglion ;    inferior 


NEUROLOGY.  187 


to  the  fii-st  thoracic  ganglion ;  external  to  the  dorsal  nerves  and  vertebral 
plexus  ;  and  internal  branches  to  the  inferior  cardiac  nerve. 

The  Cardiac  Nerves. — The  superior  cardiac  arises  fi'om  the  lower 
^part  of  the  superior  cervical  ganglion,  and,  descending  the  neck,  passes 
behind  the  arteria  innoiuinata,  and  joins  the  cardiac  ganglion  below  the 
arch  of  the  aorta,  receiving  in  its  coui'se  branches  from  the  pneurao- 
gastric,  and  sending  filaments  to  the  thyroid  gland  and  trachea.  The 
middle  cardiac  proceeds  from  the  middle  cardiac  ganglion ;  it  is  the 
largest  of  the  three  nerves,  and  at  the  root  of  the  neck  divides  into 
several  branches,  and  communicates  with  the  superior  and  inferior  car- 
diac, the  pneumogastric,  and  recurrent  nerves,  and  descends  to  the 
great  cardiac  plexus  at  the  bifurcation  of  the  trachea.  The  inferior 
cardiac  arises  from  the  inferior  cervical  ganglion,  communicates  with 
the  recurrent  laryngeal  and  middle  cardiac,  and  descends  to  the  gi*eat 
cardiac  plexus. 

The  cardiac  ganglion  is  a  variable  enlargement  beneath  the  arch  of 
the  aorta,  which  receives  the  superior  cardiac  nerves  and  a  branch  from 
the  pneumogastric,  and  gives  oft'  numerous  branches  to  the  cardiac 
plexuses.  The  great  cardiac  plexus  is  situated  upon  the  bifurcation 
of  the  trachea,  above  the  right  pulmonary  arter}^  and  behin<1  ^^V^e  arch 
of  the  aorta ;  the  anterior  cardiac  plexus  is  situated  in  front  of  the 
ascending  aorta,  near  its  origin;  ihe  posterior  cardiac  plexus  rests  upon 
the  posterior  part  of  the  ascending  aorta,  near  its  origin.  These  plex- 
uses intimately  intercommunicate  with  each  other  and  with  the  neigh- 
boring nerves,  and  supply  the  heart.  Two  sets  of  branches  fi'om  the 
posterior  cardiac  constitute  the  posterior  coronary  plexus ;  and  the  an- 
terior and  posterior  2)uh)ionary  plexuses  are  formed  in  part  by  branches 
from  the  great  cardiac  plexus. 

Thoracic  Ganglia. — There  are  twelve  thoracic  or  dorsal  ganglia 
on  each  side,  resting  upon  the  head  of  the  ribs ;  their  form  is  irregu- 
lar, but  they  present  the  peculiar  gray  color  and  pearly  lustre  of  the 
other  organic  ganglia.  They  send  superior  and  inferior  branches,  to 
f'ommunicute  with  the  ganglia  above  and  below,  two  or  three  external 
branches  to  the  roots  of  each  of  the  spinal  nerves,  internal  branches  to 
the  pulmonary,  oesophageal,  and  cardiac  plexuses,  and  splanchnic,  sev- 
eral large  cords  from  the  lower  ganglion,  which  unite  to  form  the 
sptlanchnic  nerve. 

The  great  splanchnic  nerve  arises  from  the  sixth  dorsal  ganglion, 
and,  receiving  branches  from  the  seventh,  eighth,  ninth,  and  tenth,  de^ 
Bcends  in  front  of  the  vertebral  column,  witliin  the  preterior  mediasti- 


188  ANATOMY. 


num,  pierces  the  diaphragm,  and  terminates  in  the  semilunar  ganglior». 
The  lesser  splanchnic  (renal)  is  formed  by  filaments  from  the  three 
lower  dorsal  ganglia,  pierces  the  diaphragm,  and  deiceuds  to  join  the 
renal  j^lexus. 

The  semilunar  ganglion  is  a  large,  LTegular  body,  pierced  by  numer-  * 
ous  openings,  and  appearing  like  an  aggregation  of  smaller  ganglia  with 
intenening  spaces.  It  is  situated  by  the  side  of  the  ccEliac  axis,  upon 
the  aorta,  and  communicates  with  the  ganglion  of  the  opposite  side, 
both  above  and  below  that  trunk,  forming  a  ganglifonn  circle,  from 
which  branches  pass  off  radiatingly  in  al'.  directions ;  hence  the  entire 
circle  is  called  the  solar  plexus.  It  is  undoubtedly  the  presiding  centre^ 
or  great  brain  of  the  organic  system,  and  probably  the  starting  point  in 
the  development  of  all  organized  beings.  Various  sensations  usually 
refeiTed  to  the  heart  liave,  no  doubt,  their  source  in  this  ganglion. 

The  solar  plexus  receives  the  great  splanchnic  and  pait  of  the  lesser 
splanchnic  nerves,  the  termination  of  the  right  pneumogHsti'ic,  branches 
from  the  right  phrenic,  and  sometimes  filaments  from  the  left,  and 
transmits  numerous  filaments  to  accompany,  as  plexuses,  all  the  branches 
given  off  by  the  abdominal  aorta,  being  the  phrenic,  gastric,  hepatic 
splenic,  supra-renal,  renal,  superior  mesejiteric,  spermatic,  and  inferior 
mesenteric  plexuses,  all  derived  from  the  solar  plexus. 

LujiBAR  Ga>*glia. — There  are  four  lumbal*  ganglia  on  each  side, 
situated  upon  the  anterior  part  of  the  bodies  of  the  lumbar  vertebrae. 
Their  superior  and  inferior  branches  communicate  with  the  ganglia 
above  and  below ;  their  external  branches  communicate  with  the  lum- 
bar nerves;  and  theu'  internal  branches  interlace  around  the  abdominal 
aorta,  constituting  the  lumbar  aortic  plexus,  and  again  over  the  promon- 
toiy  of  the  sacrum,  forming  the  hypogastric  plexus^  which  distributes 
branches  to  all  the  viscera  of  the  pelvis. 

Sacral  Ganglia. — The  sacral  ganglia  are  four  or  five  in  number 
on  each  side,  situated  near  the  anterior  sacral  foramina.  Their  superior 
and  inferior  branches  communicate  with  the  ganglia  above  and  below ; 
the  external  with  the  sacral  nei"ves ;  and  the  internal  are  disn-ibuted  to 
the  pelvic  viscera,  sending  brunches  to  the  hypogasti'ic  plexus.  The 
lower  sacral  ganglia  give  off  branches  which  join  the  azygos  ganglion 
on  the  coccyx,  which  connects  the  ganglionic  system  iofeir^nly,  as  the 
ganglion  of  Ribes  does  superiorly. 


ORGANS    OF    THS    EXTERNAL    SENSES. 


189 


CHAPTER  IX. 

.  ORGANS   OF   THE  EXTERNAL   SENSES. 

The  organs  of  sense,  which  bring  the  animal  machine  into  relation 
with  external  objects,  ai*e  five  ;  four  of  them,  the  apparatus  of  smell, 
sight,  hearing,  and  taste,  are  situated  within  the  head,  while  the  organ 
of  touch,  resident  in  the  skin,  is  disti'ibuted  over  the  entire  surface. 

THE    ORGAN    OF    SMELL. 

The  external  parts  of  the  organ  of  smell  are  called  the  nose^  and  the 
internal  parts  the  nasal  fosses. 

The  Nose. — The  anatomical  parts  of  the  noso  are  :  The  nostrils, 
which  overhang  the  mouth,  and  are  so  constnicted  that  the  odors  of  all 
substances  must  be  received  by  the  nose  before  they  can  be  introduced 
within  the  lips;  the  columna,  or  partition  between  the  nosti'ils ;  the 
•cihrisscE,  stiff  hairs  which  project  across  the  openings,  and  guard  their 
entrance  ;  the  fibre -cartilaginous  integument,  which  forms  the  tip,  called 
lobulus,  and  wings,  called  ales;  the  muscles,  already  described;  the 
bones — nasal  and  nasal  processes  of  the  superior  maxillary ;  the  mucous 
membrane,  lining  its  interior;  the  arteries,  from  the  f.icial  and  supra 
coronary;  and  the  nerves,  which  are  the  facial,  infra-orbital,  and  nasa 
branch  of  the  ophthalmic. 

Fig.  95  shows  the  fibro-cartilages  of  the  nose.     1.  One  of  Fig.  9.5. 

the  nasal  bones.  2.  Fihro-cartilage  of  the  septum.  3.  Lateral 
fibro-cartUage.  4.  The  alar  fibro-cartilage.  5.  Central  por- 
tions of  the  alar  fibro-cartilages.  which  constitute  the  colum- 
na.     6.  Appendix  of  the  alar  fibro  cartilage.     7.  Nostril. 

Nasal  Foss.a:. — The  nasal  fossas  are  two  ir- 
regular compressed  cavities  extending  backward 
from  the  nose  to  the  pharynx.  They  are 
bounded  above  by  the  lateral  cai'tilage  of  the 
nose,  and  the  nasal,  sphenoid,  and  ethmoid 
bones  ;  below  by  the  hard  palate.  On  the  outer 
waU  of  each  fossa  are  three  projecting  processes, 
called  spongy  bones ;  the  two  superior  belong  to 
the  ethmoid,  and  the  inferior  is  a  separate  bone ; 
they  increase  the  surface  upon  which  the  mu- 
cous membrane  is  spread  out.  The  spaces  be- 
tween the  upper  and  middle,  the  middle  and  lower,  and  lower  and 
floor  of  the  ncstrils.  are  the  superior,  middle,  an!  inferior  meatuses 


NASAL    CARTILAGES. 


190 


ANATOMY. 


In  the  superior  meatus  are  several  openings  into  the  nasal  fossae  of  the 

sphenoidal  and  posterior  ethmoidal  cells;  in  the  middle  the  anterior 
ethmoidal  cells,  the  frontal  sinuses,  and  the  antrum  maxillare;  and  in 
the  inferior  the  termination  of  the  nasal  duct. 

The  mucous  membrane  of  the  nasal  fossae  is  called  pituitary  or 
Schnciderian ;  it  is  continuous  with  the  lining  membrane  of  the  gastro- 
pulnionary  cavities,  and  extends  in^o  the  sphenoidal  and  ethmoidal  cells, 
fi'ontal  sinus,  and  antnim,  through  the  nasal  duct  to  the  eye,  where  it 
is  continuous  with  the  conjunctiva;  along  the  Eustachian  tubes  into  the 
tympanum  and  mastoid  cells,  and  through  the  posterior  nerves  into  the 
pharynx  and  moutli,  thence  through  the  lungs  and  alimentary  canal.  Its 
surfiice  is  furnished  with  a  delicate  columna  epithelium,  supporting 
innumerable  vibratile  cilia. 

The  arteries  of  the  nasal  fossae  are  the  anterior  and  posterior  ethmoi- 
dal branches  from  the  ophthalmic,  and  the  spheno-palatine  and  pterygo- 
palatine from  the  internal  maxillary.     The  nerves  are :  The  olfactory, 
Y]a  0,6  ^^^®     spheno-palatine     branches 

from  Meckel's  ganglion,  and  the 
nasal  branch  of  the  ophthalmic. 
The  ultimate  filaments  of  the  ol- 
factory terminate  in  papillae. 

Fig.  96  is  a  vertical  section  of  the  mid- 
dle part  of  the  cavities  of  the  nose.  7. 
Middle  spongy  bones.  8.  Superior  part 
of  the  nasal  cavities.  10.  Inferior  spongy 
bones.  11.  Vomer.  12.  Upper  jaw.  13. 
Middle    meatus.      14.    Inferior    meatus. 

17.  Palatine  process  of  the  upper  jaw. 

18.  Roof  of  the  mouth,  covered  by  mu- 
cous membrane.      19.   A  section  of  the 

NASAL  CAVITIES.  mucous  membrane. 


OF    THl-    CRGAN    OF    SIGHT. 

The  Structures  of  the  visual  organ  may  be  conveniently  divided  into 
three  classes :  the  coats,  humors,  and  appendages  of  the  eye.  The 
eyeball  is  of  a  spherical  form,  about  one  inch  in  diameter.  The  globe 
of  the  eye  is  composed  of  three  coats,  or  tunics,  and  three  humors. 

Outer  Coat,  or  First  Tunic. — The  first  coat  of  the  eyeball  is 
foiTned  of  the  sclerotic  and  cornea.  The  sclerotic  is  a  dark,  fibrous 
membrane,  investing  about  four  fifths  of  the  globe.  Its  anterior  surface 
is  covered  with  a  tendinous  layer,  called  the  tunica  albuginea,  which 
is  derived  from  the  expansion  of  the  tendons  of  the  four  recti  muscles. 
A  part  of  the  tuni:;a  a.:uginea  is  covered  by  a  mucous  membrane 


ORGANS    OF    THE    EXTERNAL    SENSES. 


19*. 


called  the  conjunctiva,  which  constitutes  the  "white  of  the  ej^e."  The 
sclerotic  forms  a  thin,  sieve-like  plate,  called  lamina  cribrosa,  at  the 
enti'ance  of  the  optic  nerve  ;  this  lamina  is  full  of  openings  for  the  pas- 
sage of  nervous  filaments.  The  largest  of  these  openings  in  the  centi'e 
is  called  the  porus  opticus,  through  which  the  arteria  centralis  retince 
— central  artery  of  the  retina — enters  the  eyeball.  The  cornea  con- 
stitutes the  anterior  fifth  of  the  globe.  It  is  circular,  ti'ansparent,  and 
resembles  a  watch-glass.  It  is  received  into  the  gi'ooved  edge  of  the 
sclerotic  in  the  manner  that  a  watch-glass  is  received  into  its  case.  It 
is  composed  of  four  layers,  the  external  being  the  white  membrane,  or 
conjunctiva,  before  mentioned. 


Fig.  97. 


Fig.  97  is  a  longitudinal 
section  of  the  globe  of  the 
eye.  1.  The  sclerotic, 
thicker  behind  than  in 
front.  2.  The  cornea,  re- 
ceived within  the  anterior 
margin  of  the  sclerotic, 
and  connected  with  it  by 
means  of  a  beveled  edge,  "j 
3.  The  choroid,  connected 
anteriorly  with  (4)  the  cil- 
iary ligament,  and  (5)  the 
ciliary  processes.  6.  The 
h-is.  7.  The  pupil.  8.  The 
third  layer  of  the  eye,  the 
retina,  terminating  ante- 
riorly by  an  abrupt  border 
at  the  commencement  of 


SECT,ION    OF    THE    GLOBE, 

the  ciliary  processes.  9.  The  canal  of  Petit,  which  encircles  the  lens  (12)  ;  the  thin  layep 
in  front  of  this  canal  Is  the  zonula  ciliaris,  a  prolongation  of  the  vascular  layer  of  thw 
retina  to  the  lens.  10.  The  anterior  chamber  of  the  eye,  containing  the  aqueous  humor; 
the  lining  membrane  by  which  the  humor  is  secreted  is  represented  in  the  diagram.  11 
The  posterior  chamber.  12.  The  lens,  more  convex  behind  than  before,  and  enclosed  in 
its  proper  capsule.  13.  The  viti-eous  humor  enclosed  in  the  hyaloid  membrane,  and  in 
ccJls  formed  in  its  interior  by  that  membrane.  14.  A  tubular  sheath  of  the  hyaloid  mem- 
brane, which  serves  for  the  passage  of  the  artery  of  the  capsule  of  the  lens.  15.  The 
neurilemma  of  the  optic  nerve.  16.  The  arteria  centi-alis  retinae,  imbedded  in  the  centra 
of  the  optic  nerve. 

Middle  Coat. — The  second  tunic  is  formed  of  the  choroid,  ciliary 
ligament,  iris,  and  ciliary  processes.  The  choroid  is  a  vascular  mem- 
brane, of  a  rich  brown  color  externally,  and  of  a  deep  black  on  its 
inner  surface.  Posteriorly  it  has  an  opening  for  the  passage  of  the 
optic  nerve ;  it  is  connected  anteriorly  with  the  iris,  ciliaiy  processes, 
and  with  the  junction  of  the  sclerotic  and  cornea,  by  a  dense  white 
structm-e,  called  the  ciliary  ligament,  which  surrounds  the  circum- 
*Brence  of  the  iris,  like  a  ring.     The  choroid  membrane  is  composed 


192 


ANATOMY. 


of  tjiree  layers,  the  externa\  being  principaJy  an  arrangement  of  veins 
called  vence  vorticosce.     The  middle  layer  is  formed  by  the  ramification 
of  minute  arteries.     The  internal  layer  is  a  delicate  cellular  structure, 
containing  the  pigmentum  nigrum^  or  coloring  matter  of  its  posterior 
sorface. 


Fig.  98. 


Fig.  98  is  a  dissection  of  the  eye- 
ball, showing  its  second  tunic,  and 
the  mode  of  the  distribution  of  th? 
venae  vorticosse  of  the  choroid. 
After  Arnold.  1.  Part  of  the  scle- 
rotic coat.  2.  The  optic  nerve. 
3  3.  The  choroid  coat.  4.  The  .«| 
ciliary  ligament.  5.  The  ii'is.  6 
6.  The  venae  vorticosas.  7  7.  The 
trunks  of  the  venae  vorticosae  at 
the  point  where  they  have  pierced 
the  sclerotica.  8  8.  The  posterior 
ciliary  veins,  which  enter  the  ej-e^ 
ball  in  company  with  the  posterior 
ciliary  arteries,  by  piercing  the 
sclerotic  at  9.  10.  One  of  the 
lung  ciliary  nerves,  accompanied 
by  a  long  ciliary  vein. 


nSSECTION    OF    THE    EYEBAI.L. 


chambers  of  the  eye 
the  pupil  of  the  eye. 

Fig:.  99. 


The  ciliary  ligament  forms 
a  circle  round  the  iris,  connecting  the  cornea  and  sclerotic  at  their 
junction  witli  the  iris  and  external  membrane  of  the  choroid. 

The  iris,  or  rainbow,  is  so  denominated  from  its  variety  of  colors  in 
different  individuals.     It  makes  a  partition  between  the  front  and  back 
and  has  a  circular  opening  near  its  centre,  called 
The  iris  is  composed  of  two  layers ;  the  anterior 
is  muscular,  consisting  of  both  cu'- 
cular  fibres  which  surround  the  pu- 
pil, and   radiating  fibres   from   the 
centi-e  to  the  circumference  ;  the 
combined  conti'action  of  these  fibres 
diminishes  the  diameter  of  the  pupil. 

Fig.  99  is  the  anterior  segment  of  a  trans- 
verse section  of  the  globe  of  the  eye,  seen 
from  within.  1.  The  divided  edge  of  the 
three  tunics ;  sclerotic,  choroid  (the  dark  lay 
er),  and  retina.  2.  The  pupil.  3.  The  iris,  tlie 
surface  presented  to  view  in  this  section  being 
the  uvea.  4.  The  ciliary  processes.  5.  The 
scalloped  anterior  border  of  the  retina. 


ANTERIOR    SEGMENT 


The  cilici'y  processes  consist  of 


li 


circmB 
ffitli^ 

thetiirei 

rue  62 

tniii  < 
cesIRo' 


istliei 

layers, 


of  arte 
withti 
m\k, 
thebu 

ropje 

Hn 
ciiaiiiix 
tliectf 
h'n 
theiii 
ciliaris 
secrete 
siidroi 

Tue 
oftbi 


ORGANS  OF  THE  EXTERNAL  SENSES 


193 


triar^gular  folds  of  the  middle  and  internal  layers  of  the  choroid.  Their 
circumference  connects  with  the  ciliaiy  ligament ;  they  are  covered 
with  a  thick  black  pigment. 


Fig.  100. 


Fig.  100  is  the  postt'rior  segment  of  n 
transverse  section  of  the  globe  of  the  eye, 
seen  from  within.  1.  The  divided  edge  of 
the  three  tunica.  The  membrane  covering 
the  vv'hole  internal  surface  is  the  retina.  2. 
The  entrance  of  the  optic  nerve  with  the 
arteria  centralis  retinsa  piercing  its  centre. 
3  3.  The  ramifications  of  the  arteria  cen- 
tralis. 4.  Foramen  of  Soemmering,  in  the 
centre  of  the  axis  of  the  eye ;  the  shade  from 
the  side  of  the  section  obscures  the  limbus 
luteus,  which  surrounds  it.  5.  A  fold  of  the 
retina,  which  generally  obscures  the  foramen 
after  the  eye  has  been  opened. 


Inner  Coat. — The  third  tunic 
fs  the  retina.  It  is  formed  of  tliree 
layers.  The  external  is  a  mere 
film ;  the  middle  or  nervous  is  the  expansion  of  the  optic  nerve,  en- 
veloping the  vitreous  humor,  and  extending  forward  to  the  ciliary  pro- 
cesses; the  inner  membrane  is  the  vascular,  composed  of  ramifications 
of  arteries  and  veins.  The  anterior  margin  of  the  retina  is  connected 
with  the  anterior  surfiice  of  the  lens  by  a  thin  vascular  layer,  called 
zonula  ciliaris.  There  is  a  circular  spot  in  the  retina,  in  the  centre  of 
the  back  part  of  the  globe,  called  the  foramen  of  Soemmering,  sur- 
rounded by  a  yellowish  halo,  called  limhus  luteus. 


POSTERIOR    SEGBIENT. 


Humors  of  the  Eye. — The  aqueous  humor  occupies  the  two 
ghambers  of  the  eye.  The  anterior  chamher  is  the  space  bounded  by 
the  cornea  in  front,  and  the  ms  and  pupil  behind ;  the  posterior  cham- 
ber is  the  very  small  space  between  the  pupil  and  posterior  surface  of 
the  iris  in  front,  and  the  ciliaiy  processes,  crystalline  lens,  and  zonula 
ciliaris  behind.  Both  chambers  are  lined  by  a  thin  membrane,  which 
secretes  the  fluid  of  tlie  aqueous  humor,  which  does  not  exceed  five  or 
six  drops  in  bulk. 

The  vitreous  humor  makes  the  greater  part  of  the  bulk  of  the  globe 
of  the  eye.  It  is  a  glassy,  transparent  fluid,  enclosed  in  a  delicate 
membrane,  called  the  hyaloid.  The  inner  sm*face  of  the  hyaloid  is 
disposed  in  thin  lamellae  or  plates  reflected  inward,  forming  diflerent 
apartments  or  cells,  like  the  ti'ansverse  section  of  an  orange,  for  holding 
the  vitreous  humor. 

The  crystaLliiu  humor,  or  lens  is  situated  bebind  the  pupil,  -sur- 
1—17 


194  ANATOMY 


rounded  by  the  ciliary  processes,  and  embedded  in  the  front  part  (»f 
the  vitreous,  from  which  it  is  separated  by  the  hyaloid  membrane. 
The  capsule  of  the  lens  is  an  elastic,  transparent  membrane  which  sur- 
rounds it.  The  lens  is  formed  of  concentric  la^^ers,  the  external  being 
soft,  the  middle  firmer,  and  the  interior  still  firmer.  The  cajial  of 
Petit  is  a  small  triangular  channel  around  the  cuTumference  of  the  lens. 

Uses  of  the  Structures. — The  oi  ^^ar  group  of  muscles  has  al- 
ready been  described. 

The  firm  sclerotic  coat  gives  shape  and  form  to  the  eye,  and  protects 
its  complicated  and  delicate  tissues.  The  ti-ansparent  cornea  furnishes 
a  medium  for  the  transmission  of  the  rnjs  of  light.  The  choroid  sup- 
ports the  nutritive  vessels,  and  by  the  black  pigment  of  ite  posterior 
surface  absorbs  the  scattered  rays  of  light,  that  might  otherwise  con- 
fuse the  image  impressed  on  the  retina.  The  iris  regulates  the  quan- 
tity of  light  admitted  through  the  pupil,  by  conti'acting  when  the  rays 
are  too  sti'ong,  and  expanding  when  the  light  is  more  feeble.  The  hu- 
mors refract  the  rays  so  as  to  impress  the  object  on  the  retina  in  the 
most  favorable  manner  for  distinct  vision 

APPENDAGES    OF    THE    EYE. 

These  are  the  eyehroius,  eyelids,  eyelashes,  conjunctiva,  caruncula 
lachrymalis,  and  the  lachrymal  apparatus. 

The  eyebrows,  called  super  cilia,  are  projecting  ai'ches  of  integument 
covered  with  short  thick  hairs,  foiming  the  upper  boundary  of  tha 
orbit  of  the  eye. 

The  eyelids,  called  pa(2Jc6?-rt?,  are  valvular  layers  in  front  of  the  eye. 
The  elliptical  space  between  is  divided  into  the  outer  and  inner  canthus. 
The  inner  canthus  id  prolonged  into  ati'iangular  space  toward  the  no8a» 
which  is  called  the  lacus  lachrymalis.  The  lachrymal  papilla  is  a 
small  angular  projection  at  the  commencement  of  the  lacus  lachiymalis 
on  each  side,  each  of  which  j)apil]a  has  a  small  orifice  at  its  apex,  called 
punctu77i  lachrymale,  and  constituting  the  commencement  of  the  lach- 
rymal canal.  The  thin,  firm,  fibro-cartilaginous  bands  supporting  the 
edges  of  the  eyelids  are  cfJled  tie  tarsal  cartilages ;  in  their  internal 
surface  ai*e  embedded  a  numijer  of  secretiig  tubes  or  follicles,  called 
tlie  Meibomian  glands. 

The  eyelashes,  called  cilia,  are  triple  rows  of  long  tliick  hail's,  curl 
ing  upward  from  the  upper  lid,  and  downward  from  the  lower ;  nu  ar- 
rangement which  prevents  their  interlacing  each  other. 

The  conjunctiva  covers  the  anterior  surface  ^f  the  eye,  and  is  so 
reflected  O!!  the  lids  as  to  form  their  inner  layer.     The  duplicates 


ORGANS    OF    THE    EXTERNAL    SENSES.  195 

formed  between  the  globe  and  lids  of  the  eye  are  called  the  superior 
and  inferior  imlpehral  sinuses. 

The  caruncula  lachrymalis  is  a  small  reddish  body  occupying  the 
lacus  lachrymalis  at  the  inner  canthus.  It  is  composed  of  an  assem- 
blage of  mucous  follicles,  and  secretes  the  whitish  matter  usually  found 
at  the  inner  angle  of  the  eye.  On  the  outer  side  of  the  caruncula  is 
a  fold  of  the  conjunctiva,  called  p^zca  semilunaris  ;  this  is  the  7nem- 
brana  nictitans  in  birds,  and  the  rudiment  of  the  third  lid  in  animals. 

Fig.  lOl  Is  a  representation  of  the  appendages  Fig.  101. 

of  the  eye.  1.  The  superior  tarsal  cartilage.  2. 
The  lower  border  of  the  cartilage,  on  which  are 
seen  the  openings  of  the  Meibomian  glands.  .3. 
The  inferior  tarsal  cartilage ;  along  the  upper 
border  of  this  cartilage  the  openings  of  the  Mei- 
bomian glands  are  likewise  seen.  4.  The  lachry- 
mal gland — its  superior  or  orbital  portion.  5.  Its 
inferior  or  palpebral  portion.  6.  The  lachrymal 
ducts.  7.  The  plica  semilunaris.  8.  The  carun- 
cula lachrymalis.  9.  The  puncta  lachrymalia  of 
the  lachrymal  canals.  10.  The  superior  lach- 
rymal canal.  11.  The  inferior  lachrymal  canal. 
12.  The  lachrymal  sac.  14.  The  dilatation  of  the 
nasal  duct,  where  it  opens  into  the  inferior  meat- 
us of  the  nose.     15.  The  nasal  duct. 


APPENDAGES   OF   THE    EYE. 


The  lachrjmial  apparatus  consists  of  the  lachrymal  gland  with  its 
excretory  duct,  the  iJuncla  lachrymalia,  tlie  lachrymal  canals,  the  lach- 
rymal sac,  and  the  nasal  duct. 

The  lachrymal  gland  is  situated  at  the  outer  and  upper  part  of  the 
orbit.  It  secretes  the  tears,  which  are  ordinarily  conveyed  away  by 
small  ducts  which  run  a  short  distance  between  the  conjunctiva,  and 
then  open  on  ts  surface  a  little  above  the  upper  border  of  the  tarsal 
cartilages.  The  kichrymal  canals  commence  at  the  j^uncta  lachrymalia 
and  run  inward  to  the  lachrymal  sac.  The  superior  duct  first  ascends, 
then  turning  suddenly  inward,  forms  an  abrupt  angle ;  the  inferior  duct, 
hy  descending,  and  then  turning  abniptly  inward,  forms  a  similar  angle. 
The  lachrymal  sac  is  the  upper  extremity  of  the  nasal  duct.  It  con- 
sists of  a  mucous  membrane  covered  by  a  fibrous  expansion  of  the  ten- 
dons of  the  orbicularis  and  tensor  tarsi  muscles.  The  nasal  duct  is  a 
short  canal,  three  fourths  of  an  inch  long,  running  downward,  back- 
ward, and  outward  to  the  inferior  meatus  of  the  nose,  terminating  thero 
in  an  enlarged  orifice. 

OF    THE    ORGAN    OF    HEARING. 

The  auditory  apparatus  is  divided  anatomically  into  the  extertud  «ar, 
tympanum,  or  middle  efl,r,  and  labyrinth    ."ir  internal  ear. 


199 


ANATOMY. 


STRUCTURE    OF   THE    EAR. 

fig  102  le  a  representation  of  all  parta  of  the  ear.  1.  Meatus  audltorlus  estemus.  2, 
Drum  of  the  era-,  or  tympauum.  3,  4,  5.  The  bones  of  the  ear.  7.  Vestibule,  the  central 
part  of  the  labyrinth.  8,  9,  10.  The  semicircular  canals.  11,  12.  The  channels  of  the 
cochlea  13.  Auditory  nerve.  14.  Eustachian  tube,  the  channel  from  the  middle  ear  to 
the  throat. 


The  External  Ear. — The  external  ear  consists  of  the  pinna,  a 
tunnel-shaped  cartilaginous  plate,  which  collects  the  vibrations  of  air, 
and  the  meatus,  the  tube  which  conveys  them  to  the  tympanum. 

The  2^'fina  presents  several  folds  and  hollows  upon  its  surface ;  a 
prominent  rim,  called  helix,  a  curved  ridgo  within  it,  called  antihelix ; 
this  divides  above,  and  encloses  a  space  called  scaphoid  fossa  ;  the 
pointed  process  over  the  opening  of  the  ear  is  called  tragus ;  a  tubercle 
opposite  anlilragus ;  the  dependent  portion  of  the  pinna  is  the  lohulus; 
a  space  between  the  helix  and  antihelix  is  called /055a  innominata;  and 
the  large  central  space  to  which  {lU  the  channels  converge  is  the  concha, 
wliich  opens  into  the  meatus. 

The  )n"sclcs  of  the  pinna  are  the  major  helicis,  minor  helicis,  tragicus, 
anlilragicus,  and  transvcrsus  aurlculce ;  they  are  merely  rudimentary 
In  the  human  ear,  but  in  many  animals  are  large  and  active. 

The  meatus  audita rius  is  about  an  inch  iu  length,  extending  inward 
and  a  little  forward  from  the  concha  to  the  t}-mpanum,  and  narrower 
in  the  middle  than  at  either  extremity.  In  the  substance  of  its  lining 
Q»en)branf)  ore  oirv-nUmmt  j^kiuds,  ^vhich  eMdCJrete  tlie  aar-\Fax.     Short. 


ORGANS    OF    THE    EXTERNAL    SENSES. 


im 


Btiff  hairs  stretch  across  its  interior,  to  prevent  tlie  ingress  of  insecta 
and  dust. 

The  pinna  derives  a  plentiful  supply  of  arteries  from  the  anterior 
auricular  branch  of  the  temporal,  and  the  posterior  auricular  fi"om  the 
carotid.  Its  nerves  are  In-anches  derived  fi'om  the  anterior  auricular 
of  the  fifth,  the  posterior  auricular  of  the  facial,  and  the  auricularis 
magnus  o.'  the  cemcal  plexus. 

Tympa>'um. — The  middle  ear  is  an  irregular  bony  cavity  within  the 
petrous  portion  of  the  tempoial  bone.  It  is  bounded  externally  by  the 
membrana  tympani,  and  filled  with  air,  which  entei-s  by  the  Eustacliian 
cube. 


Fig.  103  is  a  diagram  exhibiting  the 
principal  divisions  and  parts  of  the  ear. 
p.  Pinna,    t.  Tympanum.   I.  Labyrinth. 

I.  Upper  part  of  the  helix.  2.  Antihclix. 
3.  Tragus.  4.  Antitragus.  5.  Lobulue. 
C>.  Concha.  7.  Upper  part  of  the  fossa 
innominata.  8.  The  meatus.  9.  Mem- 
brana tympani,  divided  by  the  section. 
10.  The  three  small  bones  of  the  ear, 
malleus,  incus,  and  stapes,  crossing  the 
area  of  the  tympanum  ;  the  foot  of  the 
stapes  blocks  up  the  fenestra  ovalis 
upon  the  inner  wall  of  the  tympanum. 

II.  The  promontory.  12.  Fenestra 
rotunda;  the  dark  opening  above  the 
bones  leads  into  the  mastoid  cells.  13. 
Eustachifui  tube ;  the  little  canal  upon 
this  tube  contains  the  tensor  tympani 
muscle  in  its  passage  to  the  tympanum. 
14.  Vestibule.  15.  The  three  semicir- 
cular canals,  horizontal,  perpendicular, 
and  oblique.  16.  The  ampuHse  upon 
the  perpendicular  and  horizontal  ca- 
nals. 17.  Cochlea.  18.  A  depression 
between  the  convexities  of  the  two 
tubuli  which  communicate  with    the 


Fig.  103. 


DIAGRAM   OF  THE   EAR. 


tympanum  and  vestibule;  one  is  the  scala  tympani,  terminating  at  12;  the  other  the 

scala  vestibuli. 


The  memhrana  tympani  is  a  thin,  semi-transparent  membrane, 
placed  obliquely  across  the  meatus,  concave  externally  and  convex 
toward  the  tympanum,  and  composed  of  an  externa)  epidermal,  a  mid- 
dle muscular,  and  an  internal  mucous  coat. 

The  proper  bones  of  the  ear  {ossicula  auditUs),  viz.,  malleus,  incus^ 
and  stapes,  are  contained  in  the  tympanum.  Tho  malleus  (hammer- 
like)  consists  of  a  head,  neck,  and  handle  called  mcnuh^.um,  which  >* 


198  AN.^TOMY. 

connected  with  tl  e  raembrana  tympani  by  its  whole  length.  The  incus 
has  au  imaghied  resemblance  to  an  anvil,  from  which  circumstance  its 
name  is  derived;  it  consists  of  a  flattened  body  and  two  processes;  its 
body  articulates  with  the  head  of  the  malleus.  The  stapes  is  shaped 
like  a  stirrup ;  its  head  articulates  with  a  process  of  the  incus  called 
OS  orhkulare.  These  bones  are  connected  together  and  held  in  their 
places  by  various  ligaments,  and  moved  upon  themselves  by  four  mus- 
cles, called  tens(A  tympani,  laxator  tympani,  laxator  tympani  minor, 
and  stapedius. 

There  ai'e  ten  foramina,  or  openings,  in  the  t^-mpanum,  five  large 
and  five  small.  The  large  openings  are,  meatus  auditorius,  already 
described:  fenestra  oralis,  communicating  between  the  tympanum  and 
vestibule  ;  fenestra  rotunda,  communicating  between  the  vestibmle  and 
cochlea ;  a  large,  irregular  opening  by  which  the  mastoid  cells  commu- 
nicate with  the  upper  and  posterior  circumference  of  the  tympanum ; 
and  the  Eustachian  tube,  a  communicating  canal  between  the  tympa- 
num and  pharynx.  The  small  openings  are  two  for  the  entrance  and 
exit  of  the  chorda  tympani;  one  situated  in  a  fissure  called  Glasseri,  for 
the  laxator  tympani ;  one  immediately  above  the  opening  of  the 
Eustachian  tube,  for  the  tensor  tymjyani ;  and  one  for  the  stapedius,  at 
the  apex  of  a  conical  body  called  the  pyramid.  Above  the  fenestra 
ovalis  is  a  rounded  ridge  formed  by  a  projection  of  the  aqucsductus 
Fallopii.  Beneath  the  feuesti'a  ovalis  is  the  jiromontory  formed  by 
a  projection  of  the  first  turn  of  the  cochlea,  the  surface  of  which  pre- 
sents three  grooves  for  lodging  the  tympanic  branches  of  Jacobson's 
nerve. 

The  arteries  of  the  tympanum  are  derived  fi-om  the  internal  maxil- 
lary, internal  carotid,  and  posterior  auricular.  Its  nerves  ai'e  branches 
from  the  facial,  the  chorda  tj'mpani,  the  tj^mpauic  branches  of  Jacob- 
son's,  and  a  filament  from  the  otic  gang'ion. 

The  Internal  Ear. — The  term  lalyrinth  is  applied  to  the  internal 
ear  on  account  of  the  complexity  of  its  communications.  It  consists  of 
a  bony  and  a  membranous  portion.  The  osseous  labyiinth  presents  a 
series  of  cavities  channeled  through  the  substance  of  the  petrous  bone, 
and  is  situated  between  the  cavity  of  the  tympanum  and  meatus  audi- 
torius  internus.  It  is  divided  into  vestibule,  semicircular  canals,  and 
coclilea. 

The  vestibule  is  a  small,  three-cornered  cavit}'  within  the  inner  wall 
of  the  tympanum ;  its  corners  are  called  cornua,  or  ventricles.  The 
semicircular  canals  open  into  it  by  five  orifices  behind,  and  the  cochlea 
by  a  single  one  in  front.     T::e  fenesti'ti  ivalis  is  on  its  outer  wall,  and 


ORGANS    OF    TEE    EXTERNAL    SENSES. 


199 


on  its  inner  several  small  holes,  a  cluster  of  which  is  called  macula 
cribrosa,  for  the  entrance  of  a  portion  of  the  auditory  nerve.  The 
scala  vestibuli  is  the  termination  of  the  vestibular  canal  of  the  cochlea. 
The  aqucsductus  vestibuli  is  the  commencement  of  the  small  canal 
which  opens  under  the  osseous  scale  upon  the  posterior  surface  of  the 
petrous  bone. 

The  semicircular  canals  are  three  bony  channels,  communicating 
with  the  vestibule  into  which  they  open  by  both  extremities,  each  ex- 
ti'emity  being  expanded  like  a  fiask,  and  called  ampulla. 

The  cochlea  (snail-shell)  forms  the  anterior  j)art  of  the  Libj^inth.  It 
is  a  tapering,  osseous  canal,  one  inch  and  a  half  in  length ;  and  makes 
two  turns  and  a  half  spirally  around  a  central  axis,  called  the  modiolus, 
wliich  is  a  porous  mass  of  bone  perforated  by  numei-ous  filaments  of 
the  cochlear  nerve.  The  canal  of  the  cochlea  is  partially  divided  into 
two  passages  {scalce)  by  a  thin,  porous  plate  of  bone,  called  lamina 
spiralis,  which  terminates  at  the  apex  with  a  hook-shaped  process 
called  hamulus ;  this  is  covered  by  the  ciqwla.  The  two  scake  com- 
municate over  the  hamulus  by  an  opening  called  heiicolre.ma.  Near 
the  termination  of  the  scala  tj^rnpani  is  the  small  opening  of  the  cochlear 
asqueduct.  The  internal  surface  of  the  osseous  labyrinth  is  lined  by  a 
fibro-serous  membrane,  which  exteriorly  serves  as  a  periosteum,  and 
internally  as  a  serous  membrane,  secreting  a  limpid  fluid  called  aqua 
lalj^rinthi. 


Fig.  104  shows  the  cochlea  divided  pcoral- 
lel  with  its  axis  through  the  centime  of  the 
modiolus.  1.  Modiolus.  2.  The  infundibu- 
lum.  3,  3.  Cochlear  nerve,  i,  4.  The  scala 
tympani  of  the  first  turn  of  the  cochlea.  5, 
5.  Scala  vestibuli  of  the  first  turn ;  the  sep- 
tum between  4  and  5  is  the  lamina  spiralis. 
8.  Loops  formed  by  filaments  of  the  cochlear 
nerve  on  the  lamina  spinalis.  9,  9.  Scala 
tympani  of  the  second  turn  of  the  cochlea. 

10,  10.   Scala  vestibuli   of  the  second  turn. 

11.  Half  turn  of  the  scala  vestibuli ;  the  dome 
over  it  is  the  cupola.  14.  Ilelicotrema ;  a 
bristle  is  passed  through  it,  in  front  of  which 
is  the  hamulus. 


'*  'i|  ^ 
THE    COCHLEA. 


The  membranous  labyrinth  is  in  form  a  perfect  counterpart  of  the 
vestibule  and  semicu'cular  canals,  but  smaller  in  size.  In  sti'ucture  it  is 
composed  of  four  layers ;  an  external,  or  serous,  a  vascular,  a  nervous, 
and  an  internal,  or  serous.  Its  cavity  is  filled  with  a  limpid  fluid,  and 
contains  two  small  ca  careous  masses,  called  otoconites ;  and  it  coosista 


200 


A.N  ATOMY 


of  a  small  sac,  sacculus  cojiimums,  of  three  semicircular  membranous 
canals,  and  a  small  round  sac,  sacculus  jproprius. 


Fig.  105. 


THt    LABYRINTH. 


Fig.  105  is  the  labyrinth  of  the  left  enr,  laid 
open  to  exhibit  its  cavities  and  the  membranous 
labyrinth,  1.  Cavity  of  the  vestibule.  2.  Am- 
pulla of  the  superior  semicircular  canal.  4.  The 
superior  cnnol,  with  its  contained  membranous 
canal.  5.  Ampulla  of  the  inferior  canal.  6.  Ter- 
mination of  the  membranous  canal  of  the  hori- 
zontal Ecraicircular  canal  in  the  sacculus  com- 
munis. Ampulla  of  the  middle  semicircular 
ca.nal.  b  The  same  canal  with  its  membranous 
canal,  i.  Common  canal.  10.  Membranous 
common  canal.  II.  Otoconite  of  the  sacculus 
communis.  12.  Sacculus  proprins  ;  its  otoconito 
is  seen  through  its  membranous  parieties.  13. 
Fir.=t  turn  of  the  L-'>chlea.  11.  Extremity  of  the 
scala  tympani,  corresponding  with  the  fenestra 
rotunda.  15.  Lamina  spiralis.  18.  Half  turn  of 
the  cochlea.  19.  Lamina  spiralis,  terminating  in 
its  falciform  extremity.  The  dark  space  included 
within  the  falciform  curve  of  the  extremity  of 
the  lamina  spiralis  is  the  helicoti'cma.  20.  The 
infundibulum. 


The  auditory  nerve  divides,  in  the  meatus  auditorius  internus,  into  a 
vestibular  and  a  cochlear  branch.  The  vestibular  nei-ve  divides  into 
three  branches,  which  are  disti-ibuted  to  the  various  parts ;  in  the  sub- 
stance of  the  Bacculi  and  ampullss  the  nervous  filaments  radiate  in  all 
directions,  anastomosing  Avith  each  other,  and  forming  interlacements 
and  loops,  finally  terminating  upon  the  inner  surface  of  the  membrane 
in  minute  papillae,  resembling  those  of  the  retina.  The  auditory  nerve 
divides  into  numerous  filaments,  which  enter  the  foramina  in  the  basi'> 
of  tho  cochlea,  and  are  distributed  to  the  tissue  of  the  lamina  spiralis 
The  arteries  of  the  labyrinth  are  derived  mainly  from  the  auditory 
branch  of  the  superior  cerebellar  aitery. 


THi:  ORGA>'  OF  TASTE. 


The  tongue  is  composed  of  longitudinal,  transverse,  oblique,  and 
vertical  musculai-  fibres,  between  which  is  a  quantity  of  adipose  sub- 
stance ;  it  is  connected  posteriorly  with  the  os  hyoides  by  a  muscular 
attachment;  and  to  the  epiglottis  by  mucous  membrane,  which  fonns 
tlic  three  folds  called  frfpna  epiglottidis ;  and  on  each  side  with  the 
lower  jaw  by  tlio  same  membrane,  which  forms  a  fold  in  front  beneath 
its  under  surface,  called /rrt?nww,  lingKE. 

The  suriaco  of  tlio  tongue  is  covorcd  by  a  donsi    layer,  which  sup 


0EGAN9    OF    THE    EXTERNAL    SENSE8. 


2(U 


ports  its  pajnllfS,  of  which  there  are  four  kinds.  1.  PapillcE  circum- 
vallaUe,  or  lenticular,  are  of  large  size,  and  fifteen  or  twenty  in  number, 
situated  near  the  root,  and  arranged  in  two  rows,  which  meet  at  the 
middle  line,  like  the  branches  of  tiie  letter  A.  At  their  point  of  meet- 
ing is  a  deep  mucous  follicle,  called /pr«77ien  ccecum.  2  and  3.  Papilla 
coniccs  and  i)apillts  filiformes,  conical  and  filiform  in  shape,  cover  the  sur- 
jli-^-e  of  the  tongue  in  front  of  the  circumvallatee ;  their  extremities  are 
])ierced  by  a  minute  aperture,  hence  they  may  be  regarded  as  follicles 
rather  than  sentient  points,  the  ti'ue  sentien*-  organs  being  extremely 
minute  papillae  occupying  their  surface  as  well  as  that  of  the  other 
papillae.  4.  Papill<T,  fungi  formes,  or  cajntalce,  are  larger  than  the  for- 
mer, have  rounded  heads,  and  are  irregularly  dispersed  over  the  dorsum 
of  the  tongue  ;  a  number  of  these  are  seen  at  the  tip. 

Behind  the  papillae,  at  the  root  of  the  tongue,  ai'e  a  number  of  mu- 
wus  glands. 

The  tongue  and  its  papillte  nre  seen  In  Fig.  106.  1.  The 
raphe,  which  sometimes  bifurcates  in  the  dorsum,  as  in 
the  figure.  2,  2.  Lobes  of  the  tongue;  the  rounded  emi- 
nences on  this  part  of  the  organ  and  near  its  tip  are  the 
fungiform  papillse  ;  the  smaller  papillae,  among  which  the 
former  are  dispersed,  are  the  conical  and  filiform  papilla). 
3.  Tip  of  the  tongue.  4,  4.  Its  sides,  on  which  the  papil- 
IsB  are  arranged  in  fringed  and  lamellated  forms.  5,  5. 
rheA-shaped  row  of  papillis  circumvallatse.  6.  Foi'ainen 
ocecum.  7.  Mucous  glands  at  the  root  of  the  tongue.  8. 
Epiglottis.  9,  9.  Frgena  epiglottidis.  10,  10.  Greater  cor- 
nua  of  the  hyoid  bono. 

The  tongue  is  abundantly  supplied  with 
blood  by  the  lingual  arteries.  Its  nerves  are 
of  large  size,  and  three  in  nun:tber.  The 
nerve  of  common  sensation  and  taste  is  the 
gustatory  branch  of  the  fifth  pah',  which  is 
distributed  to  the  papillae ;  the  glosso-pharyn- 
geal  supplies  the  mucous  membrane,  follicles, 
and  glands,  and  is  a  nerve  of  sensation  and 
motion  ;  the  hypo-glossal  is  the  principrd  motor 
nerve,  disti'ibuted  to  the  muscles.  The  chorda 
tympani,  sent  from  the  facial  nerve  to  the  lingualis  muscle,  must  be 
added  to  the  motor  influence. 


THE  TONGUE. 


THE  ORGAIV  OF  TOUCH. 

The  skin,  which  is  continuous  with  the  mucoas  membrane  of  tho 
Jiiternal  cavitiee.  is  oom}X)sed  of  t\ro  layers — def-mj,  and  einchrma. 


202  ANATOMY. 

The  derma,  or  cutis  (true  skin),  18  chiefly  composed  of  elastic  eel 
lulo-fibrous  tissue,  abundantly  supplied  with  blood-vessels,  lymphatics, 
and  nerves.  It  is  divided  into  a  deep  stratum,  caUed  corium,  the  stiiic- 
ture  of  which  is  dense,  white,  and  coarse,  ftrmin^  a  network  of  chan- 
nels, by  which  the  branches  of  vessels  and  nerves  pass  to  the  super- 
ficial layer ;  and  a  superficial  stratum,  called  pajnllary,  which  is  raised 
in  the  form  of  papillee,  or  conical  prominences,  each  being  composed 
of  a  convoluted  capillary  vessel  and  a  convoluted  nervous  loop. 

Fig.  107  Fig.  107  shows  the  anatomy  of  a  portion  of  the  skin 

taken  from  the  palm  of  the  hand.  1.  Papillary  layer, 
marked  by  longitudinal  furrows  (2),  which  arrange  the 
papilltfi  into  ridges.  3.  Transverse  furrows,  which  divide 
the  ridges  into  small  quadnmgular  clumps.  4.  The  reta 
mucosum  raisec  from  the  papillary  layer  and  turned 
back.  5,  5.  Perspiratory  ducts  dravoi  out  straight  by  the 
separation  of  the  rete  mucosum  from  the  papillary  layer. 


INTEGUMENT    OF    THE    HAND. 


The  ejpiderma,  or  cuticle  (scarf-skin),  en- 
velops and  protects  the  derma,  of  wliich  it  is 
a  product.  Its  external  surface  is  hard  and 
horny,  its  internal  soft  and  cellular ;  this  sur- 
face or  layer  is  called  the  rete  mucosum.  The 
whole  epidermal  structure  is  laminated,  the 
plates  or  scales  increasing  in  density  fi-om  the  inner  to  the  outer 
surface. 

The  j^ores  of  the  epiderma  are  the  openings  of  the  perspiratory 
ducts,  hair  follicles,  and  sebiparous  glands.  The  arteries  of  the  derma 
divide  into  innumerable  intermediate  vessels,  forming  a  capillary  plexus 
in  the  superficial  sti'ata  and  papillary  layer.  No  lymphatics  have  been 
discovered  in  the  papillro,  but  they  are  supposed  to  be  interwoven  with 
the  capill.u-y  and  mucous  plexuses  in  the  superficial  strata  of  the  derma. 

Appendages  of  the  Skin. — These  are  the  nails,  hair,  sebiparous 
glands,  and  perspiratory  glands  and  ducts. 

Tho  nails  are  a  part  of  the  epiderma,  and  identical  in  sti'ucture ; 
[hcjr  are  implanted  in  a  fold  of  the  derma,  called  matrix,  which  acts 
the  part  of  a  follicle  ;  at  the  bottom  of  tho  gi'oove  of  the  follicle  are  a 
number  of  filiform  pnpilke,  which  produce  tho  mai-gin  of  the  root,  and, 
by  tho  successive  formation  of  new  cells,  push  the  nail  onward  in  its 
gi-owth.  The  concave  surface  of  the  nail  is  in  contact  with  the  derma, 
and  the  latter  is  covered  by  papilla,  which  detain  the  nail  in  place,  and 
increase  ita  thi^kue.as  by  tho  addition  of  nowly-formed  cells  on  its  under 
Burfac-e 


ORGANS    OF    THE    EXTERNAL    SENSES. 


203 


Fig.  108. 


ANATOMY    OF    THE    SKIIV 


111  Fig.  lOS  are  seon — 1.  Tlie  epiderma. 
2.  Its  deep  layer,  the  rcte  muoosum.  .3. 
'l"wo  of  the  quadrangular  papillary  clumps 
composed  of  minute  conical  papilla},  such 
as  are  seen  in  the  pa-lm  of  the  hand  or  sole 
of  the  foot.  4.  Deep  layer  of  the  derma, 
the  corium.  3.  Adipose  cells.  6.  A  su- 
doriparous gland  with  its  spiral  duct,  as 
are  seen  in  the  palm  of  the  hand  and  sole 
of  the  foot.  7.  Another  sudoriparous 
gland  with  a  etraighter  duct,  such  as  is 
seen  in  the  scalp.  8.  Two  hairs  from  the 
Bcalp,  enclosed  in  their  follicles  ;  their 
relative  depth  in  the  skin  is  preserved. 
0.  A  pair  of  sebiparous  glands,  opening 
by  short  ducts  into  the  follicle  of  the  hair. 

The  hairs  are  horny  append- 
ages, produced  by  the  involution 
of  the  epiderma,  constituting  the 
follicle,  and  subsequent  evolution 
of  the  same  sti'ucture,  constitu- 
ting the  shaft  of  the  hair.  Hairs 
are  variable  in  length  and  thick- 
ness in  different  parts  of  the  body.  Their  free  exti-emity  is  generally 
pointed,  and  sometimes  split  into  filaments  ;  the  central  extremity,  called 
the  bulb,  is  implanted  deeply  in  the  integument,  extending  through  the 
epiderma  into  the  cellular  tissue,  where  it  is  surrounded  by  adipose 
cells.  The  hair  is  formed  from  its  follicle  by  a  process  identical  with 
the  formation  of  the  epiderma  by  the  papillary  layer  of  the  derma. 

The  color  of  the  hair,  and  also  of  the  epiderma,  is  owing  to  the 
ooloration  of  the  primitive  gi-anules,  of  which  the  cells  are  comi)Osod. 

The  sebiparous  glands,  which  are  embedded  in  the  derma,  are  sac- 
culated glandular  bodies,  of  a  complex  variety  of  structure,  from  a 
j)ouch-liko  follicle  to  a  lobulated  gland.  In  some  situations  ^heir  ex- 
cretory ducts  open  on  the  surface  of  the  epiderma,  and  in  others  they 
terminate  in  the  follicles  of  the  hairs.  In  the  meatus  auditorius  the 
sebipai^ous  glands,  called  ceruminous,  are  large,  and  in  the  eyelids  are 
tho  largest  in  the  body,  and  are  there  called  Meibomian. 

The  sudoriparous  glands  are  deeply  situated  in  the  corinm  and  sub- 
cutaneous tissue,  and  surrounded  by  areolar  tissue.  They  are  small 
oblong  bodies,  composed  of  convoluted  tubuli,  or  a  congeries  of  globu- 
lar sacs,  opening  in  a  common  efferent  duct,  which  ascends  through 
the  derma  and  epiderma,  and  terminates  on  tilie  surface  by  an  oblique 
funnel-shaped  aperture  or  pore 


204 


ANATOMY. 


CHAPTER  X. 


OK   THE   VISCEKA— SPLANCHNOLOGY. 


Ficr.  109. 


Those  organs  of  th<^ 
body  called  viscera,  occupy 
three  gi*eat  internal  cavi 
ties,  the  cranio -spinal, 
thorax,  and  abdomen.  Tho 
first  is  occupied  by  the 
brain  and  spinal  marrow 
already  described ;  the 
thoracic  cavity,  or  chest, 
contains  the  heart,  lungs, 
and  thymus  gland ;  the 
abdominal  cavity  prop- 
er contains  the  stomach 
and  intestines,  liver,  pan- 
creas, spleen,  kidneys, 
and  supra-renal  capsules ; 
and  its  lower  portion,  call- 
ed the  pelvis,  contains  the 
bladder  and  internal  organs 
of  generation. 

The  relative  situation  of 
the  principal  viscera  may 
be  seen  in  Fig.  109. 

A.  Heart.  B,  B.  Lungs.  C. 
Liver.  D.  Stomach.  E.  Spleen. 
TO,  m.  Kidneys,  ff.  Bladder,  d 
is  tho  diaphragm  which  forms 
the  partition  between  the  thorax 
and  abdomen.  Under  the  latter 
is  the  cardiac  orifice  of  the 
stomach,  and  at  the  right  ex- 
tremity, or  pit  of  tho  stomach 
Is  the  pyloric  orifice. 


VITAL    SYSTEM 


THORACIC    V13CKRA. 

Tut.  Hfap.t. — Tho  heart,  which  is  the  -entraj  organ  of  circulation. 


!SPLANCII^^OLO  JV.  205 

is  a  strong,  museular  oifgan,  enclosed  in  a  proper  membrane,  called 
peiicardmm,  and  situated  between  two  layers  of  pleura,  which  consti- 
tute the  mediastinum. 

The  pericardium  (heart-case)  consists  of  an  external  fibrous  and  an 
internal  serous  layer. 

The  heart  is  placed  oblique  between  the  lungs,  with  its  apex  pointing 
to  the  space  between  the  fifth  and  sixth  ribs,  two  or  three  inches  from 
the  sternum  on  the  left  side.  It  consists  of  two  auricles,  right  and  left, 
and  two  ventricles,  also  right  and  left.  The  right  is  the  venous,  and 
the  left  the  arterial  side  of  the  heart. 

The  right  auricle  is  larger  than  the  left ;  its  interior,  called  sinus, 
presents  five  openings  and  two  valves. 

The  openings  are  :  the  superior  cava,  which  pours  the  venous  blood 
from  the  upper  part  of  the  body  into  its  upper  part ;  the  inferior  cava, 
which  returns  the  blood  of  the  lower  half  of  the  body  into  its  lower 
part;  I^q  coronary  vein,  y^hhch.  returns  the  blood  from  the  substance 
of  the  heart;  the  foramina  Thebeseii,  small  pore-like  openings  through 
vvhich  the  venous  blood  oozes  from  the  muscular  stTUcture  into  the 
auricles ;  and  auricula-ventricular,  the  communication  between  the 
auricle  and  ventricle. 

The  valves  are  :  the  Eustachian,  which  belongs  to  the  fcetal  circula- 
tion, and  serves  to  direct  the  placental  blood  from  the  inferior  cava 
through  the  foramen  ovale  into  the  left  auricle ;  and  the  coronary,  a 
semilunar  fold  across  the  mouth  of  the  coronaiy  vein. 

There  are  two  relicts  of  the  foetal  structure,  the  annulus  ovalis,  situ- 
ated on  the  partition  {septum  arcularium)  between  the  two  auricles, 
occupying  the  place  of  the  foramen  ovale  of  the  foetus ;  and  the  fossa 
ovalis,  an  oval  depression  corresponding  vnt\i  the  fcetal  foramen  ovale, 
and  closed  at  birth  by  a  thin  valvular  layer. 

The  proper  structure  of  the  auricle  is  divided  into  an  intervening 
portion  between  the  openings  of  the  cavas,  called  tuberculum  Loiveri, 
and  numerous  small  parallel  columns  of  muscular  fibres  situated  in  tlie 
appendix  auricula. 

The  right  ventricle  receives  the  venous  blood  from  the  right  auricle, 
and  ti-ansmits  it  to  the  lungs.  Its  anterior  side  is  convex  the  greatei 
proportion  of  the  front  of  the  heart;  its  posterior  and  lower  feide  is  flat, 
resting  upon  the  diaphragm.  It  contains  two  openings,  two  sets  of 
valves,  and  a  muscular  and  tendinous  structure. 

The  openings  are,  the  auricular  ventricular,  the  communication  be- 
iweeu  the  right  auricle  and  ventricle ;  and  the  opening  of  the  pulmo- 
nary artery,  which  is  situated  close  to  the  septum  between  the  vontricles. 

The  ivr^vij  are,  the  Iri^uspd,  three  tj-iangular  folds  of  the  lining 
18 


20o 


ANATOMY. 


nembrane,  strengthojied  by  a  layer  of  fibrous  tissue,  connected  by 
heir  base  around  the  auriculo-ventricular  opening,  and  prevent  the 
regurgitation  of  blood  into  the  auricle  dui-ing  the  contraction  of  the 
ventricle ;  and  the  semilunar,  three  in  number,  situated  around  the 
commencement  of  the  pulmonaiy  artery. 

The  muscular  and  iendiKous  apparatus  belongs  to  the  ti-icuspid  valves. 
It  consists  of  thick  muscular  columns  {columme  carnca:),  and  their  ten- 
dons {chordts  tendinece),  which  stand  3ut  fit'om  the  walls  of  the  ventri 
cles,  and  serve  as  muscles  to  the  valves. 

The  left  auricle  receives  the  aiterial  blood  from  the  lungs;  it  is 
smaller  and  thicker  than  the  right.  It  has  four  openings  for  the  pul- 
monary veins,  two  from  the  right  and  tAvo  from  the  left  lung ;  and  au 
auriculo-ventricular  opening,  which  communicates  between  it  and  the 
left  ventricle.  Its  musculi  p>ectinati  are  fewer  in  number  than  in  the 
right  am-icle,  and  are  situated  only  in  the  appendix  auricula?. 

The  left  ventricle,  which  receives  the  blood  from  the  left  auricle 
and  sends  it  through  the  aorta,  forms  the  apex  of  the  heart ;  its  figure 
is  conical  externally  and  internally.  Its  openings  are,  the  auriculo- 
ventricular,  between  the  auricle  and  ventricle,  and  the  aortic.  Its 
valves  are  the  mitral,  attached  around  the  auriculo-veuti'icular  commu- 
nication to  prevent  the  reti^ogi'ade  passage  of  the  blood,  and,  like  the 
tricuspid,  are  fhrnished  with  a  musculai"  apparatus;  and  the  semilunar 
pkced  around  the  commencement  of  the  aorta. 


Fig.  110. 


ANATOMY    OF    THE    HEART 


Artery  and  arch  of  the  a«^tft. 
th«  ligbt  «Mc  of  the  heart. 


Fig.  110  is  a  general  view  of  the  inter- 
nal structure  of  the  heart.  1.  Right 
auricle.  2.  Entrance  of  the  superior 
cava.  3.  Enti'ance  of  the  inferior  cava. 
4.  Opening  of  the  coronary  vein,  half- 
closed  by  the  valve.  5.  Eustachian 
valve.  6.  Fossa  ovalis,  surrounded  by 
the  annulus  ovaUs.  7.  Tuberculum 
Lovveri.  8.  Musculi  pectiuati  in  tiie 
appendix  auriculse.  9.  Auriculo  ven- 
tricular opening.  10.  Cavity  of  right 
ventricle.  11.  Tricuspid  valve,  attached 
by  the  chordae  tendinsB  to  the  cameaj 
columuae  (12).  13.  The  pulmonary  ar- 
tery, guarded  at  its  commencement  by 
three  semilunar  valves.  14.  Right  pul- 
monary artei-y,  passing  beneath  the 
arch  and  behind  the  ascending  aorta. 
15.  Left  pulmonary  artery,  crossing  in 
front  of  the  descending  aorta.  *  Re- 
mains of  the  ductus  anteriosus,  acting 
as  a  ligament  between  the  pulmonary 
The  arrows  maik  the  course  of  the  venous  blood  throuch 
Ifi.   Left  acriclo.     17.   Openings  o/  tbe  fwirth  pulrannaiv 


SPLANCHNOLOGY 


207 


reins.  18.  Auriculc-ventricular  opening.  19.  Left  ventricle.  20.  Miti-al  valve,  attached 
by  its  chordas  tendinae  to  two  large  columnae  carnese,  which  project  from  the  walls  of 
the  ventricle.  -21.  Commencement  and  course  of  the  ascending  aorta  behind  the  pul- 
monary artery,  marked  by  an  arrow;  the  entrance  of  the  vessels  is  guarded  by  three 
semilunar  valves.  22.  Arch  of  the  aorta.  The  comparative  thickness  of  the  two  ventri- 
cles is  shown  in  the  diagram.  The  course  of  the  blood  through  the  left  side  of  the  heart 
is  denoted  by  arrows. 

The  general  structure  of  the  neart  is  an  arrangement  of  strong 
muscular  fibres,  disposed  in  several  layers,  so  as  to  form  fibrous  rings 
and  bands,  which  afford  it  tlie  greatest  possible  amount  of  strength  for 
Its  bulk.  lis  arteries  are  the  anterior  and  j^osterior  coronary  ;  its  veins 
empty  into  the  right  auricle  b}  the  common  coronary ;  its  lymjjhatici 
terminate  in  the  glands  about  its  root;  and  its  nerves  are  derived  fi'om 
the  cardiac  plexus- 
es, which  are  form- 
ed by  communica- 
ting filaments  from 
the  ganglionic  and 
pneumogastric. 

Fig.  Ill  is  an  external 
view  of  the  heart,  a. 
Left  ventricle,  b.  Right 
ventricle,  c,  e,  f.  Aorta 
arising  from  the  left  ven- 
tricle, ff.  Arteria  inno- 
minata.  k.  Left  subcla 
vian  artery,  i.  Left  ca- 
rotid, k.  Pulmonary  ar- 
tery. I,  I.  Its  right  and 
left  branches.  m,  m. 
Veins  of  the  lungs,  n. 
Right  auricle.  o.  As- 
cending cava.  g.  De- 
scending cava.  r.  Left 
auricle,  s.  Left  coronary 
artery.  P.  Portal  veins, 
which  return  the  blood 
from  the  liver  and  bow- 

*^^-  THE    HEART. 


ORGANS    OF    VOICE    AND    RESPIKATION. 

The  cartilaginous  and  muscular  sti'ucture  at  the  upper  part  of  the 
windpipe,  called  the  larynx,  constitutes  the  apparatus  of  voice ;  the 
lungs  and  trachea  are  the  organs  of  resph-ation. 


or    THE    LAEYKX. 

The  kirynx  is  a  short  lulw.  of  an  houT-glass  forn\  Fituated  at  the 


208  AN  ATOM  V. 

upper  and  front  part  of  the  neck,  composed  of  cartilages,  ligaments, 
muscles,  vessels,  nerves,  and  mucous  m&inhrane. 

The  cartilages  are:  1.  Thyroid  (shield-like),  which  consists  of  two 
lateral  portions  (alee)  meeting  at  an  angle  in  front,  and  forming  the  pro- 
jecting part  of  the  throat,  called  powiwm  Adami  (Adam's  apple).  Each 
ula  forms  a  rounded  border  posteriorly,  which  terminates  above  in  a 
superior  cornu,  and  below  in  an  iiiferior  cornu.  2.  Cricoid  (like  a  ring), 
a  circular  ring,  narrow  in  front  and  broad  behind,  where  it  has  two 
rounded  surfaces,  which  ai'ticulate  with  the  arytenoid  cartilages.  The 
cesophngus  is  attached  to  a  vertica.  ridge  on  its  posterior  surface.  3. 
Two  arytenoid  (pitcher-like) ;  ti'iangular  in  form,  and  broad  ^nd  thick 
below,  where  they  articulate  with  the  upper  border  of  the  cricoid; 
above  they  are  pointed  and  prolonged  by  two  small  pyriform  cartilages, 
"ailed  cornicula  laryngis,  which  form  part  of  the  lateral  wall  of  the 
larynx,  and  afford  attachment  to  the  chorda  vocalis  and  several  of  the 
articulating  muscles.  4.  Two  cuneiform. ;  small  cylinders,  about  seven 
lines  in  length,  and  enlarged  at  each  extremity ;  they  are  attached  by 
the  lower  end  to  the  arytenoid,  and  their  upper  extremity  forms  a 
prominence  on  the  border  of  the  aryteno-epiglottidean  fold  of  mem- 
brane ;  they  are  occasionally  wanting.  5.  Epiglottis ;  shaped  like  a 
cordate  leaf,  and  sitiiated  immediately  in  front  of  the  opening  of  the 
larynx,  which  it  closes  when  the  larynx  is  drawn  up  beneath  the  base 
of  the  tongue,  as  in  the  act  of  swallowing.  The  laryngeal  cartilages 
ossify  more  or  less  in  old  age,  particularly  in  the  male. 

The  ligaments  are:  1.  Three  thyro-hyoidean,  which  connect  the 
thyroid  cartilage  with  the  oa  hyoides.  2.  Two  capsular  crico-thyroid, 
which  articulate  the  thyroid  with  the  cricoid,  and  with  their  synovial 
membranes  from  the  articulation  between  the  inferior  cornu  and  sides 
of  the  cricoid.  3.  The  cricc -thyroidean  memhrane,  a  fan-shaped  layer 
of  elastic  tissue,  attached  by  its  apex  to  the  lower  border  of  the  thy- 
roid, and  by  its  expanded  margin  to  the  upper  border  of  the  cricoid  and 
base  of  the  aiytenoid ;  above  it  is  continuous  with  the  lower  margin  of 
the  chorda  vocalis.  4.  Two  capsular  crico-arytenoid,  which  connect 
those  cartilages.  5.  Two  superior  thyro-arylenoid,  thin  bands  between 
the  receding  angle  of  the  thyroid  and  the  anterior  inner  border  of  each 
arytenoid ;  the  lower  border  constituting  the  upper  boundaiy  of  the 
venti'iclo  of  the  larynx.  G.  Two  inferior  thyro-arytenoid,  the  chordcc 
vocales,  which  are  thicker  than  the  superior,  and,  like  their  composeJ 
of  clastic  tissue.  Each  ligament,  or  vocal  chord,  is  attachea  in  front  to 
the  receding  angle  of  the  thyroid,  and  behind  to  the  anterior  angle  of 
the  base  of  the  arytenoid.  The  inferior  border  of  the  chorda  vocalis 
w  continuous  with  the  lateral  expansion  of  the  crioo-thyroid  ligament 


SPLANCHNOLOGY. 


209 


Tlio  superior  border  forms  the  lower  boundary  of  the  venti-icle  of  the 
larynx.  The  space  between  the  two  chordae  vocales  is  the  glottis,  or 
'  ,ui  glottidis.  7.  "Three  glaso-epi glottic,  folds  of  mucous  membrane 
meeting  the  anterior  surface  of  the  epiglottis  with  the  root  of  the 
tongue.  8.  The  hyo-eji glottic,  an  elastic  band  connecting  the  anterior 
a-pect  of  the  epiglottis  with  the  hyoid  bone.  9.  The  thy i-o-ejn glottic, 
a  slender  elastic  slip  embracing  the  apex  of  the  ej)iglottis,  and  inserted 
into  the  thyroid  above  the  chordae  vocales. 


Fig.  112  is  a  vertical  section  of  the  larynx,  showing 
it.-  ligaments.  1.  Body  of  the  os  hyoides.  2.  Its  great 
cnruu.  3.  Its  lesser  cornu.  4.  The  ala  of  the  thyroid. 
ii.  Its  superior  cornu.  6.  Its  inferior  cornu.  7.  Pomum 
Adami.  8,  8.  Thyro-h5'oidean  membrane  ;  the  openinnr 
Rf'ar  the  posterior  numei'al  transmits  the  euperic 
laryngeal  nerve  and  artery.  9.  Thyro-hyoidcan  liga- 
ment, a.  Epiglottis,  b.  Hypo-epiglottic  ligament,  c. 
Tliyro-epiglottic.  d.  Arytenoid  cartilage,  c.  Outer 
angle  of  its  base.  /.  Corniculum  laryngis.  ff.  Cuneiform 
n  rtilage.  k.  Superior  thyro-arytenoid  ligament,  i. 
riiorda  vocalis,  or  inferior  thyroarytenoid ;  the  ellipti- 
cal space  between  the  two  thyro-arytenoid  is  the  laryn- 
g<al  venti'icle.  k.  Cricoid  cartilage.  I.  Lateral  portion 
of  the  crico-thyroidean  membrane,  in.  Its  central  por- 
tion, n.  Upper  ring  of  the  trachea,  which  is  received 
within  the  ring  of  the  cricoid  cartilage,  o.  Section  of 
the  isthmus  of  the  thyroid  gland,  p,  p.  The  levator  of 
the  glandulae  tbyroidese 


The  muscles  are  eight  in  number:  five 
larger  ones  of  the  chordae  vocales  and  glottis, 
and  three  smaller  of  the  epiglottis.  The 
origin,  insertion,  and  use  of  each  is  expressed 
by  its  name.  They  are  the  crico-thyroid,  posterior 
and  lateral  crico-arytenoid,  thyro-arytenoid,  aryte- 
noid, tliyro-epiglottic,  and  superior  and  inferior  ary- 
teno- epiglottic.  The  posterior  crico-arytenoid  opens 
the  glottis;  the  ai'ytenoid  approximates  the  aryte- 
noid cartilages  posteriorly,  and  the  crico-arytenoi- 
deus  lateralis  and  thyro-aiytenoidei  anteriorly ;  the 

Fig.  113  is  a  side  view  of  the  larynx,  one  aia  of  the  thyroid 
cartilage  being  removed.  1.  Remaining  ala.  2.  One  of  the 
arytenoid  cartilages.  3.  One  of  the  cornicula  laryngis.  4.  Cri- 
coid cartilage.  57  Posterior  crico-arytenoid  muscle.  6.  Crico- 
arytenoideus  lateralis.  7.  Thyro-arytenoic3us.  8.  Cricc-thy- 
roidean  membrane.  9.  One  half  of  the  ep  glottis.  10.  Upper 
pait  of  the  tracliea. 


LIGAMENTS   OF  THE  LAHYNX. 


THE   LARYNX   IjAT* 
ERALLY. 


210  ANATOMY. 

kittev  also  close  tlie  glottis  mesially.  The  crico-tliyroidei  are  tensors 
of  the  vocal  chords,  aiK  with  the  thyio-arytenoidei,  regulate  their  posi- 
tion and  vibrating  length.  The  remaining  muscles  assist  in  regulating 
the  tension  of  the  vocal  chords  by  varying  the  position  of  then 
cartilages. 

The  aperture  of  tlie  laiynx  is  a  triangular  opening,  broad  in  front 
and  narrow  behind ;  bounded  m  front  by  the  epiglottis,  behind  by  the 
arytenoid  muscle,  and  on  the  sides  by  folds  of  mucous  membrane.  The 
cavity  is  divided  into  two  })arts  by  an  oblong  consti-iction  produced  by 
the  ])rominence  of  the  vocal  chords ;  the  part  above  the  consti'iction  is 
broad  above  and  narrow  below,  and  the  part  beneath  is  narrow  above 
and  broad  below ;  while  the  space  included  by  the  constiiction  is  a 
narrow,  ti'iangular  fissure,  the  glottis,  bounded  ^n  the  sides  by  the 
chordae  vocales  and  inner  surface  of  the  arytenoid  cartilages,  and  behind 
by  the  arytenoid  muscle ;  it  is  nearly  an  inch  in  length,  somewhat 
longer  in  the  male  than  female.  Immediately  above  the  prominence 
caused  by  the  chorda  vocalis,  and  extending  nearly  its  length  on  each 
side  of  the  cavity  of  the  larynx  is  the  ventricle  of  the  larynx^  an  ellipti- 
cal fossa  which  serves  to  isolate  the  chord. 

The  mucous  membrane  lines  the  entire  cavity  of  the  larynx,  its 
prominences  and  depressions,  and  is  continuous  with  that  of  the  mouth 
and  pharynx,  which  is  prolonged  through  the  ti'achea  and  bronchial 
tubes  into  the  lungs.  In  the  venti'icles  of  the  larynx  the  membrane 
forms  a  ca?cal  pouch,  called  sacculus  laryngis,  on  the  surface  of  which 
are  the  openings  of  numerous  follicular  glands,  whose  secretion  lubri- 
cates the  vocal  chords. 

The  arteries  of  tho  larynx  are  derived  from  the  superior  and  inferior 
thyroid ;  the  nerves  are  the  superior  laryngeal  and  recurrent  laryiigeal 
branches  of  the  pneumogastric. 

KF    THE    TRACHEA. 

The  trachea  (windpipe)  commences  opposite  the  fifth  cervical  verte- 
ora,  and  extends  to  the  third  dorsal,  where  it  divides  into  the  right  and 
left  bronchi,  the  right  hronchus  passing  off  to  the  upper  part  of  the 
right  lung  at  nearly  right  angles,  and  the  left,  which  is  smaller,  descend- 
ing obliquely  beneath  the  arch  of  the  aorta  of  the  left  lung. 

It  is  composed  of  fifteen  to  twenty  cartilaginous  rings,  which  form 
the  anterior  two  thirds  of  its  cylinder;  fibrous  membrane^  which  forms 
the  posterior  third  of  the  tube ;  mucous  membrane,  which  lines  it  inter- 
nally; longitudinal  elastic  fibres,  situate (\  beneath  the  mucous  mem- 
brane; and  muscular  fibres,  which  form  a  thin,  transverse  layer  between 
tlie  exti'cmities  of  the  cartilages;  tl  sir  posterior  surface  is  covered  by 


SPLANCHNOLOGY. 


211 


ellular  tissue,  in  which  are  lodged  the  tracheal  glands,  which  secrete 
he  lubricating  mucus. 

THE    THYROID    GLAND. 

In  structure  this  body  is  composed  of  a  dense  aggi'egation  of  minute 
Qdependent  membranous  cavities,  enclosed  by  a  plexus  of  capillary 
essels,  and  connected  by  cellular  tissue  The  cavities  are  filled  with 
yto-blasts  and  .cells.  It  is  situated  upon  the  trachea,  above  the  sternum, 
eing  divided  into  two  lobes,  one  of  which  is  placed  on  each  side ;  the 
oimoction  between  the  lobes  is  called  the  isthmus.  This  gland  is 
irger  in  children  and  females  than  in  adults  and  males.  It  is  profusely 
ui)plied  with  Mood  by  the  superior  and  inferior  thyroid  arteries ;  ita 
ierves  are  derived  from  the  superior  laryngeal  and  sympathetic.  The 
unction  of  this  organ  is  entirely  unknown.  Its  enlargement  constitutes 
he  disease  called  goitre,  or  bronchocele. 


OF    THE    LUNGS. 


Fiar.  114. 


Fig.  114  represents  the 
ntcrior  aspect  of  the 
naton:y  of  the  heart  and 
angs.  1.  Right  venti'i- 
le ;  the  vessels  to  the 
3ft  of  the  number  are  the 
riiddle  coronary  artery 
nd  veins.  2.  Left  ven- 
ricle.  3.  Right  auricle. 
.  Left  auiiclo.  5.  Pul- 
nonary  artery.  6.  Right 
lulmonary  artery.  7. 
jcft   pulmonary    artery. 

I.  Remains  of  the  ductus 
irteriosus.  9.  Aortic  arch. 
0.  Superior  cava.  11.  Ar- 
ena innominata;  in  front 
if  it  is  the  right  venainno- 
Qinata.  12.  Right  subcla- 
ian  vein  ;  behind  it  is  its 
orresponding  artery.  13. 
light  common  carotid 
irtery  and  vein.  14.  Left 
■ena  innominata.  15. 
joft  carotid  artery  and 
'ein.    16.  Left  subclavian 

Ttery  and  vein,     17.  Trachea.     18.  Right  bronchus.      19.   Left  bronchus.     20,  20.  Pul- 
noiiary  veins ;  18,  20,  from  the  root  of  the  right  lung ;  and  7,  19,  20,  the  root  of  the  left. 

II.  Upper  lobe  of  right  lung.    22.  Its  middle  lobe.    23.  Its  inferior  lobe.    24.  Superior 
obe  of  left  lung.    25.  Its  lower  lobe. 


HEART    AND    LUXGS. 


The  lungs  are  two  conical  organs  occupying  the  cavity  of  the  cheat 


212  ANATOMY 


on  each  side  of  the  heart,  from  which  they  ai-e  separated  by  a  mem- 
branous partition,  the  mediastinum.  They  are  tapering  above,  where 
they  extend  bo3'ond  the  level  of  the  first  rib,  and  broad  and  concave 
below,  where  they  rest  on  the  convex  surface  of  the  diaphragm.  Their 
color  is  pinkish-gray,  variously  mottled  and  marked  with  black.  Each 
lung  is  divided  into  two  lobes  by  a  long,  deep  fissure,  and  in  the  right 
lung  the  ujjper  lobe  is  subdivided  by  a  second  fissure. 

The  root  of  each  lung,  which  retains  it  in  position,  comprises  the'i 
pulmonary  artery  and  veins,  and  bronchial  tubes,  with  the  bronchial 
ve-;sels  and  pulmonary  plexuses  of  nerves. 

The  structure  of  the  lungs  is  composed  of  ramifications  of  the  bron->-'§itiiei 
chial  tubes,  terminating  in  intercellular  passages  and  air-cells,  and  the 
ramifications  of  the  pulmonary  artery  and  vein,  bronchial  arteries  and 
veins,  lymphatics  and  nerves,  the  whole  held  together  by  cellular  tis- 
sue, and  called  the  parenchyma. 

The  bronchial  tubes,  on  entering  the  lungs,  divide  into  two  branches-, 
»nd  each  of  these  divide  and  subdivide  until  lost  in  intercellular  pas- 
sages, and  these,  after  several  bifurcations,  ultimately  terminate  by  a 
caecal  extremity,  which  is  the  air-cell.  The  sti'ucture  of  the  bronchial 
tubes  is  changed  fi-om  cartilaginous  to  membranous  afber  they  have 
ari'ived  within  one  eighth  of  an  inch  of  the  surface  of  the  lung,  and 
diminished  to  a  diameter  between  one  thhtieth  and  one  fiftieth  of  an 
inch. 

The  pulmonary  artery,  which  ti'ansmits  the  venous  blood  to  tlie 
lungs,  terminates  in  a  minute  network  of  capillary  vessels,  distributed 
through  the  walls  of  the  air-passages  and  air-cells ;  these  converge  to 
form  the  pulmonary  veins,  which  return  the  arterial  blood  to  the  heart. 

The  lymphatics  of  the  substance  and  surface  of  the  lungs  terminate 
in  the  bronchial  glands. 

The  nerves,  derived  from  the  ganglionic  and  pneumogastinc,  form 
anterior  and  posterior  plexuses  upon  the  front  and  back  of  the  root  of 
the  lungs,  from  which  branches  follow  the  coui-se  of  the  bronchial 
tubes  to  supply  the  intercellulai-  passages  and  air-cells. 


tki, 


caue 


riii 
t:pa 


THE    PLEURA. 

Each  lung  is  invested  and  sustained  by  the  p/cwra,  a  serous  mem 
brane,  which  invests  it  as  far  as  the  root,  and  is  then  reflected  upon  the 
sides  of  the  chest  and  across  the  diaphragm.  The  part  enclosing  tlie 
lung  is  called  j^lcura  ])ulmonalis,  and  that  in  contact  v/ith  the  parietieg 
of  tiie  chest,  tlie  pleura  costalis  ;  the  tsvo  reflected  portions  in  the 
middle  of  the  chest  form  a  septum,  called  mediastinum,  which  divides 
the  thorax  into  two  pulmonary  cavities;  this  portion  is  diatingiiisliea 


"111 

K^-tii 
liere 


SPLANCHNCLOGY.  21S 

.nto  anterior,  jyostsri.ir,  and  middle  portions,  the  latter  containiug  the 
heart  and  its  pericardium,  the  ascending  aorta,  the  superior  vena  cava, 
the  bifurcation  of  the  trachea,  the  pulmonarj  ^teries  and  veins,  and 
the  phrenic  nerves. 

THE    ABDOMINAL    VISCERA. 

The  abdominal  cavity  \r>  bounded  above  by  the  diaphi-agm,  below  by 
the  pelvis,  in  front  and  laterally  by  the  lower  ribs  and  abdominal  mus- 
cles, and  beliind  by  the  vertebral  column  and  abdominal  muscles ;  it 
contains  the  alimentary  canal,  liver,  pancreas,  spleen,  and  kidneys,  with 
the  supra-renal  capsules. 

Abdomi.nal  Regions. — For  convenience  the  abdominal  cavity  is 
divided  into  nine  regions,  by  two  transverse  lines  'around  the  body,  one 
pai-allel  with  the  inferior  convexity  of  the  ribs,  and  the  other  with  the 
highest  points  of  the  crests  of  the  ilia ;  and  two  perpendicular  lines, 
one  at  each  side,  drawn  from  the  cartilage  of  the  eighth  rib  to  the 
middle  of  Poupart's  ligament ;  the  central  region  of  the  upper  zone  is 
called  the  epigastric^  and  its  lateral  divisions  right  and  left  hypochon- 
driac ;  the  middle  region  of  the  middle  zone  is  the  wnhilical,  the  t^vo 
lateral  the  lumbar ;  the  middle  of  the  lower  zone  is  the  hypogastric, 
and  the  two  lateral  the  iliac.  In  the  upper  zone  is  found  the  liver,  ex- 
tending from  the  right  to  the  left  side ;  the  stomach  and  spleen  on  the 
left,  and  the  pancreas  and  duodenum  behind ;  in  the  middle  zone  the 
transverse  colon,  upper  part  of  the  ascending  and  descending  colon, 
omentum,  small  intestine,  mesenteiy,  and,  behind,  the  kidneys  and 
supra-renal  capsules.  In  the  lower  zone  is  the  inferior  portion  of  the 
omentum  and  small  intestine,  the  caecum,  ascending  and  descending 
colon  with  the  sigmoid  flexure,  and  the  ureters. 

The  peritoneum  is  the  serous  membrane  of  the  abdominal  cavity ;  it 
invests  each  viscus  separately,  and  is  then  reflected  upon  the  surround- 
ing parieties,  enclosing  the  whole  in  a  sac.  The  diaphi-agm  is  lined  by 
two  layers,  which,  descending  to  ihe  upper  surface  of  the  liver,  form 
its  coronary  and  lateral  ligaments  ;  and,  after  surrounding  the  liver  and 
meeting  at  its  under  surface,  pass  to  Che  stomach,  forming  the  lesser 
omentum.  After  surrounding  the  stomach  they  descend  in  front  of  the 
intestines,  forming  the  great  omentum  ;  they  then  surround  the  traus- 
*  verse  colon,  and  pass  backward  to  the  spine,  forming  the  meso-colon^ 
where  the  layers  separate.  The  j^osterior  ascends  in  front  of  the  pan- 
creas and  aorta  to  the  diaphragm;  the  anterior  descends,  and,  after 
investing  all  the  small  intestines,  returns  to  the  spine,  thus  forming  the 
mesentery.  Descending  into  the  pelvis,  it  forms  the  mesQ-rectum^  and 
a  poaci]  called  the  ruito-vesiccd  fold,  b^tve^u  Uie  r^ctoua  aiad  bladder; 


214 


ANATOMY 


It.  then  ascends  ui,on  the  nock  of  the  bM^^Tlbi^^^  ^. 


Fig.  115. 


ABDOAIIIVAL    CAVITY 
Fit.'.  115  exhibits  the  abdominal  cavity,  with  the  i 


lilf^^n.    A.  ne«»<'ndm(r  a<«^      \-   v    a  -•  i aucreas.    K.  hJdnevfl.    aAu, 


Ascendiog  rcna  «,vn.     R.  Eoctum.     B.  Bladder' 


SPLANCHNOLOGY.  215 

In  the  female  it  is  reflected  on  the  posterior  surface  of  the  vagina 
and  both  surfaces  of  the  uterus,  forming  on  each  side  the  'broad  liga- 
ment of  the  latter  viscus. 

The  great  omentum  consists  of  four  layers,  the  two  which  descend 
from  the  stomach  again  returning  upon  themselves  to  the  transverse 
colon ;  a  quantity  of  adipose  matter  is  deposited  around  the  vessels 
which  ramify  tlii'ough  it.  Its  function  is  to  protect  the  intestines  from 
cold  and  friction,  and  facilitate  their  movements  upon  each  other  in 
their  peristaltic  action. 

The  mesentery  retains  the  small  intestines  in  their  places,  and  gives 
passage  to  the  mesenteric  arteries,  veins,  nerves,  and  lymphatics. 

There  are  small,  irregular  pouches  of  the  peritoneal  membrane, 
filled  with  fat,  and  situated  like  fringes  upon  the  large  intestines,  which 
are  called  o.ppendkes  eiyjAoias.  The  gastro-phrenic  ligament  is  a  du- 
pFicature  extending  from  the  diaphragm  to  the  lesser  curve  of  the 
stomach  and  extremity  of  the  oesophagus ;  the  gastro-splenic  omentum 
is  a  duplicature  connecting  the  stomach  and  spleen. 

In  structure  a  serous  membrane  consists  of  an  external  cellular 
fibrous  layer,  which  is  vascular  and  adherent  to  surrounding  sti'uctures, 
and  an  internal  dense  and  smooth  layer,  deficient  of  vessels.  In  gen- 
eral character  serous  membranes  resemble  a  shut  sac,  and  secrete  b 
fluid  resembling  the  serum  or  wateiy  pai't  of  tne  blood. 

THE    ALIMENTARY    CANAL. 

The  alimentary  canal  is  a  continuous  tube  from  the  mouth  to  the 
'anus,  musculo-membranous  in  sti'ucture,  and  distributed  into  various 
; portions,  called  mouth,  phaiynx,  oesophagus,  stomach,  and  intestines; 
{the  intestines  are  subdivided  into  the  small,  which  are  distinguished 
into  duodenum,  jejunum,  and  ileum;  and  large  intestines,  distinguished 
into  caecum,  colon,  and  rectum. 

The  Mouth. — The  mouth  is  an  irregular  cavity,  containing  the 
organs  of  taste  and  instruments  of  mastication. 

The  lips  are  two  fleshy  folds  attached  to  tlie  surface  of  the  jaws, 
ind  formed  externally  of  common  integument,  internally  of  mucous 
membrane,  with  layers  of  miiscles  and  numerous  small  glands  between. 

The  cheeks  (buccae)  form  the  sides  of  the  face,  and  are  constituted 
.limilarly  to  the  lips;  then-  glands  ai-e  called  buccal. 

The  hard  palate  is  a  dense  structure  of  mucous  membrane,  fibrous 

[issue,  glands,  vessels,  and  nerves,  firmly  connected  to  the  palate  pro- 

jesses  of  the  upper  maxillary  and  palate  bones.     Its  middle  line  ia 

^.narked  by  an  elevated  raphe,  on  each  side  of  which  are  traneRrersd 

idges  and  grooves. 


1' 


£16  ANATOMY, 


The  gums  are  tliick,  dense  folds  of  mucous  membrane  attached  to 
[he  periosteum  of  the  alveolar  processes,  and  remarkable  for  tlieir 
insensibility. 

The  tongue  has  been  ah'eady  described. 

The  soft  palate  (velum  pendulum  palati)  is  a  fold  of  mucous  mem- 
brane, with  glands  and  muscles,  at  the  back  part  of  the  moulh,  con- 
tinuous above  with  the  hard  palate  ;  the  uvula  is  a  small  rounded  pro- 
cess hanijing  from  the  middle  of  its  inferior  border. 

The  tonsils  (amygdalte)  are  tvvo  glandular  almond-shaped  bodies  oq 
each  side  of  the  fauces,  between  folds  of  the  mucous  membrane  of  the 
soft  i)alate,  which  are  called  the  anterior  and  j^osterior  pillars.  They 
are  composed  of  an  assemblage  of  mucous  follicles  opening  on  the  sur- 
face of  the  glands. 

The  isthmus  of  the  fauces  is  the  space  included  between  the  soft . 
palate  and  root  of  the  tongue ;  it  is  the  opening  between  the  mouth 
and  pharynx. 

The  salivary  glands  communicate  with  the  mouth  by  their  excre- 
toiy  ducts;  they  are  the  parotid,  submaxillary,  and  sublingual.  The 
parotid,  the  lai-gest,  is  situated  immediately  in  front  of  the  external 
ear,  extending  deeply  behind  the  ramus  of  the  lower  jaw.  Embedded 
in  its  substance  are  the  external  carotid  artery,  temporo-maxiilaiy  vein, 
and  facial  nerve.  Its  excretory  duct  opens  on  the  internal  surface  oft 
the  cheek  opposite  the  second  molar  tooth  of  the  upper  jaw.  The 
submaxillary  is  situated  in  the  posterior  angle  of  the  submaxillary  tri- 
anglo  of  the  neck,  and  behind  the  lower  jaw.  Its  excretory  duct 
opens  on  the  papillae  under  the  tongue,  by  the  side  of  the  fra^numi 
lingurc.  The  sublingual  is  a  flattened  body  beneath  the  mucous  mem 
brano  of  the  floor  of  the  mouth,  on  each  side  of  the  frsenum  linguaeJ 
Its  secretion  is  poured  into  the  mouth  by  seven  or  eight  small  ducts, 
which  oi)eu  on  each  side  of  the  fra?num  lingiias.  In  struGture  the 
salivaiy  glands  are  conglomerate,  consisting  of  lobes  made  up  of  small 
lobules,  and  these  of  still  smaller  lobules,  the  smallest  lobule  being  com- 
posed of  granules,  which  are  minute  cffical  pouches,  formed  by  the 
dilatation  of  the  extreme  ramifications  of  the  ducts. 

TuE  Pharynx. — The  j^harynx  is  a  musculo-membranous  sac  be 
tween  the  mouth  and  oesophagus.  Its  anterior  part  is  incomplete,  aod 
has  opening  into  it  the  two  posterior  nares,  the  two  Eustachian  tubes, 
)nouth,  larynx,  and  oesophagus. 

The  CEsophagus. — Tho  asophagus  is  the  continuation  of  the  oli- 
rueatftry  ccumlI  front  tlio  pliaryux  to  the  iitoamch.     la  itti  doa^caading 


SPLANCHNOLOGY.  217 


coui'se  along  the  spine  it  inclines  to  the  left  in  the  neck,  to  the  right  in 
the  upper  part  of  the  thorax,  and  to  the  left  again  as  it  passes  through 
the  posterior  mediastinum.  It  terminates  at  the  cardiac  orifice  of  the 
stomach  about  the  tenth  dorsal  vertebra. 

The  Stomach. — The  stomach  is  an  expansion  of  the  alimentary 
tube,  its  greater  or  splenic  end  being  situated  in  the  left  hypochondriac 
region,  where  it  is  in  contact  with  the  concave  surface  of  the  spleen, 
and  its  lesser  or  pyloric  end  extending  into  the  epigastric  region.  Above 
it  forms  a  lesser  curvature,  and  below  a  greater  curvature ;  its  opening 
into  the  oesophagus  is  the  cardiac  orifice,  and  its  opening  into  the  duo- 
denum the  pyloric  orifice.     (See  fig.  107.) 

The  Small  Intestine. — The  small  intestine  is  about  twenty-five 
feet  in  length,  extending  from  the  pylorus  to  the  caecum.  Its  first 
division  is  the  duodenum,  about  twelve  fingers'  breadth  in  length.  It 
ascends  obliquely  backward  to  the  under  surface  of  the  liver,  then 
descends  perpendicularly  in  front  of  the  right  kidney,  and  then  passes 
transversely  across  the  third  lumbar  vertebra.  A  little  below  its  middle 
it  receives  the  ductus  communis  choledochus  from  the  liver,  and  pan- 
creatic duct  from  the  pancreas.  The  second  division  is  called  jejunum ; 
it  forms  the  upper  two  fifths  of  the  small  intestine ;  it  is  thicker  to  the 
touch  than  the  other  portions,  and  has  a  pinkish  tinge.  The  third  divi- 
sion is  the  ileum ;  it  is  smaller  in  diameter,  and  thinner  in  texture,  and 
paler  than  the  jejunum.  It  opens  into  the  colon  at  an  obtuse  angle,  in 
the  right  iliac  fossa. 

The  Large  Intestine. — The  large  intestine  is  about  five  feet  in 
length,  sacculated  in  appearance,  and  divided  into  the  caecum,  colon, 
and  rectum.  The  ccecum  is  the  most  dilated  portion  of  the  intestinal 
tube,  forming  a  blind  pouch,  or  cul-de-sac.  Attached  to  its  exti'emity 
is  a  w^orm-shaped  tube,  from  one  to  five  or  six  inches  in  length,  called 
appendix  vermiformis ;  it  is  the  rudiment  of  the  long  caecum  found  in 
all  mammiferous  animals  except  man  and  the  higher  quadrupeds.  The 
colon  is  divided  into  transverse,  ascending,  and  descending,  and  in  the 
right  iliac  fossa  it  makes  a  remarkable  curve  upon  itself,  called  the  sig- 
moid flexure.  'Rie  rectum  is  the  termination  of  the  large  intestine  ;  it 
descends  in  front  of  the  sacrum,  and  near  the  exti'emity  of  the  coccyx 
curves  backward,  and  terminates  at  the  anus,  which  is  situated  a  little 
more  than  an  inch  in  front  of  the  coccyx.  The  integument  around  the 
anus  is  covered  with  hairs,  and  arranged  into  numerous  radiated  plates, 
which  are  obliterated  during  the  passage  of  fseces.  (See  fig  107  .) 
I— 19 


218  ANATOMY. 


Structure  or  the  Alimentary  Canal. — The  pharynx  has 
mucous,  fibrous,  and  muscular  coats ;  the  oesophagus  has  only  mucous 
and  muscular  coats ;  the  stomach  and  intestines  have  mucous,  muscular, 
and  serous  coats.  The  mucous  is  the  internal  coat,  the  muscular  the 
middle,  and  the  serous  the  external. 

The  mucous  coat  veiy  closely  resembles  the  cutaneous  covering  of 
the  exterior;  it  is  composed  of  three  layers,  an  epithelium,  a,  mucous 
jyroper,  and  a  fibrous.  The  epithelium  is  the  epiderraa  of  the  mucous 
membrane.  The  proper  mucous  layer  is  analogous  to  the  papillary 
layer  of  the  skin.  In  the  stomach  it  forms  polyhedral  cells,  into  the 
floor  of  which  the  gfistric  follicles  open ;  in  the  small  intestine  it  pre- 
sents numerous  minute  projecting  papillae,  called  villi,  which  give  the 
surface  a  velvety  appearance ;  in  the  large  intestine  the  surface  resem- 
bles the  cellular  network  of  the  stomach.  The  Jibrous  layer  (formerly 
called  '■'nervous  coaV^)  is  the  membrane  of  support,  as  the  corium  is  to 
the  papillary  layer  of  the  skin. 

The  muscular  coat  of  the  pharynx  consists  of  the  muscles  already 
described ;  that  of  the  rest  of  the  alimentary  canal  is  composed  of 
two  planes  of  muscular  fibres,  one  of  which  is  external  and  longitudinal, 
and  the  other  internal  and  circular. 

The  serous  coat  is  a  layer  of  membrane  derived  from  the  peritoneum. 

In  the  oesophagus  the  mucous  membrane  is  disposed  in  longitudinal 
plicce ;  in  the  stomach  it  is  formed  into  plaits,  or  ruga ;  at  the  pj- lorus 
it  forms  a  spiral  fold,  which  constitutes  a  part  of  the  pyloric  valve  ;  in 
the  lower  part  of  the  duodenum,  the  whole  length  of  the  jejunum, 
and  upper  part  of  the  ilium,  it  forms  valvular  folds,  called  valvula  con- 
niventes ;  at  the  termination  of  the  ilium  in  the  ctecum  it  forms  two 
projecting  folds,  ca]led  ileo-ccscal  valve ;  in  the  caecum  and  colon  it  is 
raised  into  cresentric  folds ;  and  in  the  rectum  it  forms  three  valvular 
folds. 

The  glands  and  follicles  of  the  intestinal  structure  are  situated  in 
the  loose  cellular  or  areohr  tissue  of  the  mucous  coat,  connecting  the 
muceus  with  the  fibrous  layer.  The  pharyngeal  glands  are  large 
and  numerous  around  the  posterior  nares ;  the  esophageal  glands  are 
small  lobulated  bodies  opening  upon  its  surface  by  a  long,  oblique  excre- 
tory duct ;  the  gastric  foLicles  are  long  tubular  bodies  situated  per- 
pendicularly side  by  side  throughout  the  mucous  membrane  of  the 
stomach,  and  intended  probably  for  the  secretion  of  the  gasti'ic  juice; 
the  duodenal  glands  are  small  flattened  granular  bodies,  resembling 
in  sti'ucture  small  salivary  glands,  and  opening  on  the  surface  by  minute 
excretoiy  ducts ;  the  solitary  glands  are  small  saccular  cavities  in  the 
small  intestines,  without  an  excretory  duct,  and  in  the  Urge  intestine* 


SPLANuHNOLOGY.  219 


small  circular  prominence,  with  a  minute  excretory  opening  in  the 
centre ;  the  aggregate,  or  Peyer''s  glands,  are  circular  patches  sur- 
rounded by  simple  follicles,  near  the  lowen-  end  of  the  ilium ;  and  the 
simple  follicles  are  small  pouches  of  mucous  layer,  dispersed  in  immense 
numbers  over  the  whole  mucous  membrane. 

The  arteries  of  the  alimentary  canal  are  the  pterygo-palatine,  ascend- 
ing pharyngeal,  superior  thyroid,  and  inferior  thyroid,  in  the  neck ; 
oesophageal  m  the  thorax ;  gastric,  hepatic,  splenic,  superior,  and  infe- 
rior mesenteric,  in  the  abdomen ;  and  inferior  mesenteric,  iliac,  and  in- 
ternal pudic,  in  the  pelvis.  The  veins  from  the  abdominal  portion  of 
the  canal  unite  to  form  the  vena  portae.  The  lymphatics  and  lacteals 
open  into  the  thoracic  duct.  The  nerves  of  the  pharynx  are  derived 
from  the  glosso-pharyngeal,  pneumogasti-ic,  and  ganglionic ;  those  of 
the  stomach  are  the  pneumogastric,  and  ganglionic  branches  fi-om  the 
solar  plexus ;  those  of  the  intestinal  canal  are  the  superior  and  inferior 
mesenteric  and  hypogasti'ic  plexuses ;  the  extremity  of  the  rectum  is 
supplied  by  the  inferior  sacral  nerves  from  the  spinal  cord. 

THE    LIVER. 

The  hvei  is  a  large  conglomerate  gland,  and  the  largest  organ  in  the 
body,  weighing  about  feur  pounds,  and  measuring  about  twelve  inches 
through  its  longest  diameter.  It  occupies  the  right  hypochonai lac  re- 
gion, and  extends  across  the  epigastrium  into  the  left  hypochondriac, 
frequently  reaching,  by  its  left  extremity,  the  upper  end  of  the  spleen. 
It  is  marked  anteriorly  by  a  deep  notch,  which  divides  it  into  two  lobes. 
Above  and  behind  it  is  in  relation  with  the  diaphragm,  below  with  the 
stomach  and  ascending  portion  of  the  duodenum,  ti'ansverse  colon, 
right  supra-renal  capsule,  and  right  kidney;  its  free  anterior  border 
corresponds  with  the  lower  margin  of  the  ribs. 

It  is  held  in  its  place  by  five  ligaments ;  the  longitudinal,  a  fold  of 
peritoneum  extending  through  its  notch ;  two  lateral,  formed  by  layers 
of  peritoneum,  which  connect  its  lobes  with  the  diaphragm ;  the  coro- 
nary, formed  by  the  separation  of  the  two  layers  of  the  lateral ;  and 
the  round,  a  fibrous  cord  resulting  from  the  obliteration  of  the  umbilical 
vein ;  this  passes  through  a  fissure  in  its  under  surface  from  the  um- 
bilicus to  the  inferior  cava. 

Its  under  surface  is  marked  by  five  fissures ;  the  longitudinal,  the 
bwer  part  of  which  contains  the  remains  of  the  ductus  venosus ;  the 
transverse,  through  which  the  hepatic  artery,  portal  vein,  and  hepatic 
ducts  enter  the  liver,  the  fissure  for  the  gall-hladder,  and  the  fissure 
for  the  vena  cava. 

These  fissures  divide  the  liver  into  five  lobes;  the  "igh,  five  or  six 


220  ANATOMY 


times  ims^er  than  the  left;  the  left,  the  lobus  quadratus,  on  the  under 
surface  of  the  right  lobe  ;  the  lobus  spigelii,  a  triangular  portion,  also 
on  tlie  under  surface  of  the  right  lobe  ;  and  the  lobus  caudatus,  a  small 
appenfliige  of  the  former. 

The  vessels  and  lymphatics  of  the  liver  have  been  described ;  its 
nerves  from  the  animal  system  proceed  from  the  right  phrenic  and 
pneumogastric ;  those  from  the  organic  system  ai'e  derived  fi'om  the 
hepatic  plexus. 

Mknute  Anatomy  of  the  Liver. — The  liver  is  composed  of 
lobules,  a  connecting  medium  called  Glisson's  capsule.,  of  the  ramifica- 
tions of  the  portal  vein,  hepatic  duct,  hepatic  artery,  hepatic  veins, 
lymphatics,  and  nerves,  and  is  enclosed  by  the  peritoneum,  and  retained 
in  position  by  its  folds. 

The  lobules  are  small  granular  bodies,  iiTegular  in  form,  about  the 
size  of  millet  seeds,  and,  when  divided  longitudinally,  have  a  foliated 
appearance.  Each  lobule  is  composed  of  a  plexus  of  biliary  ducts,  of  a 
venous  plexus  ^ormed  by  branches  of  the  portal  vein,  of  a  hepatic  vein, 
and  of  minute  arteries ;  nerves  and  absorbents  are  also  supposed  to 
enter  into  their  formation,  but  hare  not  been  ti'aced  into  them.  To 
microscopic  examination  a  lobule  presents  numerous  minute  bodies  of 
a  yellowish  color  and  various  forms,  connected  with  each  other  by  ves- 
sels ;  these  minute  bodies  are  the  acini  of  Malpighi. 

The  branches  of  the  portal  vein  are  disti'ibuted  through  canals  chan- 
neled in  every  plirt  of  the  organ.  This  vein  brings  the  returning  blood 
from  the  chylopoietic  viscera,  and  also  conducts  the  venous  blood  fi-om 
the  ultimate  ramifications  of  the  hepatic  artery ;  its  branches  in  the 
canals  are  called  vaginal,  and  form  a  venous  vaginal  plexus ;  these 
give  off  interlobular  branches,  and  the  latter  enter  the  lobules  and  form 
lobular  venous  plexuses ;  from  the  blood  circulating  in  these  plexuses 
the  bile  is  secreted. 

The  bile  in  the  lobule  is  received  by  a  network  of  minute  ducts,  the 
lobular  biliary  plexus  ;  from  the  lobule  it  is  conveyed  into  interlobular 
ducts ;  and  these  proceed  into  the  biliary  vaginal  j^lcxus  of  the  portal 
canals,  and  thence  into  the  excreting  ducts,  by  which  it  is  carried  into 
the  duodenum  and  gall-bladder,  after  being  mingled  in  its  course  with 
thr  mucous  secretion  from  the  numberless  mucipai'ous  follicles  in  the 
walls  of  the  ducts. 

The  hepatic  artery  distributes  branches  through  all  the  portal  canals, 
gives  off  vaginal  branches,  which  form  a  vaginal  hepatic  plexus,  from 
which  the  interlobular  branches  arise,  and  these  latter  terminate  ulti- 
mately in  the  lobular  venous  plexuses  of  the  portal  vein.     The  artery 


SPLANCHNOLOGY. 


221 


ramifies  abundantly  in  the  coats  of  the  hepatic  ducts,  supplying  mate- 
rials for  their  mucous  secretion,  and  for  the  nutrient  vessels  of  the 
entire  organ. 

The  hepatic  veins  commence  in  the  centre  of  each  lobule  by  minute 
radicles,  which  collect  the  impure  blood  from  the  lobular  venous 
plexus,  and  convey  it  into  the  interlobular  veins  ;  these  open  into  veins 
called  suhlobular,  and  the  sublobular  unite  to  form  the  large  hepatic 
trunks  by  which  the  blood  is  conveyed  into  the  vena  cava.  • 


An  important  physiologica' 
deduction  from  the  anatomi- 
cal structure  of  the  liver  is, 
that  bile  is  wholly  secreted 
from  venous  blood,  and  not 
from  a  mixture  of  venous  and 
arterial  blood,  as  stated  by 
Muller;  and  an  equally  im- 
portant pathological  inference 
is,  that  bile  is  wholly  an  ex- 
crementitious  fluid,  and  not 
"auxiliary  to  digestion,"  as 
many  physiologists  suppose. 

Fig.  116  is  a  horizontal  section  of 
three  superficial  lobules,  showing 
the  two  principal  systems  of  blood- 
vessels. 


Fig.  116. 


LOBTJIiES  OF  THE   LIVER. 


The  Gall-B ladder. — ^The  gall-bladder  is  a  pyriform  sac,  which 
serves  as  a  reservoir  for  the  bile.  It  is  situated  on  the  under  surface 
of  the  right  lobe  of  the  liver,  and  composed  of  serous,  fibrous,  and  mu- 
cous coats.  Its  mucous  coat  is  raised  into  minute  rugae,  which  form  a 
spiral  valve  at  the  neck  of  the  sac. 

The  biliary  ducts  are  three :  the  ductus  communis  cJioledocJms,  which 
is  the  common  excretory  duct  of  the  liver  and  gall-bladder,  about  three 
inches  long,  and  about  the  size  of  a  crow-quill,  commences  at  the  mid- 
dle of  the  duodenum,  and  before  reaching  the  liver  divides  into  the 
cystic,  which  is  about  an  inch  in  length,  and  enters  the  neck  of  the 
gall-bladder,  and  the  hepatic,  which  continues  onward  to  the  transverse 
fissure,  where  it  divides  into  two  branches,  which  ramify  through  the 
portal  canals  to  all  parts  of  the  liver. 

THE    PANCREAS. 

The  pancreas  (sweet-bread)  ia  a  'ong,  flat,  conglomerate  gland,  in 


222  ANATCMY. 


structure  and  function  analogous  to  the  salivary  glands.  It  is  about 
six  inches  long,  weighs  about  four  ounces,  situated  transversely  across 
the  abdomen  behind  the  stomach,  opposite  the  fii-st  and  second  lumbar 
vertebrae.  Its  greater  end,  or  head,  is  placed  toward  the  right,  sur- 
rounded by  the  curve  of  the  duodenum ;  the  lesser  end  extends  to  the 
left  as  fiir  as  the  spleen.  Upon  the  posterior  part  of  its  head  is  a  lobular 
fold,  called  the  lesser  pancreas. 

In  structure  the  pancreas  is  composed  of  reddish-yellow  polyhedral 
lobules,  these  consisting  of  smaller  lobules,  and  these  again  composed 
of  the  ramifications  of  minute  ducts,  terminating  in  c3Bcal  pouches.  The 
pancreatic  duct  commences  at  the  papillae  on  the  inner  surface  of  the 
duodenum  by  a  small  dilatation  common  to  it  and  the  ductus  communis 
choledochus,  and  passes  obliquely  through  the  middle  of  the  gland, 
giving  oflf  numerous  branches  to  be  distributed  through  its  substance. 
A  smaller  duct,  the  ductus  pancreaticus  minus,  receives  the  secretion 
of  the  lesser  pancreas ;  it  generally  opens  into  the  principal  duct  near 
the  duodenum,  but  sometimes  passes  into  that  intestine  separately. 

Its  arteries  are  branches  of  the  splenic,  hepatic,  and  superior  mesen- 
teric ;  its  veins  open  into  the  splenic ;  its  lymphatics  terminate  in  the 
lumbar  glands;  its  nerves  are  filaments  of  the  splenic  plexus. 

THE    SPLEEN. 

The  spleen  is  an  oblong  flattened  viscus,  of  a  dark,  bluish-red  color, 
situated  in  the  left  hypochondrium.  Its  size  and  weight  are  variable  ; 
its  texture  is  exceedingly  spongj',  vascular,  and  fi'iable.  Its  internal 
surface  is  marked  with  several  large  irregular  openings  for  the  entrance 
and  exit  of  vessels ;  this  is  the  hilus  lienis.  A  second  spleen  is  some- 
times found  appended  to  one  of  the  branches  of  the  splenic  artery, 
about  the  size  of  a  hazel  nut,  and  occasionally  two  and  three  of  these 
bodies  have  been  found. 

The  spleen  is  profusely  supplied  with  blood ;  the  splenic  artery  is 
very  large  in  n-oportion  to  the  bulk  of  the  organ,  and  its  branches  are 
distributed  to  distinct  sections,  sparingly  anastomosing  with  each  other. 
The  veins,  by  their  numerous  dilatations,  form  most  of  its  bulk ;  their 
blood  is  poured  into  the  splenic  vein,  which  is  one  of  the  trunks  that 
form  the  portal.  The  lymphatics  are  remarkable  for  their  number 
and  large  size,  and  terminate  in  the  lymphatic  glands.  Its  nerves  are 
the  splenic  plexus,  derived  from  the  solar. 

The  function  of  the  spleen  is  unknown.  Most  physiologists  have 
conjectured  that  it  was  in  some  way  auxiliary  to  digestion;  others,  with 
more  probability,  have  regarded  it  as  a  sort  of  brain-appendage  to  the 
organic  nervous  sjsten:,     Tliis  hypothesis  is  strengthened  by  its  pecu- 


SPLANCHNOLOGY.  223 

liar  structure,  which  has  many  points  of  resemblance  both  to  secernent 
glands  and  the  cerebro-spinal  substance ;  and  by  the  absence  of  an 
excretory  duct. 

THE    SUPRA-RENAL    CAPSULES. 

The  supra-renal  capsules  are  two  small,  yellowish,  flattened  bodies, 
surmounting  the  kidneys,  and  inclining  toward  the  vertebral  column. 
The  right  is  triangular  in  shape,  the  left  semilunar;  they  are  connected 
to  the  kidneys  by  the  common  cellular  tissue  and  a  fissure  on  the  an- 
terior surface  divides  each  capsule  into  two  lobes.  Both  capsules  rest 
against  the  curve  of  the  diaphragm  on  a  level  with  the  tenth  dorsal 
vertebra.  They  are  larger  in  the  foetus  than  in  the  adult,  and  are  sup- 
posed to  perform  some  function  connected  with  embryonic  life. 

Their  stnicture  is  composed  of  cortical  and  medullary  substances. 
Their  arteries,  derived  from  the  aorta,  renal  and  phrenic  arteries,  are 
remarkable  for  the  innumerable  minute  twigs  into  which  they  divide 
before  entering  the  capsule.  The  supra-renal  vein,  whose  large  ti'unk 
in  its  centre  gives  the  capsule  the  appearance  of  a  central  cavity,  col- 
lects the  blood  from  the  medullaiy  venous  plexus,  and  receiving  several 
branches  which  pierce  the  cortical  layer,  opens  directly  into  the  vena 
cava  on  the  right  side,  and  into  the  renal  vein  oh  the  left.  Their 
lymphatics  are  large  and  numerous,  and  terminate  in  lumbar  glands. 
The  nerves  are  derived  fi'om  the  phrenic  plexus. 

THE    KIDNEYS. 

The  secreting  organs  of  the  urine  are  situated  in  the  lumbar  regions, 
behind  the  peritoneum,  and  on  each  side  of  the  vertebral  column,  which 
their  upper  extremities  approach.  Each  kidney  is  between  four  and 
five  inches  long,  two  and  a  half  broad,  about  an  inch  thick,  weighing 
from  three  to  five  ounces.  The  right  kidney  is  somewhat  lower  than 
the  left,  from  the  position  of  the  liver ;  the  left  is  covered  in  front  by 
the  gi-eat  end  of  the  stomach  and  the  spleen. 

The  structure  of  the  kidney  is  dense  and  fragile,  and  when  divided 
presents  an  external,  vascular,  or  cortical,  and  an  internal,  tubular,  or 
medullary  substance.  The  tubular  portion  is  formed  of  pale-reddish 
conical  masses,  and  the  vascular  portion  of  blood-vessels  and  plexiform 
convolutions  of  uriniferous  tubuli,  which  not  only  constitute  the  surface, 
but  dip  between  the  cones  and  surround  them  nearly  to  their  apices. 

The  cones,  or  pyramids,  ai"e  composed  of  minute  straight  tubuli 
uriniferi,  of  a  diameter  not  exceeding  that  of  a  fine  hair,  which  com- 
mence at  the  apices  of  the  cones,  and  bifurcate  from  point  to  point 
toward  the  circumference  of  the  kidney. 


224 


ANATOMY 


SECTION    OF    THE    KIDNEY. 


Fig.  117.  Fig,  117  is  a  eection  of  the  kidney  surmounted  by  the 

suprarenal  capsule ;  the  swellings  on  the  surface  mark 
its  original  constitution  in  distinct  lobes.  1.  Supra-renal 
capsulo.  2.  Vascular  portion.  3,  3.  Tubular  portion, 
consisting  of  cones.  4,  4.  Two  of  the  papillae  project- 
ing into  their  corresponding  calices.  5,  5,  5.  The  three 
int'undibula ;  the  middle  5  is  situated  in  the  mouth  of  a 
calyx.     6.  Pelvis.    7.  Ureter. 

In  tlie  cortical  portion  are  contained  a 
multitude  of  very  small,  jeJ,  globular  bodies, 
culled  glomeruli,  or  corpora  ATaljjighiana, 
each  of  's^bich  is  composed  of  a  plexus  of 
capillary  vessels,  and  a  coil  of  uriniferous  tu- 
bule, both  enclosed  in  a  thin  membranous 
capsule.  The  cones  of  the  interior  are  in- 
vested by  mucous  membra "»«,  which  is  con- 
tinuous at  their  apices  with  the  uriniferous 
tubuli,  and  is  reflected  fi-ora  their  sides  so  as 
to  form  around  each  a  cup-like  pouch,  or  calyx.  The  calices  commu- 
nicate with  a  common  cavity  of  large  size  at  each  exti-emity  and  in  the 
middle,  and  three  cavities,  called  the  infundibula,  unite  and  form  a 
membranous  sac,  which  occupies  the  hilus  reualis,  the  pelvis  of  th% 
kidney. 

The  excretory  duct  of  the  kidney  is  called  ureter ;  it  is  a  membranous 
tube  about  as  large  as  a  goose-quill,  and  nearly  eighteen  inches  long ; 
it  is  situated  behind  the  peritoneum,  crossed  by  the  spermatic  vessels, 
and  in  its  course  downward  crosses  the  common  iliac  artery  and  vein, 
and  then  the  external  iliac  vessels ;  within  the  pelvis  it  crosses  the 
umbilical  artery  and  vas  deferens  in  the  male,  and  the  upper  part  of 
the  vagina  in  the  female,  and  terminates  upon  the  internal  surface  of 
the  bladder.     Sometimes  there  are  t^vo  ureters  to  one  kidney. 

Mr.  Bowman,  who  has  investigated  the  intimate  sti'ucture  of  the 
ividneys,  thinks  there  are  tv\'-o  distinct  sj'stems  of  capillary  vessels, 
through  both  of  which  the  blood  passes  in  its  course  from  the  arteries 
into  the  veins,  and  that  certain  saline  substances  and  morbid  products, 
as  sugar  and  albumen,  which  escape  from  the  system  through  the 
urine,  and  also  the  principal  constituents  of  urine,  such  as  urea,  lithic 
acid,  etc.,  are,  Hke  the  bile  in  the  liver,  derived  from  venous  blood. 


THE    PELVIC    VISCERA. 


The  cavity  of  the  pelvis  is  the  lower  portion  of  the  abdominal  cavity; 
it  is  included  within  the  bon^s  of  the  pelvis,  below  the  level  of  the 
linea-ilio-pectinea  and  the  pre  nonto:y  of  the  sacrum.     The  male  pel- 


SPLANCHNOLOGY  22» 

Tic  viscera  are  the  urinaiy  bladder,  prostate  gland,  vesicula  seminales, 
and  rectum. 

The  bladder  is  an  ovoid-oblong  membranous  sac,  situated  behind  the 
ossa  pubis  and  in  front  of  the  rectum.  Its  middle  portion  is  called  the 
body ;  its  upper  segment  tlie  fundus  ;  its  broad  surface  resting  on  the 
rectum,  the  bise ;  and  the  naiTt  w  constricted  portion  against  the 
prostate  glimd,  the  neck. 

It  is  composed  of  serous,  muscular,  and  mucous  coats ;  the  muscular 
coat  is  composed  of  longitudinal  fibres  externally,  and  an  internal  layer 
of  transverse  and  oblique  fibres,  so  arranged  as  to  diminish  the  diame- 
ter of  the  viscus  in  all  directions  in  the  expulsion  of  its  contents ;  a 
ring  of  elastic  tissue  surrounds  the  urethra  within  the  prostate  gland, 
to  which  the  longitudinal  fibres  are  attached,  whose  contraction  en- 
larges the  passage  from  the  bladder  into  the  urethra.  Upon  the  inter* 
nal  surface  of  its  base  is  a  pale  triangular  plane,  called  trigonum  vest- 
cale,  the  most  sensitive  portion  of  the  bladder,  and  occasioning  great 
suffering  when  pressed  upon  by  calculi.  At  the  enti'ance  of  the 
urethra  there  is  a  slight  elevation  of  the  mucous  membrane,  called 
vvula  vesiccE.  It  is  retained  in  its  place  by  seven  true  ligaments ;  two 
anterior,  formed  by  the  pelvic  fascia;  two  lateral,  formed  by  a  reflec- 
tion of  the  pelvic  fascia  and  jevatores  ani  muscles  upon  the  sides  of  its 
base  ;  two  umbilical,  the  fibrous  cords  resulting  fi'om  the  obliteration  of 
the  umbilical  arteries  of  the  fcetus ;  the  urachus,  a  small  fibrous  cord, 
formed  by  the  obliteration  of  a  tubular  canal  existing  in  embryo,  at- 
tache! I  to  the  apex  of  the  bladder,  and  thence  ascending  to  the  umbili- 
cus; and  four  false  ligaments,  v.diich  are  folds  of  peritoneum,  the  two 
lateral  corresponding  with  the  passage  of  the  vasa  deferentia  from  the 
sides  of  the  bladder  to  the  internal  abdominal  rings,  and  the  two  poste- 
rior with  the  course  of  the  umbilical  arteries  to  its  fundus. 

The  external  surface  of  the  bladder  corresponding  with  the  trigonum 
is  triangular,  and  separated  from  the  rectum  merely  by  a  thin  layer  of 
fibrous  membrane,  the  recto-vesical  fascia.  It  is  through  this  space, 
bounded  behind  by  the  recto-vesical  fold  of  peritoneum,  and  on  each 
side  by  the  vas  deferens  and  vesicula  sejninalis,  which  converge  al- 
most to  a  point  at  the  base  of  the  prostate  gland,  that  the  opening  is 
made  in  the  recto-vesical  operation  for  puncturing  the  bladder. 

The  prostate  gland  is  situated  in  front  ol  the  neck,  of  the  bladder, 
and  upon  the  rectum,  through  which  it  may  be  felt  with  the  finger, 
fc<urrounding  the  commencement  of  the  urethra  for  a  little  more  than 
an  inch  of  its  extent,  in  size  and  form  resembling  a  Spanish  chestnut, 
[t  consists  of  two  lateral  lobes,  aa  i  a  middle  lobe  or  isthmus,  and  its 
et'TJctu  ^  is  coinposel  of  ramified    lucts,  terminating  in  lobules  of  fo!- 


226 


ANATOMY 


licular  pouches.    lis  secretion  is  poured  into  the  prostatic  portion  of  the 
urethra  bj  fifteen  or  twenty  excretory  ducts. 


Fig,  118. 


VISCERA    OF    THE    PELVIS. 


Fig.  118  is  a  side 
view  of  viscera  of 
the  male  pelvis.  1. 
Divided  surface  of 
the  OS  pubis.  2. 
Divided  surface  of 
the  sacrum.  3.  Bo- 
dy of  the  bladder. 
4.  Its  fundus  ;  the 
urachus  is  seen 
passing  upward 
from  the  apex.  5 
Its  base.  6.  Ureter 
7.  Neck  of  the  blad- 
der. 8,  8.  Pelvic 
fascia ;  the  fibres 
above  7  are  given 
off  from  the  pelvic 
fascia,  and  repre- 
sent the  anterior 
ligaments  of  the 
bladder.  9.  Pros- 
tate gland.  10. 
Membranous  por- 
tion of  the  urethra,  between  the  two  layers  of  the  deep  perineal  fascia.  11.  The  deep 
perineal  fascia,  formed  of  two  layers.  12.  One  of  Cowper's  glands,  between  the  layers 
and  beneath  the  membranous  portion  of  the  urethra.  13.  Bulb  of  the  corpus  spongi- 
osum. 14.  Body  of  the  corpus  spongiosum.  15.  Right  crus  penis.  16.  Upper  part  of 
the  first  portion  of  the  rectum.  17.  Recto-vesical  fold  of  peritoneum.  18.  Second  por- 
tion of  the  rectum.  19.  Right  vesicula  eeminalis.  20.  Vas  deferens.  21.  The  rectum 
cover*;d  by  the  descending  layer  of  the  peJvic  fascia,  just  as  it  is  making  its  bend  back- 
ward to  constitute  the  third  portion.  22.  Part  of  the  levator  ani  muscle  investing  the 
lower  part  of  the  rectum.  23.  External  sphincter  ani.  24.  Interval  between  the  deep 
and  superficial  perineal  fascia ;  they  are  seen  to  be  continuous  beneath  the  number. 

The  vesicula  seminales  are  lobulated  bodies,  about  two  inches  in 
length,  situated  on  the  under  surface  of  the  base  of  the  bladder,  and 
separated  from  the  rectum  only  by  the  recto-vesical  fascia.  Each 
vesicula  is  formed  by  convolutions  of  a  single  tube,  which  gives  off 
several  irregular  caecal  branches  ;  it  is  enclosed  in  a  dense  fibrous 
membrane,  derived  from  the  pelvic  fascia,  and  is  consti-icted  beneath 
the  isthmus  of  the  prostate  gland  into  a  small  excretory  duct.  The 
vas  deferens  of  the  testis,  somewhat  enlarged  and  convoluted,  lies  along 
the  inner  border  of  each  vesicula,  and  is  included  in  its  fibrous  invest- 
ment. It  communicates  with  the  duct  of  the  vesicula,  beneath  the 
isthmus  of  the  prostate,  and  forms  the  ejaculatory  duct,  which  is  about 
three  fourths  of  an  inch  in  lengtxi,  and  opens  on  ^iie  mucous  meiabrans 
of  the  urethra. 


SPLANCHNOLOGY.  227 

Tlie  j'^nis  and  testes,  with  their  appendages,  constitute  the  male 
organs  of  generation.  The  penis  is  divided  into  a  head,  the  anterior 
extremity  of  which  is  the  gians,  a  root  which  is  sti'ongly  adherent  to 
the  pelvis,  and  an  intei-vening  body,  consisting  of  two  structures,  called 
corpus  cavernosum  and  corpus  spongiosum.  The  integument  of  the 
penis  is  thin,  and  destitute  of  adipose  matter.  Surrounding  the  glam« 
is  a  loose  doubling,  called  the  prepuce ;  this  is  connected  to  the  orifice 
of  the  urethra  by  a  process  caUed  frcenuin ;  the  edge  around  the  base 
of  the  glans  is  called  corona  giandis ;  the  glands  of  Tyson  are  smaU 
papillary  elevations  around  the  base  of  the  glans ;  their  secretion  is 
called  smegma";  the  fascia  is  situated  beneath  the  skin,  and  is  but  8 
modification  of  the  superficial  abdominal  fasc'a;  a  portion  connecting 
the  penis  with  the  pubis  is  called  ligamentum  suspensofium. 

The  largest  part  of  its  body  is  formed  by  the  corpus  cavernosum, 
which  in  shape  resembles  a  double  cylinder;  these  cylinders,  sepai'ated 
and  pointed  at  the  root,  are  there  called  the  crura,  each  crus  beins; 
firmly  attached  to  the  ramus  of  the  pubis  and  ischium.  Externally  this 
stiTicture  is  covered  by  a  thick  fibro-elastic  coat,  and  internally  of  erec- 
tile tissue.  The  partial  separation  of  the  two  cylinders  is  called  septum 
pectiniforme.  The  corpus  spongiosum  is  situated  along  the  under  surface 
and  in  the  inferior  groove  of  the  corpus  cavernosum.  Its  posterior  ex- 
tremity is  enlarged  into  the  bulb,  and  its  anterior  is  expanded  into  the 
glans.  It  is  composed  of  erectile  tissue,  a  peculiar  cellulo-vascular 
stiTicture  entering  largely  into  the  composition  of  the  organs  of 
generation,  and  contains  in  its  interior  the  spongy  portion  of  the 
urethra. 

The  urethra  is  the  uiinary  canal  from  the  bladder  thi'ough  the 
penis.  Its  sti'ucture  is  membranous,  composed  of  mucous  and  elas- 
tic-fibrous coats.  Its  diameter  varies  in  different  parts  of  its  course, 
which  is  somewhat  curved.  The  first  portion  is  called  the  prostatic 
urethra ;  this  is  about  an  inch  in  length ;  on  its  lower  surface  is  a 
longitudinal  fold  of  mucous  membrane,  called  veru  ynontanum,  or  capuz 
gallinaginis ;  on  each  side  of  this  a  depression  called  prostatic  sinus,  into 
which  the  prostatic  ducts  open ;  at  the  anterior  extremity  of  the  veru 
montanum  are  the  openings  of  the  ejaculatory  ducts.  The  next  portion 
is  membranous ;  this  is  eight  or  ten  lines  in  length,  and  very  narrow, 
surrounded  by  loose  tissue  and  a  few  muscular  fibres.  The  rest  is  the 
spongy  portion,  six  or  seven  inches  in  length ;  it  is  narrowest  in  the 
body  of  the  organ ;  posteriorly  it  is  dilated  into  the  bulb,  forming  the 
bulbous  urethra,  and  anteriorly  in  the  glans  it  enlarges  into  the  fossa 
navicularis.  The  external  opening,  meatus  urinarus,  is  the  most  con- 
stricted portion  of  *he   canal,   so  that   a  catheter  which  will    ente? 


228  ANATOMY 


that  opening  will  pass  freely  through  the  whole  extent  of  a  healthy 
urethra. 

Cowj)er^s  glands  are  two  small  lobulated  bodies,  about  the  size  of 
peas,  situated  beneath  the  membranous  portion ;  their  excretory  ducts 
open  into  the  bulbous  portion.  The  whole  internal  siu'face  of  the 
spongy  portion  of  the  urethra  is  marked  with  lacunce,  or  openings  of 
mucous  glands  situated  ni  the  submucous  cellular  tissue.  These  open- 
ings are  du'ected  forward,  and  sometimes  obstruct  the  point  of  a  small 
catheter  in  its  passage  to  the  bladder. 

The  testes  are  elandu;ar  organs  suspended  from  the  abdomen  by  the 
spermatic  cord,  and  enclosed  in  an  integument  called  the  scrotum.  The 
scrotum  is  composed  of  a  tegumentary  layer,  exti'emely  thin,  transparent, 
and  coriTi gated,  and  beset  with  hairs  having  very  prominent  roots,  and 
a  proper  covering  called  dartos,  a  fibro-muscular  tissue,  which  sends 
inward  a  oartition.  septum  scroti,  which  divides  it  into  two  cavities  for 
the  two  testes. 

The  sjjenfiatic  cord,  composed  of  arteries,  veins,  nerves,  lymphatics, 
the  excretory  duct  of  the  testicle,  and  investing  tunics,  is  the  medium 
of  communication  between  the  testes  and  interior  of  the  abdomen.  It 
commences  at  the  internal  abdominal  ring,  where  the  vessels  composing 
it  converge,  and  passes  obliquely  along  the  spermatic  canal,  escaping  at 
the  external  abdominal  ring,  and  descending  through  the  scrotum  to 
the  posterior  border  of  the  testicle.  The  excretory  duct  of  the  testicle 
is  called  vas  deferens ;  its  coats  are  thick  and  tough,  and  it  may  be  dis- 
tinguished along  the  posterior  border  of  the  spermatic  cord  by  the  hard 
and  cordy  sensation  it  communicates  to  the  fingers. 

Each  testis  is  an  oblong  rounded  gland  suspended  in  the  cavity  of 
the  scrotum  by  the  spermatic  cord  ;  its  function  is  to  secrete  the  sem- 
inal fluid.  Encircling  its  posterior  edges  is  a  soft  flattened  body,  called 
epididymis ;  it  is  formed  by  the  convolutions  of  the  excretory  seminal 
ducts;  its  upper  extremity  is  called  globus  major,  and  the  lower  globus 
minor;  tnis  exti-emity  curves  upward  and  becomes  continuous  with  the 
vas  deferens.  The  testis  has  thi'ee  coverings,  a  serous  coat  called 
tunica  vaginalis ;  a  thick,  middle,  fibrous  membrane,  called  tunica 
aibuginea,  which  suiTounds  the  testis,  and  is  reflected  into  its  interior, 
forming  the  mediastinum  testis,  from  which  numerous  fibrous  cords, 
trahcculee  septula,  are  given  off";  and  an  internal  nutrient  membrane 
called  tunica  vasculosa,  which,  analogous  to  the  disposition  of  the  pia 
mater  in  the  brain,  sends  processes  inward  between  the  lobules  of  the 
orgcwi. 

The  substance  of  the  testis  consists  of  numerous  flattened  lobules, 
with  their  bases  toward  the  surface.     Ki'ause  counted  between  four 


SPLANCHNOLOGY. 


229 


and  five  hundred  of  them.  Each  lobule  is  invested  in  a  distinct  sheath, 
formed  of  tw^o  layers,  one  from  the  tunica  vasculosa,  and  the  other  from 
the  tunica  albuginea,  and  composed  of  several  minute  tubuli,  tubuli 
seminiferi,  exceedingly  convoluted,  frequently  anastomosing  near  their 
extremities,  and  terminating  in  loops  or  csecal  ends  of  about  —  of  an 
inch  in  diameter.  The  tubuli  seminiferi  are  of  a  bright  yellow  color, 
become  less  convoluted  in  the  apices  of  the  lobules,  and  terminate  by 
forming  from  twenty  to  thirty  small  straight  ducts  of  about  twice  the 
diameter  of  the  tubuli  seminifera;  these  ducts  are  the  vasa  rectce. 


Fig.  119  represents  the  minute  structure  of  the  testis.  1, 
1.  Tunica  albuginea.  2,  2.  Mediastinum  testis.  3,  3.  The 
lobuli.  4,  4.  Vasa  recta.  5.  Rete  testis.  6.  Vasa  efferentia ; 
six  of  them  only  are  shown  in  the  diagram.  7.  Cervi  vascu- 
losi,  constituting  the  globus  major  of  the- epididymis.  8. 
Body  of  the  epididymis.  9.  Its  globus  minor.  10.  Vas  de- 
ferens.   11.  Vasculum  aberrans. 

The  vasa  recta  enter  the  mediastinum,  and 
terminate  in  from  seven  to  thirteen  smaller 
ducts,  which  pursue  a\yaving  course  fi'om  below 
upward,  through  the  fibrous  tissue  of  the  medi- 
astinum, and  communicate  freely  with  each 
other,  constituting  the  rete  testis.  The  ducts  of 
the  rete  testis  terminate  at  the  upper  extremity 
of  the  mediastinum  in  small  ducts  called  vasa 
efferentia ;  these  vary  in  number  from  nine  to 
thirty,  and  form,  by  their  convolutions,  numerous 
conical  masses,  the  coni  vasculosi ;  from  the 
bases  of  these  cones  larger-sized  tubes  proceed, 
whose  complex  convolutions  form  the  body  of 
the  epididymis. 


Fig.  119. 


ANATOMY   OF   THE   TESTIS. 


THE    FEMALE    PELVIS. 

The  viscera  of  the  female  pelvis  are  the  bladder,  vagina,  uterus  and 
its  appendages,  the  rectum,  and  some  portion  of  the  small  intestines, 
which  occupy  the  upper  part  of  the  cavity. 

The  bladder  is  situated  behind  the  ossa  pubis  and  in  front  of  the 
uterus ;  it  is  broader  than  in  the  male,  corresponding  with  the  broader 
pelvis. 

The  urethra  is  about  an  inch  and  a  half  in  length,  and  is  lodged  in 
the  upper  wall  of  the  vagina,  in  its  course  downward  and  forward  be- 
neath the  arch  of  the  os  pubis,  to  the  meatus  urinarius.  It  is  sur- 
rounded by  a  proper  coat  of  ekstic  tissue,  to  which  the  muscles  of  th» 
20 


230 


ANATOMT. 


detrusor  urin.-e  are  attached,  and  to  which  the  remarkable  dilatability 
of  tlie  female  urethra  is  owing. 


Fig.  120. 


Fig.  120  is  a  side  view 
of  the  viscera  of  the 
female  pelvis.  1.  Sym- 
physis pubis,  to  the  up- 
per part  of  which  the 
tendon  of  the  rectus 
muscle  is  attached.  2. 
Abdominal  parieties.  3. 
Collection  of  fat,  form- 
ing the  prominence  of 
the  mons  Veneris.  4. 
Bladder.  5.  Entran.v; 
of  the  left  ureter.  6. 
Canal  of  the  urethra, 
converted  into  a  mere 
fissure  by  the  contrac- 
tion of  its  walls.  7. 
Meatus  urinarius.  8. 
Clitoris,  with  its  praBpu- 
tium,  divided  through 
the  middle.  9.  Left 
nympha.  10.  Left  la- 
bium majus.  11.  Meat- 
us of  the  vagina,  nar- 
rowed by  the  contrac- 
tion of  its  sphincter. 
12,  22.  Canal  of  the  va- 
gina, upon  which  the  transverse  rugae  are  apparent.  13.  The  thick  wall  of  separation 
between  the  vagina  and  rectum.  15.  The  perineum.  16.  Os  uteri.  17.  Its  cervix.  18. 
Its  fundus  ;  the  cavitas  uteri  is  seen  along  its  centre.  19.  Rectum,  showing  the  disposi- 
tion of  its  mucous  membrane.  20.  Anus.  21.  Upper  part  of  the  rectum,  invested  by 
the  peritoneum.  23.  Utero-vesical  fold  of  peritoneum  ;  the  recto-uterine  fold  is  seen  be- 
tween the  rectum  and  the  posterior  wall  of  the  vagina.  24.  The  reflexion  of  the  peri- 
toneum, from  the  apex  of  the  bladder  upon  the  urachus  to  the  internal  surface  of  the 
abdominal  parieties.    25.  Last  lumbar  vertebra.     26.  Sacrum.    27.  Coccyx. 


VISCERA    OF    THE    FEMALE    PELVIS. 


The  vagina  is  a  membranous  canal  leading  from  the  vulva  to  the 
uterus ;  its  structure  is  composed  of  mucous,  erectile,  and  contractile 
fibrous  tissues.  The  mucous  membrane  is  marked  by  a  number  of 
transverse  papillae,  or  rugae,  and  is  covered  by  a  thin  cuticular  epithe- 
lium, which  is  continued  from  the  labia  to  the  middle  of  the  cervix 
uteri. 

The  uterus  is  a  flattened,  pear-shaped  organ,  occupying  the  upper 
part  of  the  pelvic  cavity  between  the  bladder  and  reclum.  Its  fundus 
and  body  are  enclosed  in  s  duplicature  of  peritoneum,  which  forms  a 
transverse  septum  between  the  bladder  and  rectum,  the  folds  of  which, 
on  either  side  of  the  uterus,  are  its  broad  ligaments.  Its  lower  por- 
tion is  the  cervix;  ai'ound   the  cirrjmference  the  upper  end  of  th« 


SPLANCHNOLOGY.  231 

vagina  is  attached ;  its  opening  into  the  vagina  is  the  os  uteri.  Its 
sti'ucture  consists  of  an  external  serous  coat,  derived  from  the  perito- 
neum, a  middle  muscular  coat,  and  an  internal  coat  of  mucous  mem- 
brane. The  muscular  coat  gives  it  density  and  bulk,  and  in  the  unim- 
pregnated  state  is  exceedingly  firm  in  texture,  appearing  to  be  composed 
of  whitish  fibres,  inextricably  interlaced  and  mingled  with  blood-vessels. 
During  pregnancy  the  fibres  become  large  and  distinct,  and  disposed  in 
two  layers.  The  superficial  layer  consists  of  vertical  fibres,  some  of 
which  are  longitudinal  and  others  oblique.  The  ileej)  layer  consists  of 
two  hollow  cones  of  circular  fibres,  having  tlwjir  apex  at  the  openings 
of  the  Fallopian  tubes,  and  intermingling  by  their  bases  on  the  body  of 
the  organ.  Around  the  cervix  they  assume  a  chcular  form,  and  inter- 
lace at  right  angles. 

Its  arteries  are  the  uterine  from  the  internal  iliac,  and  the  spermatic 
from  the  aorta.  Its  veins  are  large,  and  in  the  unimpregnated  state 
are  called  sinuses,  being  canals  channeled  through  the  substance  of  the 
organ,  and  lined  by  the  mucous  membrane.  They  terminate  in  the 
uterine  plexuses  on  each  side.  The  lymphatics  terminate  in  the  lum- 
bar glands.  The  nerves  are  derived  from  the  hypogastric,  spermatic, 
and  sacral  plexuses.  Dr.  Robert  Lee,  after  making  the  nervous  struc- 
ture of  the  uterus  a  subject  of  special  investigation,  concludes  that 
"The  human  uterus  possesses  a  great  system  of  nerves,  which  en- 
larges with  the  coats,  blood-vessels,  and  absorbents,  during  pregnancy, 
and  which  returns  after  parturition  to  its  original  condition  before  con- 
ception takes  place." 

The  appendages  of  the  uterus  are  the  Fallopian  tubes  and  ovaries, 
enclosed  by  the  lateral  duplicatures  of  the  peritoneum,  which  consti- 
tute the  broad  ligaments. 

The  Fallopian  tubes  are  the  oviducts  by  which  the  impregnated 
ovum  is  conveyed  to  the  uterus.  Each  tube  is  four  or  five  inches  in 
length ;  its  canal  is  exceeding  small ;  its  opening  into  the  uterus  is 
called  ostium  uterinum,  and  that  of  its  outer  or  free  extremity,  ostiw^, 
abdominale  ;  this  end  has  a  fringed-like  appendage,  called  fimbria. oU^ 
and  is  connected  with  the  ovary  by  a  short  ligamentous  cord,  by  which 
i1  is  conducted  to  the  surface  of  the  ovary  during  sexual  excitement. 
The  r.oats  of  the  tubes  are  peritoneal,  muscular,  and  mucous. 

The  ovaries  are  oval,  flattened,  whitish  bodies,  situated  in  the  poste- 
rior layer  of  peritoneum  of  the  broad  ligament,  and  connected  to  the 
upper  angles  of  the  uterus  by  a  rounded  cord,  called  the  ovarian  liga- 
ment. In  structure  each  ovaiy  is  composed  of  cellulo-fibrous  parenchy- 
ma or  stroma,  traversed  by  blood-vessels,  and  enclosed  in  a  capsule 
consisting  of  vascular,  fibrous,  and  serous  layere     In  the  rolls  of  tha 


232  A  N  A  T  0  M  Y. 

stroma  the  small  vesicles  or  ovisacs  of  the  future  ova,  the  Graafian 
vesicles,  are  developed.  Each  ovar}''  contains  about  fifteen  fully  formed 
vesicles,  although  innumerable  microscopic  ovisacs  exist  in  the  paren- 
chyma. A  yellow  spot  or  cicati'ix,  called  corjjus  luteum,  is  found  in 
one  or  both  ovaries  after  conception.  A  false  corpus  lutcum  is  some- 
times met  with  in  the  ovaries  of  virgins ;  it  is  of  a  similar  appearance, 
oal  smaller  in  size  and  without  a  central  cavity. 

The  external  organs  of  generation  in  the  female  are  the  mons 
Veneris,  labia  majora,  labia  minora,  and  clitoris  ;  the  internal  being  the 
vagina,  utenis,  ovaries,  and  Fallopian  tubes,  which  have  been  de- 
scribed. 

The  mons  Veneris  is  the  prominent  integument  upon  the  front  of  the 
ossa  pubis ;  its  cellular  tissue  is  loaded  with  adipose  substance,  and  the 
surface  covered  with  hair.  The  labia  majora  are  longitiidinal  folds  of 
adipose  cellular  tissue  and  integument,  which  form  the  common  urino- 
sexual opening,  or  vulva.  The  labia  minora,  or  nyynjyha,  are  smaller 
folds,  situated  within  the  former.  The  clitoris  is  a  small  elongated 
body,  situated  in  front  of  the  ossa  pubis,  analogous  to  the  corpus  cav- 
ernosum  of  the  penis,  and,  like  it,  arises  by  crura  from  the  pelvis ;  its 
exti'emity  is  called  its  glans.  The  entrance  of  the  vagina  is  about  an 
inch  behind  the  clitoris ;  it  is  closed  in  virgins  by  a  partial  membrane 
stretched  across  the  opening;  this  is  called  the  hymen  ;  it  is  extremely 
variable  in  its  form  and  appearance,  and  not  unfrequently  is  entirely 
wanting.  Sometimes  it  is  imperforate,  and  occasionally  it  is  so  firm  as 
to  require  a  surgical  ti'ans-section.  Frequently  there  is  the  appear- 
ance of  a  fringe  of  papillfe,  carunculce  myrtiformes,  around  the  opening 
of  the  vagina,  which  are  the  remains  of  a  rudimentaiy  or  ruptured 
hymen.  The  meatus  urinarius  is  situated  behind  the  clitoris,  and  im- 
mediately in  front  of,  and  surrounded  by,  a  tubercle  at  the  upper  angle 
of  the  vagina,  and  formed  by  the  prominence  of  its  upper  wall. 

THE    MAMMARY    GLANDS. 

The  mammce  exist  in  a  rudimentary  state  in  the  male,  and  form  a 
part  of  the  reproductive  system  of  the  female.  They  are  situated  in 
the  pectoral  region,  and  only  separated  from  the  pectoralis  major  m'.s- 
cle  by  a  thin  fascia.  The  base  of  each  mamma  is  somewhat  elliptical ; 
the  anterior  aspect  is  convex,  having  a  central  prominence  of  integu- 
ment, called  the  nipple-,  suiTounded  by  a  colored  ai'eola.  In  sti-ucture 
it  is  a  conglomerate  gland,  consisting  of  lobes  held  together  by  firm 
cellular  tissue ;  the  lobes  are  composed  of  lobules,  and  those  of  minute 
cajcal  vesicles,  which  ai-e  the  ultimate  termination  of  the  excretory 
ducts.     Tbe    excretory  ducts,  tubuli   lactifeH,  are   teu   to    fift.aeR    in 


SPLANCHNOLOGY.  233 

number,  commencing  by  small  openings  at  the  apex  of  the  nipple,  and 
passing  inward  parallel  with  each  other  to  the  centi-al  part  of  the 
organ,  where  tliey  form  dilatations,  ampullce,  and  give  off  numerous 
branches  to  ramify  through  the  gland  to  their  ultimate  termination  in 
the  minute  lobules.  The  ducts  and  caecal  vesicles,  in  common  with  ail 
others  in  the  body,  are  lined  by  mucous  membrane. 

GENERAL    ANATOMY    OF    THE    FffiTUSi 

The  medium  weight  of  a  child  of  the  full  period  is  about  seven 
pounds,  and  its  length  seventeen  inches.  The  head  is  disproportionately 
large,  and  greatly  lengthened  from  before  backward,  while  the  face  is 
small.  The  chest  is  fully  expanded,  and  the  upper  extremities  well 
developed.  The  great  size  of  the  liver  renders  the  upper  part  of  the 
abdomen  large  and  prominent;  the  lower  part  is  small  and  conical,  and 
the  lower  extremities  very  small  comparatively. 

The  osseous  system  is  to  a  great  extent  soft  and  cartilaginous.  The 
bones  of  the  head  are  separated  by  spaces  where  the  ossification  has 
not  yet  taken  place,  allowing  them  to  move  upon  and  even  overlap 
each  other. 

The  muscular  system  is  well  developed  at  bu'th,  the  muscles  being 
generally  large  and  fully  formed.     Their  color  is  lighter,  and  their 
texture  softer  than  in  the  adult.     On  the  fibres  of  animal  life  the  trans 
verse  striae  are  not  distinguishable  until  the  sixth  month  of  foetal  life. 

The  vascular  system  presents  many  peculiarities.  The  two  auricles 
of  the  heart  communicate  by  means  of  the  foramen  ovale.  There  is  a 
communication  between  the  pulmonary  artery  and  descending  aorta 
by  means  of  a  large  trunk,  the  ductus  arteriosus.  The  internal  iliac 
arteries  are  continued  to  the  placenta,  by  which  the  foetal  blood  is  re- 
turned to  the  placenta  for  revivification.  There  is  also  a  communica- 
tion between  the  umbilical  vein  and  the  inferior  vena  cava,  the  ductus 
venosus. 

In  the  nervous  system  the  brain  is  very  soft,  almost  pulpy,  but  the 
nerves  are  firm  and  well  developed. 

The  eye  and  ear  of  the  organs  of  sense  are  large  and  fully  developed, 
^  while  the  internal  structure  of  the  nose  is  very  imperfectly  developed. 

Thi5  lungs  are  dense^  and  solid  in  structure  until  inflated  by  the  act 
of  inspiration.  The  lung  is  proportionately  large,  and  early  developed, 
at  first  appearing  like  a  simple  vessel,  but  gradually  becoming  more 
complicated  until  perfected  at  birth.  The  two  auricles  communicate 
with  each  other  until  the  moment  of  birth.  There  is  also  a  commu- 
nication between  the  puimjuary  artery  and  aorta,  called  ductus  arte- 
riosus. 


234 


ANAT0M7. 


In  the  foetal  circulation  the  pure  blood  is  brought  fi'om  the  placenta 
y  the  umbilical  vein,  which  passes  through  the  umbilicus  and  enters 
the  liver,  dividing  these  into  numerous  branches. 

Of  the  abdominal  viscera,  the  liver  is  first  formed ;  the  stomach  and 
spleen  are  comparatively  small,  the  pancreas  large;  the  large  intestines 
ai'e  filled  with  a  gi'eenish  viscous  secretion,  called  meconium. 

Note. — The  particular  aoatoiny  an(/  physiology  of  the  foetus  will  be 
given  in  I'ait  Vllf. 


PART    II. 


PHYSIOLOGL 

Defijsitions. — Physiology  is  the  doctrine  of  the  functions.  It  ex- 
plains the  actions  and  uses  of  the  various  organs  and  parts  of  the  living 
body  in  its  healthy  or  normal  condition.  Its  abnormal  or  diseased 
states  belong  to  the  department  of  pathology.  The  functions  have 
been  divided  into  various  classes,  and  each  class  admits  of  numerous 
subdivisions.  The  ancient  physiologists  divided  them  into  vital,  animal., 
and  natural,  corresponding  to  nutritive,  mental,  and  excretory  processes. 
Some  modern  authors  have  adopted  Bichat's  arrangement  into  individ- 
ual and  social,  the  former  being  subdivided  into  animal  and  organic. 
In  general  terms,  innervation,  circulation,  and  respiration  are  called 
vital  functions ;  while  these  with  digestion,  absorption,  assimilation, 
secretion.,  and  calorijication,  are  regarded  as  nutritive  functions;  sensa- 
tion, voice,  muscular  motion,  and  mental  manifestation  constitute  the  ani- 
mal  or  relative  functions ;  and  generation  is  the  reproductive  function. 


CHAPTER  I. 

OF  THE  TISSUES. 


General  Characters  of  the  Tissues. — Though  the  bodily 
structures  admit  of  many  divisions,  according  to  form,  color,  consistency, 
and  arrangement,  the  phenomena  of  life  may  be  more  clearly  pre- 
sented by  considering  them  in  the  relations  of  primary  and  secondary. 
The  j^?rzmari/  tissues  are  the  cellular  or  areolar,  muscular,  and  nervous. 
The  vital  property  of  the  cellular  substance  is  elasticity,  of  the  muscu- 
1  lar  contractility,  and  of  the  nervous  sensibility.  Distinguished  chemi- 
:  cally,  gelatin  is  the  prevailing  quality  of  the  cellular  tissue,  fbrin  of 
the  muscular,  and  albumen  of  the  nervous.     The  cellular  structure 


2m  PHYSIOLOGY. 


supplies  tlie  body  with  materials  of  form,  the  muscular  furnishes  the 
agents  of  action,  and  the  nervous  provides  the  instruments  of  feeling. 
The  secondary  tissues  are  membranes,  ligaments,  cartilages,  and  a 
portion  of  the  bones,  hair,  and  nails,  being  various  forms  of  cellular  or 
gelatinous  substance  in  different  degrees  of  density. 

The  varied  forms  of  all  animal  and  even  vegetable  tissues  are  consti- 
tuted of  aggi-egations  of  tsvo  kinds  of  cells,  variously  modified.  The 
cells  are  called  formative  and  secreting;  the  only  difference  between 
them  is,  the  former  secretes  a  solid  or  semi-solid  substance,  which  re- 
mains in  the  body  with  the  debris  of  the  cell  for  an  appreciable  time, 
and  the  latter  secretes  a  fluid  which  escapes  from  the  body  with  the 
remains  of  the  cell  which  produced  it.  Each  of  these  little  cell-bodies 
has  been  compared  to  a  laboratory,  which  receives  from  the  surround- 
ing matter  the  elements  which  it  requires,  and  combines  them  so  as  to 
accomplish  a  desired  result. 

DEVELOPMEiiT  OF  Cells. — A  Cell  Originates  in  a  mass  of  soft  or 
liquid  matter  which  is  formed  of  a  combination  of  elements  capable  of 
being  fitted  into  an  organized  structure.  The  matter  is  called  blastema. 
In  this  blastema  a  minute  point  arises,  which  gi-adually  increases  in 
size,  while  a  transpai'ent  wall  springs  up  from  one  side  of  the  point  or 
gi'anule,  and  continues  to  swell  until  the  granule  is  seen  to  exist  in  and 
adhere  to  one  side  of  the  cell  wall.  Thus  is  formed  the  cell  wall,  with 
its  fluid  contents,  and  the  gi-anule  or  nucleus  which,  in  a  further  stage 
of  development,  exhibits  in  its  interior  several  new  gi'anules  or  nucleoli. 

-  Fig,  121.  The  development  and  mul- 

1  tiplication  of  cells  are  repre- 

sented in  fig  121.  1.  Devel- 
opment of  cell  from  the  blas- 
tema. On  the  left  is  seen  the 
corpuscle  which  becomes  the 
nucleus ;  on  the  right  the 
complete  nucleated  cell,  2. 
Development  of  new  cells 
within  the  parent  cell.  3. 
Development  of  new  cells 
from  the  outer  w^all  of  pre- 
existing cells. 

DEVELOPMENT    OF    CELLS. 

ihe  cells  undergo 
various  transformations  in  the  production  of  the  different  structures. 
They  may  lose  their  fluid  contents,  and  their  walls,  by  collapsing  and 
adliering  together,  form  simple,  membranous,  transparent  disks. 
They  also  elongate,  so  as  to  form  tubes  or  solid  rods ;  in  the  forme»* 
case  they  adhere  by  their  ends  to  neighboring  cells,  and  their  cavities 


lies  of' 


pw 
pop«rt 
lies  a 

iEteRin 

KffJI 

Itie 
if  a  ( 


ih\ 

F' 
tirougl 

liieb 

Lie  ey( 

Ettet 

filatf 

^t 

celt:  i 
{'ilj  ma 
cetworl 
[feces  i 
Tfiei 

Eoreb 


THE    TISSUES. 


237 


mutually  open  into  each  other,  forming  a  vessel ;  in  the  lattei  case  the 
contained  fluid  is  lost,  and  a  solid  rod  or  fibre  is  the  result.  The  cavi- 
ties of  cells  may  be  obliterated  by  solid  deposits  within  them,  as  in  the 
formation  of  cartilage. 


The  Cellular  Tissue. — The  cellular  or  areolai'  tissue  is  the  sim- 
plest form  of  animalized  matter.  It  is  flexible  and  adhesive,  yet  these 
properties  seem  to  be  included  in  the  general  term,  elasticity.  It  per- 
vades and  connects  together  every  part  of  the  system,  and  being  com- 
posed of  membranous  layers  irregularly  joined,  so  as  to  form  numerous 
interstices  of  various  capacities,  air  introduced  under  the  skin  may  dif- 
fuse itself  all  over  the  surface  of  the  bod}',  a  cii'cumstance  often  result- 
ing from  wounds  of  the  lungs. 

The  cellular  tissue  is  not  composed 
of  a  congeries  of  distinct,  isolated 
cells,  but  of  cavit'es  and  interstices 
freely  communicai'ing  with  each 
other ;  hence  the  term  areolar  is 
generally  applied  to  this  structure  by  ^ 
late  authors.  There  are  two  kinds 
of  this  tissue,  called  reticular  and  adi- 
pose.  The  former  is  dispersed 
throughout  the  entire  body,  except 
the  brain,  the  bones,  and  humors  of 
the  eye.  It  is  scarcely  perceptible 
in  the  tendons  of  muscles,  but  plenti- 
ful in  their  fleshy  parts.  The  adipose 
portion  is  a  connection  of  fibres  run- 
ning in  various  directions  so  as  to 
form  cavities,  which  have  been  called 
cells ;  into  these  cavities  the  fatty  or 
oily  matters  are  deposited.  In  some  parts  of  the  body  it  is  merely  9 
network  of  slender  fibres,  which  give  pliability  and  looseness.  In  other 
places  it  is  more  or  less  loaded  with  oil. 

The  uses  of  the  areolar  structure  are,  to  g  *^e  form  and  symmetrical 
smoothness  to  the  body  by  filling  up  the  interstices,  defend  the  various 
organs  and  parts  against  pressure,  connect  difiterent  parts  so  as  to  admit 
of  some  degi-ee  of  sliding  motion  between  them,  and  sei"ve  as  a  bed  for 
more  tender  organs,  as  the  eye.  It  also  relieves  the  body,  to  some 
extent,  of  the  immediate  bad  effects  of  excessive  alimentation,  by  afibrd- 
ing  a  reservoir  for  surplus  animal  fat.     It  is  a  common  error  to  suppose 


AREOLAR    TISSUE. 


PHYSIOLOGY. 


that  persons  who  increase  in  bulk  after  having  attained  maturity  of 
growth,  acquire  more  jiesh.  They  are  merely  burdened  with  a  useless 
load  which  should  have  been  expelled  as  waste  matter.  The  areolar 
structure  is  very  readily  regenerated  when  destroyed. 

The  Muscular  Tissue. — The  muscular  or  fibrinous  tissue  is  of  a 
higher  gi-ade  of  organization.  Physiologists  ascribe  to  it  the  vital 
properties  of  contractility,  irritahility  or  excitability,  and  tonicity ;  but 
to  my  mind,  one  term  includes  all  the  others.  They  are  all  merely 
expressions  of  the  power  of  the  muscular  fibre  to  act,  move,  contract, 
upon  the  application  of  exciting  causes.  Muscles  are  said  to  be  im- 
pressible to  stimuli,  and  to  conti*act  when  so  impressed,  by  which  mo- 
tion or  action  is  produced.  The  term  contractility  seems  to  imply 
impressibility — the  susceptibility  to  be  acted  on  and  the  action  itself. 
IiTitability  and  excitability  are  but  diflferent  names  for  this  susceptibil- 
ity. Tonicity,  by  which  physiologists  mean  the  ability  to  maintain  per- 
manently a  certain  degree  of  contractility,  is  certainly  nothing  but  a 
greater  or  less  degree  of  contractile  energy. 

All  the  actions  or  motions  of  the  vai'ious  parts  and  organs  are  pro- 
duced by  the  contraction  or  shortening  of  these  muscular  fibres,  or 
rather,  theh*  alternate  contraction  and  expansion. 

Muscular  contraction  is  accompanied  with  the  production  of  souna 
and  heat ;  the  sound  is  probably  owing  to  the  movement  of  the  adja- 
cent fibres  on  each  other,  and  the  elevation  of  temperature  is  doubtless 
to  be  attributed  to  those  chemical  changes  by  which  the  disintegration 
and  renewal  of  the  tissue  is  eflfected. 


Fig.  123. 


In  Fig.  12.3  are  represented 
fragments  of  striped  element- 
ary fibres,  and  showing  a 
cleavage  in  opposite  direc. 
tions.  1.  Longitudinal  cleav- 
age. 2.  3,  4.  Transverse 
cleavage  forming  disks.  5. 
A  detached  disk,  showing  the 
primitive  particles,  called 
sarcous  elements.  7,  8.  Sep- 
arated fibrillas,  show^ing  the 
beaded  enlargements. 

An  ordinary  muscle 
consists  of  bundles  of 

MAGNIFIED    FRAGMENTS    OF    MUSCULAR    FIBRES.    ^,  i  •  i 

fibres,  aiTanged  with 
great  regularity  in  the  direction  of  its  action.  Each  individual  fibre 
may  be  separated  into  fibrillaB  by  the  splitting  o-f  its  contents  in  a  longi- 


THE    TISSUES.  'JSO 


tudina    direction  ;  these  fihrillae  then  present  a  banded  appearance, 
caused  by  the  arrangement  of  the  contents  of  the  tube. 

In  structure  muscular  tissue  is  divided  into  striated  {striped)  and 
non-striated  {unstrvped) — the  former  being  mainly  appropriated  to  the 
voluntaiy  functions,  and  the  latter  to  the  organic  or  involuntary.  Func- 
tionally muscles  are  divided  into  voluntary  and  involuntary.  The  foiTner 
contract  in  obedience  to  the  will,  and  are  the  instruments  by  which  the 
mind  acts  on  external  objects.  Their  fibres  are  arranged  in  parallel 
lines,  and  are  connected  together  by  areolai*  substance.  Those  of  in- 
voluntary motion  are  more  simple  in  their  structure  and  arrangement 
than  those  under  the  influence  of  the  wiD.  Their  fibres  are  disposed 
in  layers,  generally  transverse  or  diagonal,  with  distinct  parallel  lines 
continually  interlacing.  In  this  way  they  form  circular  rings  around 
the  cavities  of  the  circulating  vessels,  as  the  arteries,  veins,  absorbents, 
excretory  ducts,  and  hollow  viscera,  as  the  stomach,  bowels,  uteruf., 
and  bladder,  constituting  one  of  their  coats  or  coverings,  which,  by 
conti'acting,  diminishes  the  calibre  or  cavity  in  length  and  diameter ; 
and  thus  their  contents  are  moved  forward  or  expelled.  The  muscular 
tissue  is  not  reproduced  when  once  desti'oyed,  but  the  loss  is  supplied 
by  areolar  substance,  which  is  wholly  insensible. 

The  Nervous  Tissue. — The  nervous  is  the  highest  order  of  organ- 
ized matter.  Though  sensibility,  or  feeling,  is  its  only  property  we 
can  call  vital,  its  immediate  relation  to  mind  causes  it  to  manifest  varied 
and  wonderful  powers.  Ti&e  nervous  substance  is  the  medium  through 
which  all  impressions  are  received  fiom  the  external  world,  and  through 
which  the  mind  conveys  its  mandates  to  the  voluntary  muscles.  All 
motions,  changes,  or  functional  actions  which  are  performed  by  the 
muscles,  depend  on  the  power,  energy,  or  influence  transmitted  to  the 
muscular  tissue  from  the  nerves. 

The  nervous  structure  is  -composed  cf  a  white  or  fibrous  matter, 
which  in  the  nervous  trunks  is  tubular,  with  a  secondary  deposit  within 
the  cavity  of  the  tube  ;  and  a  gray  or  vesicular  substance  found  in  the 
ganglions.  Wherever  these  two  kinds  of  nervous  matter  are  united 
together  they  constitute  a  nervous  centre. 

The  ultimate  nerve-fibre  is  tubular,  consisting  of  an  external  thin 
and  delicate  membrane,  which  forms  a  sheath,  and  isolates  the  contain- 
ed matter  in  its  whole  course  from  its  centi'al  to  its  peripheral  extrem- 
ity. This  has  been  called  the  tubular  membrane,  within  which  is  con- 
tained a  more  opake  substance,  called  the  white  substance  of  Schwann  ; 
and  within  this  white  substance  is  a  transparent  material,  called  the 


240 


PHYSIOLCG  Y 


euis  cylinder.     The  whole  of  this  contained  substance  is  very  soft,  and 
.nay  be  made  to  move  along  in  the  cavity  of  the  tube. 

Fig.  124  is  a  diagram  of  tubular 
fibre  of  a  spinal  nerve,  a.  Axis 
cylinder,  b.  Inner  boi'der  of  wbite 
substance,  c,  c.  Outer  border  of 
white  substance,  d,  d.  Tubular 
membrane.  B.  Tubular  fibres ;  e, 
in  a  natural  state,  showing  the 
parts  as  in  A.  /.  The  white  sub- 
stance and  axis  cylinder  interrupt,- 
ed  by  pressure,  while  the  tubular 
membrane  remains,  g.  The  same 
with  varicosiiies.  h.  Various  ap 
pearances  of  the  white  substance 
and  axis  cylinder  forced  out  of  the 
tubular  membrane  by  pressure. 
i.  Broken  end  of  tubular  fibre, 
with  the  white  substance  closed 
over  it.  R.  Lateral  bulging  of 
white  substance  and  axis  cylinder, 
from  pressure.  I.  The  same,  more 
complete,  g.  Varicose  fibres  of 
various  sizes,  from  the  cerebellum. 
C.  Gelatinous  fibres  from  the  solar 
plexus,  treated  with  acetic  acid,  tc 
exhibit  their  cell  nuclei.  B  and  C 
are  magnified  320  diameters. 

Physiologists      ai'e      not 
agi"eed  respecting  the  com- 
plete regeneration  of  ner- 
vous tissue  after  it  has  been 
once  destroyed.     Of  its  partial  restoration  there  can  be  no  doubt. 

The  nerve-fibres,  which  originate  in  the  brain,  and  are  distributed 
to  tlie  muscles,  have  no  proper  termination,  but  form  loojps,  which 
either  return  into  themselves  or  join  others  formed  by  the  ultimate 
ramifications  of  the  main  ti'unks. 

The  vesicular  matter,  wherever  found,  is  regarded  as  a  generator  of 
nervous  influence ;  and  the  white  or  tubular  as  the  carrier  of  that  in- 
fluence to  the  various  pai-ts  of  the  system.  The  former  portion  is 
supplied  with  much  the  largest  proportion  of  blood. 

The  general  nervous  system  is  susceptible  of  a  division  mto  five 
subordinate  systems:  1.  The  nutritive  system,  or  nerves  of  organic 
life.  '2.  The  motory  system,  or  nerves  of  voluntary  motion.  3.  The 
sentient  system,  or  nei-ves  of  setsation.  4.  Tha  mental  system,  or 
brain.     5.  The  reflex  system. 


//  \/  w 

d   d  h    c  d 

TUEITLAB    FIBRE    OF    SPINAL    NERVE. 


THE    TISSUES.  241 

The  Nutritive  Nervous  System. — This  system  includes  all  the 
organic  or  involuntary  nerves.  In  the  order  of  development  it  })re- 
cedes  the  others,  as  it  relates  to,  and,  in  fact,  presides  over,  all  the 
processes  of  organic  or  vegetative  life.  All  the  functions  belonging  to 
the  growth,  development,  and  ti'ansformation  of  the  bodily  structures 
are  controlled  by  these  nerves.  They  have  no  sensibility  of  which  the 
l>raiu  takes  cognizance ;  yet  they  have  an  impressibility  or  a  feeling  of 
their  own.  To  illusti'ate  :  the  brain  does  not  feel  food  in  the  stomach, 
nor  blood  in  the  heart,  nor  air  in  the  lungs,  nor  bile  in  the  liver,  yet 
their  presence  is  recognized  or  felt  by  the  organic  nerves.  These 
nerves,  too,  have  their  little  brains,  or  special  centres,  which  serve  to 
supply  the  nervo-electric  influence  to  particular  parts  and  organs,  and 
connect  the  whole  together  in  close  sympathetic  functional  relations. 
The  semilunar  ganglion  may  be  considered  as  the  pi'esiding  centi'e,  or 
great  brain,  and  the  other  ganglia  the  central  points,  or  lilfle  brains  of 
the  nutritive  S3'stem. 

In  the  lowest  orders  of  animals  the  nutritive  or  organic  system  is 
concentered  in  a  single  straight  nervous  cord,  which  performs  all  tho 
functions  of  those  animals,  as  the  brain,  which  belongs  to  a  higher  gi-ado 
of  being,  does  not  exist.  It  is  stated  as  a  remarkable  circumstance, 
that  those  animals  which  have  no  brain  are  also  destitute  of  a  spleen  or 
melt.  This  fact  s,trongly  favors  the  hypothesis  that  the  principal  func- 
tion of  the  spleen  is  to  supply  the  organic  nerves  with  an  additional 
laboratory  of  their  peculiar  electrical  or  other  power  or  influence. 
The  organic  nerves  evidently  derive 'their  nourishment  and  support,  as 
well  as  the  principle  or  element  by  which  they  operate  to  control  and 
regulate  the  organic  functions,  in  a  great  measure  directly  from  the 
arteries,  for  which  purpose  their  filaments  penetrate  the  arterial  coats, 
and  spread  out  on  their  internal  surfaces.  The  superaddition  of  a  brain 
in  the  higher  animals  seems  to  demand  an  additional  source  or  organic 
nervous  power,  for  the  special  purpose  of  its  development  and  support. 
And  for  this  purpose  the  spleen,  by  its  large  provision  of  arterial  bloo  ^ , 
and  absence  of  an  excretory  duct,  seems  well  adapted. 

The  organic  nerves  are  connected  with  the  cerebral  by  frequent 
anastomoses,  which  circumstance  accounts  for  the  reciprocal  influence 
between  mental  impressions  and  bodily  affections. 

The  Motort  Nervous  System. — AH  the  nerves  of  voluntary 
motion  originate  from  the  brain  and  spinal  marrow.  In  a  perfectly 
healthy  state  of  the  whole  organism,  they  are  completely  under  the  con- 
trol of  the  will.  In  various  spasmodic  and  convulsive  diseases,  this  rela- 
tion is  for  a  time  nearly  or  quite  destroyed.  The  motor  nerres  are 
1—21 


242  PHYSIOLOGY 

distributed  to  every  muscular  fibre  in  the  body,  and  fire  the  instruments 
through  which  the  mcnta.  impulse  is  communicated  to  the  muscles. 
All  voluntary  action  is  the  motion  produced  by  the  conti'aclion  of  the 
muscular  fibres  in  obedience  to  the  volition  or  decision  of  the  miu  I, 
conveyed  to  the  muscles  by  the  motory  system  of  nerves. 

The  Sentiknt  Nervous  System. — The  nerves  of  sensation  like 
those  of  voluntary  motion,  are  said  to  originate  from  the  brain  and 
spinal  maiTow.  They  are  the  instiuments  of  communication  from  the 
external  world  to  the  brain,  being  the  media  of  the  external  senses — 
seeing,  hearing,  tasting,  smelling,  and  feeling.  Thus  the  optic  nerve 
conveys  to  the  brain  impressions  of  light ;  the  auditory,  of  sound  ;  the 
gustatory,  of  savors  ;  the  olfactory,  of  o  l«vs  ;  and  the  nerves,  of  touch, 
distributed  to  all  parts  of  the  body  whic  i  are  endowed  with  sensibility, 
convey  impressions  of  the  chemical  or  mechanical  properties  of  bodies, 
as  heat,  cold,  form,  size,  density,  pressure,  etc. 

Each  nerve  of  a  special  sense  is  endowed  with  a  modification  of  the 
general  sense  of  feeling  peculiar  to  and  inherent  in  itself;  for  under 
no  circumstances  can  the  ear  feel  the  impression  of  light,  the  eye  of 
sound,  or  the  skin  of  odors. 

The  Reflex  Nervous  System. — The  spinsri  cord  is  regarded  as 
a  conveyer  of  nei*vous  influence  to  and  fi-om  the  brain,  and  also  as  a* 
originator  of  nervous  influence.  When  the  spinal  cord  is  divided  c 
severely  injured,  the  motor  nerves' given  off  hetow  the  injured  point  d 
not  resjjond  to  the  volition  ti'ansmitted  from  the  brain,  while  all  th*» 
nerves  a-bove  that  point  are  under  the  influence  of  the  brain.  The  im^ 
pressions  on  the  sensitive  nerves  are  not  propagated  to  the  sensoriu»i 
from  below,  but  are  from  above  the  injured  poijit. 

The  sj)inal  cord  is  divided  into  t^vo  lateral  halves,  and  each  of  these 
mto  an  anterior,  middle,  and  posterior  column,  coiresponding  probably 
to  the  sensory,  motor,  and  organic  nerves.  The  anterior  root  of  the 
spinal  nerves  is  the  motor  or  efferent  root,  which  conveys  impressions 
from  the  brain ;  the  posterior  is  the  sensory  or  afferent  root,  which  con- 
veys impressions  to  the  brain.  A  part  of  the  fibres  of  both  roots  are 
unconnected  with  the  brain,  having  their  origui  in  the  gi-ay  matter  of 
the  spinal  cord.  These  fibres  are  supposed  to  form  a  distinct  nei'vous 
circle,  and  they  constitute  the  system  to  which  those  actions  are  due, 
called  rejicx.  All  spasmodic  or  con^'ulsive  movements  of  the  body  are 
considered  examples  of  exti'eme  reflex  action :  the  producing  causes 
of  them  may  be  seated  in  the  spiual  cord  itself,  then  called  centric  irri- 
tation, or  at  a  distance,  the  irritntion  of  which  is  transmitted  to  the 


THE    TISSUES. 


243 


cord,  called  concentric  irritation.  Reflex  motions  are  those  muscular 
actions  or  contractions  which  take  place  in  consequence  of  impressions 
conveyed  to  the  spinal  cord  by  the  afferent  nerves,  and  reflected  from 
them  by  the  efferent  nerves. 

A  spinal  nerve  contains  a  bundle  of  sensory  fibres  passing  upward  to 
the  brain ;  a  motor  set,  conveying  the  influence  of  volition  from  the 
brain ;  an  excitor  set,  or  centripetal  fibres,  terminating  in  the  true 
spinal  cord,  or  ganglion,  and  conveying  impressions  to  it ;  and  a  motor 
set,  or  centi-ifugal  fibres,  arising  from  the  true  spinal  cord,  and  convey- 
ing the  motor  influence  reflected  from  it  to  the  muscles.  The  last  two 
named  sets  of  fibres,  with  the  gi'ay  matter  in  the  centime  of  tKe  cord, 
constitute  the  reflex  system. 


Fig.  125  is  a  diagram  of  the  origins  and 
terminations  of  the  different  groups  of 
nervous  fibres,  a,  a.  Vesicular  substance 
of  the  spinal  cord,  b,  b.  Vesicular  sub- 
stance of  the  brain,  e.  Vesicular  substance 
at'  the  commencement  of  the  afferent, 
which  consists  of  c  1,  the  sensory  nerve 
passing  to  the  brain,  and  s  1,  ice  spinal 
division,  or  excitor  nerve,  which  termi- 
nates in  the  vesicular  substance  of  the 
spinal  cord.  On  the  other  side  is  the 
efferent  or  motor  nerve,  consisting  of  two 
divisions,  c  2,  the  cerebral  portion  convey- 
ing voluntary  motion,  and  s  2,  the  spinal 
division  conveying  reflex  motion. 

The  medulla  oblongata  has  the 


GROUPS    OF    NERVOUS    FIBRES. 


general  properties  of  the  spinal 
cord,  and  associates  the  cord  and  brain  in  functiona.  qualities.  Its 
power  of  reflexion  is  considered  higher  than  that  of  any  other  part  of 
the  nervous  system,  irritation  of  it  exciting  convulsions  in  the  whole 
trunk  of  the  body.  Respiration,  deglutition,  and  those  rhythmical 
actions  of  the  respiratory  system,  laughing,  yawning,  sighing,  etc.,  de- 
pend upon  it.  It  is  supposed  also  to  be  the  seat,  in  whole  or  in  part, 
of  the  power  of  voluntary  motion. 


The  Mental  Nervous  System. — The  surface  of  the  brain  is 
arranged  in  various  convolutions,  which  constitute  the  phrenological 
organs  of  the  prevailing  system  of  mental  philosophy.  These  convolu- 
tions bear  a  close  relation  to  the  general  mental  capacity,  being  more 
numerous  and  prominent  in  persons  whose  minds  have  been  well- 
developed  by  exercise,  while  in  those  whose  brains  have  been  exer- 
cised but  little  they  are  much  less  complex,  and  in  idiots  exceedingly 


lU  PHYSIOLOGY. 


limited.  The  object  of  these  convolutions  is  to  afford  an  extensive 
surface  for  the  gray  or  vesicuhir  matter  which  generates  the  nervous 
power,  and  a  more  free  communication  between  the  blood-vessels  on 
one  side,  which  supply  the  materials  of  nei'vous  influence,  and  the 
numerous  fibres  on  the  other  side,  which  propagate  their  influence  to 
the  muscles. 

The  brain  and  spinal  cord  are  divided  by  a  mesial  line  into  equal 
right  and  left  halves  or  hemispheres ;  hence  all  the  mental  organs  are 
double,  as  are  also  the  sentient  and  motor  nerves,  which  convey  impres- 
sions to  and  from  them. 

AU  pliysiologists  agi'ee  that  the  cerebrum  is  the  seat  of  intelligence 
This  part  of  the  brain  composes  about  six  sevenths  of  the  whole  ence- 
phalon,  and  usually  weighs  from  thhty-six  to  forty-six  ounces.  Phre- 
nologians  regard  it  as  the  seat  of  all  the  mental  powers,  except  ama- 
tiveness,  whose  organ  is  the  cerebellum,  which  constitutes  about  one 
seventh  part  of  the  brain.  It  has  been  objected  to  the  cerebellum 
being  the  organ  of  sexual  impulse,  that  its  development  in  the  scale  of 
animals  bears  no  relation  to  the  energy  of  the  sexual  propensity.  But 
animals  ai'e  created  with  reference  to  the  ch'cumstances  in  which  they 
are  to  be  placed ;  and,  although  size  is  a  measure  of  power,  other 
things  being  equal,  there  is,  doubtless,  as  much  in  quality  as  in  bulk  of 
organization ;  and  in  those  cases  whei-e  the  passion  of  amativeness  has 
existed  in  connection  with  a  partial  or  total  absence  of  the  organ — the 
force  of  habit,  the  exercise  of  the  organ,  or  transmitted  organic  sus- 
ceptibility, may  explain  the  apparent  exceptions  to  general  experience. 

That  the  cerebellum  is  also  a  generator  of  nei'vous  influence  to  the 
muscles  of  locomotion,  seems  to  be  established  fi-om  experiments  on 
animals.  When  the  organ  was  removed,  although  sensibility  in  any 
part  was  never  desti'oyed,  the  animals  lost  the  power  of  standing, 
walking,  springing,  flying,  etc. 

The  whole  brain,  though  the  seat  of  sensibility,  is  itself  wholly  in- 
sensible. Any  part  of  it  may  be  cut,  pricked,  torn,  or  removed,  with- 
out exciting  pain. 

Animals  from  whom  the  cerebrum  was  removed  always  lost  the 
senses  of  sight,  hearing,  taste,  and  smell,  and  appeared  as  if  in  a  deep 
sleep,  without  the  power  of  dreaming ;  they  could,  however,  be 
aroused  to  unconscious  motions  by  irritations  operating  through  the 
sense  of  feeling.  These  facts  prove  that  it  is  not  only  the  seat  of  most 
of  the  mental  functions,  but  possesses  the  power  of  directing  the  mind 
to  particular  sensorial  impressions. 

PiiiLOSOPiii  cr  Mind. — The  brain  is  the  presiding  centre  of  senaa- 


THE    TISSUES.  24S 

tion,  voluntary  motion,  the  inte'Jectua  faculties,  and  the  passions  or 
propensities.  The  mind  is  the  aggregate  of  all  the  functions  of  the 
brain.  A  mental  power  is  the  function  of  a  particular  organ  or  portion 
of  the  brain.  All  the  mental  power?  may  be  distinguished  into  facul- 
ties and  propensities. 

The  faculties  together  constitute  the  intellect.  They  are  the  pow- 
ers concerned  in  thought  the  fi;imation  of  ideas,  the  acquisition  of 
knowledge,  the  thinking  and  knowing  part  of  the  mind.  The  faculties 
are  divided  into  perceptive  and  reflective.  The  perceptives  take  cog- 
nizance of  individual  things  and  their  mechanical  properties.  The 
reflectives  arrange,  compare,  and  analyze  subjects,  and  ti'ace  out  their 
relations  of  cause  and  effect.  The  perceptive  faculties  are  the  func- 
tions of  the  observing  organs ;  the  reflectiye  faculties  are  the  powers 
if  the  reasoning  organs. 

The  propensities  are  the  feeling  organs;  they  are  the  impulses, 
emotions,  or  passions  which  impel  to  action.  To  gratify  these  feel- 
ings or  propensities  the  intellectual  faculties  devise  means,  seek*out  ob- 
jects, study  methods.  The  external  or  special  senses,  seeing,  hearing, 
smelling,  tasting,  and  feeling,  are  the  media  through  which  the  faculties 
operate  in  their  natural  or  normal  condition.  But  they  are  capable  of 
acting  independently  of  the  external  senses  in  certain  abnormal  states, 
as  in  somnambulism,  dreaming,  mesmerism,  and  claii-voyance.  When 
the  faculties  have  discerned  the  object,  or  ascertained  the  manner  of 
satisfying  the  impulse  or  propensity,  the  will  determines  its  instra- 
mentalities — the  bodily  structures,  to  act  in  relation  to  its  possession  or 
enjoyment.  The  propensities  which  relate  merely  to  individual  pres- 
ervation are  called  selfish,  or  self-relative  ;  those  which  pertain  to  the 
family  chcle,  domestic ;  those  which  connect  us  in  mutual  interests 
and  sympathetic  relations  with  our  fellow-creatures,  social ;  the  higher 
plane  of  propensities,  which  relate  to  rules  of  action,  conscience,  and  a 
Supreme  Being,  are  termed  moral  qualities  or  sentiments;  and  those 
propensities  most  nearly  allied  in  location  and  association  with  the  fac- 
ulties are  called  semi-intellectual. 

Mind  then  appears  to  us  as  "  duality  in  unity,"  consisting  essentially 
of  faculties  and  feelings — in  other  woids,  affections  and  thoughts.  It 
is  not  difficult  to  imagine  that  the  affectuous  mind  is  the  primitive 
mental  property ;  first  in  order,  highest  oi  most  interior  in  existence, 
and,  to  extend  the  idea  poetically,  more  nearly 

"  allied 
To  angels  on  our  better  side." 

All  true  happimss  consists  in  ri'rht  feeling ;  (hindng  is  but  a  means 


246  PHYSIOLOGY. 


to  it.  Tlie  healthful  exercise  of  all  the  mental  powers  is  the  perfect 
coDclition  of  right  feeling ;  and  the  normal  play  of  all  the  bodily  func- 
tions is  indispensable  to  this  healthful  exercise  of  the  mental  powers. 
It  is,  therefore,  literally  true  that  health  of  body  and  health  of  mind  is 
happiness. 

The  mind,  however,  must  not  be  confounded  with  the  soul.  Mind 
may  be  defined  as  the  manifestation  of  the  soul  or  spirit  through  the 
material  organism. 

The  Nervous  Influence. — The  essential  natui'e  of  that  power, 
principle,  or  influence,  wdiich  endows  the  nervous  tissue  with  its  pecu- 
liai-  properties  has  always  been  a  theme  of  interesting  speculation. 
The  most  ancient  doctrine  was  that  of  the  circulation  of  a  fluid  through 
the  tubes  of  the  nervous  fibres ;  but  at  length  the  tubes  were  found 
not  to  be  hollow.  The  next  theory  was  that  of  vibration  :  it  was  sup- 
posed that  the  nerves  conveyed  impressions  from  one  extremity  to  the 
other  by  a  vibratory  motion  analogous  to  a  stringed  insti'ument ;  but 
this  doctrine  was  abandoned  on  discovering  that  the  nerves,  instead  of 
being  attached  firmly  at  their  exti'emities,  are  diflTused  into  a  soft, 
pulpy  mass.  The  prevalent  opinion  now  is,  that  the  source  of  nervous 
power  is  some  modification  of  electi'icity.  The  identity,  however,  of 
the  nervous  influence  wnth  electi'icity,  galvanism,  or  magnetism,  as 
manifested  by  any  sti-ucture  or  material  other  than  the  nervous  tissue, 
is  positively  disproved.  It  has  been  ascertained  that  if  a  ligature  be 
placed  upon  a  nerve,  its  power  of  conducting  the  true  nervous  or  func- 
tional influence  is  lost,  while  its  ability  to  transmit  electrical  cm'rents 
remains. 

In  the  present  state  of  physiological  science,  therefore,  we  can  only 
say  that  the  nervous  influence,  the  sensibilit}''  of  the  nervous  tissue, 
the  contractility  of  the  muscular,  and  the  elasticity  of  the  areolar,  are 
each  vited  properties  peculiar  to,  and  developed  in,  the  organization  of 
the  Bti-uctures  to  which  they  appertain ;  and  there  is  not  much  proba- 
bility that  we  shall  ever  arrive  at  any  better  explanation.  What  they 
are  exactly  and  essentially  we  can  no  more  demonstrate  than  we  can 
the  essential  nature  of  oxygen,  electricity,  magnetism,  or  any  other  ele- 
mentary substance  or  principle  ;  nor  would  we  be  benefited  if  we  could. 

Rationale  of  Muscular  Action. — The  voluntary  muscles  are 
disposed  in  sets,  which  are  said  to  antagonize  each  other ;  these  sets 
are  called  flexors,  extensors,  adductors,  abductors,  etc.,  as  they  draw 
the  part  to  which  they  are  attached  forward,  backward,  inward,  out- 
ward, etc.     Thus,  where  the  flexors  contract  they  close  the  fingers, 


THE    TISSUES.  247 


draw  up  the  arms,  bend  the  legs,  stc. ;  and  the  extensors,  by  contract- 
ing, open  the  fingers,  extend  the  arm,  straighten  the  leg,  etc.  The 
common  opinion  has  long  been,  that  when  the  "nervous  energy,  or 
mfluence  of  the  brain,  is  transmitted  to  one  set  of  muscular  fibres — 
the  flexors,  for  example — they  contract,  while  the  other,  or  antag- 
onizing muscles,  remain  passive,  by  which  flexion  is  produced ;  and 
that  when  the  nervous  influence  is  directed  to  the  opposing,  or  exten- 
sor muscles,  these  contract,  and  the  flexors  remain  passive,  by  which 
means  the  contrary  motion,  extension,  results. 

But  such  cannot  be  the  correct  theory  of  muscular  motion.  Experi- 
ments seem  to  have  demonstiuted  that  when  the  nerves  which  supply 
either  the  flexor  or  extensor  muscles  are  divided,  neither  will  act  or 
contract  at  all.  From  this  it  appears  that  neither  set  can  act  independ- 
ently, and  that  the  antagonizing  muscles,  as  they  are  called,  do  really 
act  in  correspondence ;  the  same  neiTous  influence  which  produces 
contraction  in  one  set,  producing  relaxation  or  expansion  in  the  other. 
We  must,  then,  regard  muscular  action,  which  is  performed  by  the 
alternate  conti-action  and  expansion  of  the  muscular  fibres — analogous 
to  electi'ical  atti'action  and  repulsion  in  inorganic  matter — not  as  de- 
pending on  two  principles  of  influence,  or  on  one  principle  alternately 
bestowed  and  withdi'awn,  but  as  resulting  from  two  properties  of  one 
principle  operating  simultaneously. 

The  same  law  of  motions  appears  to  prevail  with  regard  to  the  in- 
voluntary muscles ;  but  theh*  stracture  and  arrangement  are  so  difierent 
that  its  operation  is  more  difficultly  ti'aced.  Instead  of  ruiming  in  straight 
lines,  their  fibres  extend  in  parallel,  transverse,  diagonal,  and  circular 
directions,  thereby  embracing  the  part,  organ,  or  vessel,  so  as  to  produce 
a  complicated  series  of  motions  at  the  same  time,  as  in  the  stomach 
bowels,  bladder,  and  uterus,  where  a  kind  of  universal  compression  on 
the  contents  of  their  cavities  results  from  the  varied  directions  and 
motions  of  their  fibres. 

The  strength  and  rapidity  of  muscular  action  are  well  illustrated  in 
the  feats  performed  by  tumblers,  jugglers,  and  dancers,  and  the  articu- 
lations of  spoken  language.  Some  persons  can  pronounce  1500  letters 
in  a  minute,  each  requiring  a  separate  contraction  of  muscular  fibres, 
followed  by  a  relaxation  of  equal  length ;  so  that  each  contraction  must 
have  occurred  in  one  tenth  of  a  second. 

Mesmeric  Phenomena. — Those  manifestations  of  peculiar  abnormal 
states  and  operations  3f  the  mental  nervous  system,  known  as  dreams, 
somnambulism,  second  sight,  mesmerism,  clairvoyance,  etc.,  deserve  a 
passing  notice.     The  sum  total  of  these  phenomena  has  been  called 


248  PHYSI0L0G7 


mesmerism,  pathetism,  electrical  psychology,  or  electi-o-biology,  etc. 
The  fact  that  the  mind  can  and  does  take  coguizance  of  things — some- 
times real  and  sometimes  imaginary — while  io  the  state  or  condition 
termed  mesmeric,  which  it  cannot  and  does  not  in  its  ordinary  state  or 
condition,  is  unquestionable.     The  explanation  is  not  so  apparent. 

It  is  a  self-evident  proposition  that  the  human  mind  is  created  with 
constitutional  relations  to  all  objects  in  external  nature — in  the  universe. 
All  surrounding  objects,  without  regard  to  direction  or  distance,  may 
and  do  hold  a  specific  relation  to  the  mind,  in  other  words,  act  upon,  or 
impress,  or  hold  communication  with  it.  The  special  senses — seeing, 
hearing,  tasting,  smelling,  and  feeling — are  the  media  of  the  correspond- 
ence between  mind  and  surrounding  objects,  in  the  usual,  ordinary,  or 
normal  state.  But  if  the  brain  and  nervous  system  are  functionally 
exalted,  rendered  peculiarly  impressible,  while  the  special  senses  aro 
in  the  ordiuaiy  functional  condition,  the  mind  will  have  a  larger  field 
of  perceptions,  a  gi'eater  capacity  to  form  ideas,  whether  correctly  or 
incorrectly.  If  the  bi-ain  and  nervous  system  maintain,  by  any  unusual 
internal  or  external  exciting  cause,  the  normally  active  condition,  while 
the  external  or  special  senses  ai'e  at  rest — inactive  or  insusceptible — the 
same  increased  mental  capacity  to  feel  the  impressions  of  distant  objects, 
form  ideas,  etc.,  results.  And  if  the  brain  and  nervous  system  ai*e 
under  the  abnormal  influence  which  preternaturally  augments  their 
functions,  while  the  external  senses  ai'e  not  merely  in  a  state  of  normal 
repose,  but  of  profound  and  preternatural  rest — abnormally  insuscepti- 
ble— then  the  objects  at  a  very  gi'eat  distance,  or  in  a  direction  which 
could  not  be  seen,  feJt,  heaixi,  etc.,  in  the  normal  state,  or  through  the 
external  senses,  impress  the  mind,  and  are  distinctly  recognized.  In 
this  state,  too,  the  mind  takes  greater  or  less  cognizance  of  the  thoughts 
of  other  minds  with  which  it  is  brought  into  close  sympathetic  relations, 
and  echoes  very  accurately  the  thoughts  or  opinions  of  such  minds. 
In  this  way  clairvoyants  answer  with  surprising  correctness  many 
questions,  their  answers  ^eing  simply  the  reflection  of  the  minds, 
thoughts,  or  opinions  of  the  operator,  or  manipulator,  or  of  the  person 
placed  in  communication. 

But  many  times  the  attention  of  the  mesmerize e  or  clairvoj-ant  is 
directed  to  places,  objects,  and  persons  at  great  distances,  hundreds  or 
thousands  of  miles,  wheir  they  discover  and  describe  many  things  as 
they  really  exist,  and  others  which  have  no  reality  at  all.  These  phe- 
nomena prove  that  the  mental  field  of  vision  may  be  vastly  extended, 
but  that  its  abnormal  or  preternatural  state  does  not  render  its  impres- 
sions reliable  as  exclusive  sources  of  information;  the  ever-varying 
states  of  the  nervous  susceptibility  n:iy  render   the   cognizance   of 


THE    TISSUES.  249 


objects  in  the  abnormal  state  just  as  variable  in  regard  to  reality  or 
fantasy. 

Some  persons  have  an  organization  peculiarly  favorable  to  the  mani 
testation  of  the  phenomena  in  question,  and  others  are  capable  of  ac 
quii'ing  a  great  degree  of  mesmeric  susceptibility,  so  much  so  as  to  pass 
into  the  clau'voyant  state  at  will,  and  then  survey  with  interior  vision 
many  things  in  heaven  and  earth  as  they  really  exist,  or  revel  in  dream- 
land, as  imagination  leads  off  in  the  mental  operations. 

The  phenomena  more  strictly  physiological,  and  tho?e  effects  on  the 
nervous  influence  which  have  been  made  available  as  remedial  pro- 
cesses in  disease,  may  all  be  accounted  fov  on  the  principles  of  mental 
sympathy  and  electrical  or  magnetic  innervation.  A  strongly  magnetic, 
powerfully  electric,  or  in  other  words,  vigorously  healthy  person,  may 
rapidly  manufacture  nervous  influence,  and  readily  impart  it  to  another 
of  more  susceptible  temperament,  or  in  feeble  health.  The  hand  and 
fingers  are  exquisitely  organized  for  receiving  and  transmitting  a  large 
amount  of  nervous  influence,  and  gentle  manipulations  are  the  best 
ways  of  imparting  it.  The  exercise  of  weak,  torpid,  and  rigid  muscles, 
.»y  rubbing,  kneading,  thumping,  etc.,  is  remedial,  or  innervating,  or 
magnetically  medicinal,  very  much  in  the  ratio  of  the  capacity  of  the 
vital  organism,  and  the  development  of  the  organic  or  nutritive  nerves 
and  ganglia  of  the  operator. 

Order  of  Structural  Development. — From  minute  vesicles 
or  cells,  having  as  a  nucleus  a  small  round  body  of  matter,  surrounded 
by  a  granular  fluid,  and  enclosed  in  a  thin  membrane,  all  the  structures 
are  developed.  The  ovum  and  the  embryo  are  originally  composed 
of  such  nucleated  cells.  Some  cells  are  independent  of  and  isolated 
from  each  other,  as  the  corpuscles  of  the  blood,  chyle,  and  lymph ; 
others  cohere  by  their  surfaces  and  borders,  as  in  the  epidermis,  or 
scai'f-skin;  others  are  connected  by  an  intermediate  substance,  as  bone 
and  cartilage ;  and  others  are  united  in  rows,  forming  hollow  tubes, 
capillary  vessels,  and  the  tubuli  of  nerves  and  muscles. 

The  first  distinct  sti'ucture  developed  in  the  human  body  is  that  of 
the  nerves  of  organic  life.  The  necessity  of  this  is  apparent,  as  they 
constitute  the  presiding  centre  and  conti'oUing  instruments  over  all  the 
functions  of  nutrition  and  gi'owth.  They  form  not  only  a  general  centre 
to  the  whole  organic  system,  but  by  means  of  their  ganglia  supply  each 
particular  part  organ,  and  function  with  a  special  presiding  centre. 
These  ganglia  appear  like  mere  enlargements  of  the  nervous  cord, 
and  ai'e  numerously  distributed  throughout  the  body,  according  to  the 
importa.nce  and  complexit;^'  of  the  functions  to  which  they  specially 


250  PHYSIOLOGY, 


appertain.  They  serve  undoubtedly  to  collect,  dii-ect,  n  odify,  regulate, 
and  aiJapt  the  nervous  influence  to  the  functional  condition  of  the 
various  organs,  and  constitute,  in  one  sense,  so  many  points  of  polarity 
to  its  attractive  and  repellent  properties. 

Next  in  order,  as  second  in  functional  importance,  the  heart  and 
muscular  system  are  produced,  followed  by  blood-vessels  gradually  ex- 
tending and  enlai-ging  till  the  vascular  system  is  completed.  The 
nutritive  or  organic  nerves  intimately  accompany  the  arteries  from 
their  ganglia,  and  send  off  branches  to  aid  in  the  development  and 
preside  over  the  nourishment  of  particuhu*  organs,  to  which  they  hold 
Lhe  same  relation  that  the  brain  does  to  the  voluntary  muscles.  The 
ganglia  which  form  the  subordinate  centimes  to  the  alimentary  canal 
are  the  first  ones  produced  from  the  increasing  development  of  the 
organic  nerves.  Soon  on  each  side  of  the  central  mass  of  the  nutri- 
tive nervous  substance  numerous  ganglia,  or  little  hrains,  arise,  in  the 
shape  of  two  connected  nervous  cords,  and  eventually  form,  on  each 
side  of  the  spinal  column,  a  series  of  ganglia  extending  the  whole  length 
of  the  spine.  These  ganglia  send  out  branches  of  nerves  to  the  several 
special  centres,  to  unite  them  in  associated  action ;  to  the  muscles,  and 
to  those  branches  of  the  other  ganglia  which  are  sent  to  the  viscera, 
and  contribute  to  the  development  of  the  spine,  trunk,  and  extremities. 

The  gi'eat  centime  of  the  organic  system,  the  semilunar  ganglion,  con- 
sists of  the  two  semicircular  bodies  behind  the  pit  of  the  stomach;  they 
are  closely  connected  by  branches  passing  fi-om  one  to  the  other,  w4iich 
fonn  the  solar  plexus.  To  this  general  centre  the  numerous  special 
centres  are  united  by  nervous  cords  and  plexuses.  Death  takes  place 
vf  the  functions  of  this  system  of  nerves  be  suspended  but  for  a  moment. 

With  the  increasing  formation  of  the  ganglionic  centime  the  alimentary 
organs  are  developed  ;  the  stomach,  intestines,  pancreas,  etc.,  follow^ed 
by  the  excretory  organs,  the  liver,  kidneys,  and  skin.  Lastly  are  de- 
veloped the  lungs,  spleen,  brain,  and  spinal  maiTow,  the  membranes, 
bones,  ligaments,  and  cartilages,  terminating  in  the  hair,  nails,  and 
ppiderrais. 


CHAPTER  II. 

OF   THE  SPECIAL   SENSES. 


Sensation  is  the  recjgnition  by  the  mind  of.  an  impression.     That 
part  of  the  brain,  oj-  rather  quality',  which  perceives  impressions  is  often 


THE    SPECIAL    SENSES.  251 

calUid  the  sensorium.  Sensations  are  distinguished  into  external  and 
internal.  External  sensations  arise  from  impressions  made  upon  the 
outer  surface  of  the  body,  as  the  eye,  nose,  mouth,  ear,  and  skin, 
which  are  the  organs  of  the  external  or  special  senses.  Internal 
sensations  have  their  causes  within  the  body,  and  arise  from  functional 
conditions,  as  hunger,  thirst,  suffocation.  An  active  capillary  circulation 
is  essential  to  the  normal  sensibility  of  a  part.  If  the  blood  is  excluded 
from  the  capillary  vessels  by  severe  co.d,  the  sensibility  is  deadened  ; 
and  if  the  vessels  are  over-distended,  as  in  inflammation,  the  sensibility 
becomes  painful.  General  sensibility  is  distributed  over  the  entire 
body,  enabling  us  to  feel  those  impressions  of  surrounding  objects 
which  produce  the  various  modifications  of  pain  and  pleasure.  Special 
sensibility  pertains  to  those  organs  which  connect  the  mind  with  the 
physical  world,  and  by  which  the  mind  is  educated.  The  nerves 
of  special  sensation  have  no  general  sensibility  except  what  is  derived 
from  nerves  of  general  sensibility  distributed  to  them. 

Sense  of  Touch. — The  nerves  of  feeling  ai-e  the  posterior  roots 
of  the  spinal  nerves,  and  some  fibres  of  the  fifth  and  eighth  pairs  r 
cerebral  nerves.    They  are  distributed  to  the  pjcr.  12(5. 

papillae  of  the  skin,  which  are  small  eleva- 
tions enclosing  loops  of  blood-vessels  and 
branches  of  sensory  nerves,  situated  on  the 
external  surface  of  the  cutis  vera.  , 

Fig.  126  is  a  representation  of  the  papillge  of  the  palm    ^-^-^-c^c^— — T^.,"-''*- 

of  the  hand,  the  cuticle  bein";  removed.  CUTANEOUS   PAPILLA. 


When  a  body  to  be  touched  comes  in  contact  with  the  sensory  sur- 
face, the  only  idea  communicated  to  the  mind  is  that  of  resistance. 
The  degree  of  resistance  affords  a  knowledge  of  the  hardness  or  soft- 
ness of  the  body.  When  the  body  touched  and  the  sensory  surface 
are  moved  upon  each  other,  a  motion  is  conceived  of  extension  or 
space,  roughness,  smoothness,  and  other  mechanical  properties. 

The  knowledge  of  form  and  weight  some  late  physiologists  have 
been  unable  to  account  for  by  the  ordinary  sense  of  touch,  and  have 
got  out  of  the  difficulty  by  supposing  a  sixth  sense,  which  they  call  the 
muscular  sense,  to  exist  for  that  particular  purpose.  The  sense  of  tem- 
perature has  also  been  atti'ibuted  to  a  distinct  set  of  nerves,  because 
the  recognition  of  it  occurred  without  the  actual  contact  of  the  hot  or 
cold  body  with  the  sensory  surface.  I  do  not  see  that  either  supposition 
makes  the  matter  any  clearer.  Form  and  w^eight  are  but  degrees  of 
extension  and  resistance,  and  temperature,  whether  its  essential  nature 


252  P  I  Y  S 1 0  L  «.  G  r. 


is  caloric,  light,  or  electricity,  is  but  the  perception  of  rays  or  particles 
coming  in  contact  with  the  sensory  surface,  and  expanding  or  conti-act- 
ing,  that  is  to  say,  moving  the  conli-actile  tissues  so  as  to  imjiress  the 
nervous  papillfe. 

The  sense  of  touch  is  developed  in  different  parts  in  proportion  to 
the  supply  of  sensory  nerves.  In  man  the  acuteness  of  the  sense 
varies  in  different  regions  of  the  body.  The  lips,  tip  of  the  tongue, 
and  inside  of  the  last  joints  of  the  fingers  are  exquisitely  sensitive,  in 
consequence  of  the  nerves  being  very  numerous  and  superficially  dis- 
ti'ibuted.  The  epidermis  is  also  very  thin  in  tliose  paits,  and  the 
innumerable  lines  and  furrows  afford  the  papilla3  a  greater  degi'ee  of 
isolation.  The  development  of  the  sense  corresponds  with  the  number 
and  extent  of  these  lines  and  furrows.  The  sense  of  touch,  like  nil 
the  special  senses,  may  be  educated  to  a  surprising  degi-ee  of  acuteness 
and  accuracy,  as  with  the  Wind,  who  have  been  taught  to  read  and  even 
distinguish  colors  by  it. 

Sense  of  Taste. — The  various  papillae  on  the  surface  of  the  tongue, 
when  excited  by  contact  with  savory  substances  become  turgid  and 
erect,  so  as  to  produce  considerable  roughness  of  the  organ.  Some  of 
the  papillae,  the  filiform  particularly,  ai'e  supposed  to  be  concerned  in 
the  common  s-ensibility  or  feeling  of  the  tongue,  and  the  remainder  are 
regai'ded  as  exclusively  pertaining  to  the  sense  of  taste. 

Solubility  of  the  matter  brought  in  contact  with  the  tongue  is  a 
necessary  condition  of  taste.  The  sense  may  also  be  excited  by  me- 
chanical or  chemical  irritation  of  the  nerves.  A  smart  blow  by  the 
finger,  or  a  galvanic  shock,  ^vill  often  excite  the  taste,  which  is  then 
sometimes  acid  and  sometimes  alkaline.  As  sapid  substances  impress 
the  olfactory  as  well  as  the  gustatory  nerves,  the  sense  of  taste  is  gen- 
erally materially  diminished  when  the  nose  is  obstructed. 

Taste,  like  all  the  special  senses,  is  highly  educable,  but  in  civilized 
life  is  generally  deeply  depraved  and  perverted.  Its  object  in  the  ani- 
mal economy  is  to  dire  ft  us  in  the  selection  of  aliment;uy  substances, 
ind  assists  us  in  judging  of  their  adaptation  to  the  wants  of  the  nutritive 
apparatus.  The  ability  to  ai)preciate  and  enjoy  the  gustatory  jH'operty 
of  natural  and  hcaWiful  food  is  exactly  proportioned  to  the  integrity 
of  the  sense ;  and  those  pei-sons  who  cannot  realize  any  agreeable 
savor  in  any  article  of  nutriment  until  the  papillae  of  the  tongue  are 
stung  into  action  by  salt,  pe])per,  mustard,  vinegar,  or  other  pungents, 
know  but  little  of  the  bountiful  and  luxurious  repast  nature  hns  pro- 
vided for  her  unsophisticated  children,  or  of  the  real  pleasures  of  eat- 
ing.    Like  the  drunkard,  who  svnpHows  the  burning  poison  of  alcohol 


THE    SPECIAL    SEXSJIS.  258 


not  for  the  mere  pleasure  of  drinking,  but  tt  drown  or  appease  a  mad- 
dening and  insatiable  craving,  the  epicure  or  riotous  liver  eats  not  to 
enjoy  or  live,  so  much  as  to  silence  the  goadings  of  a  morbid  appetite. 

Sense  of  Smell. — Olfaction  enables  us  to  distinguish  flavor,  and 
thereby  judge  of  the  odorous  particles  floating  in  the  atmosphere.  Its 
use  is  to  co-operate  with  taste  in  determining  the  qualities  of  food,  and 
protect  the  respiratory  passages  by  detecting  injurious  effluvia  or  other 
deleterious  matters.  Its  seat  is  the  mucous  membrane  of  the  nose, 
though  the  whole  of  the  raucous  surface  is  not  endowed  with  the  sense 
of  smell.  The  upper  portion  of  the  membrane,  expanded  over  the 
superior  and  part  of  the  middle  spongy  bones,  is  the  olfactoiy  region, 
to  which  the  olfactory  nerve  is  distributed.  Sneezing,  which  is  called 
a  reflex  action,  is  sujoposed  to  depend  on  the  fifth  pair  of  nerves,  from 
which  is  derived  the  general  sensibility  of  the  mucous  membrane. 

The  conditions  requisite  for  the  perfect  exercise  of  this  sen?e  are, 
integrity  of  the  nervous  apparatus,  and  a  normal  degree  of  special 
sensibility.  The  odorous  particles  must  also  be  soluble.  Colds,  in- 
flammation of  the  mucous  surface,  strong  irritants  and  narcotics,  as 
cephalic  or  tobacco  snuff",  always  weaken  or  paralyze,  and  sometimes 
utterly  destroy  all  perception  of  odors.  Smelling-bottles  of  ammonia 
and  camphor,  and  all  sti'ong  and  pungent  perfumery,  not  only  injure 
the  sense,  but  injuriously  affect  the  whole  brain  through  the  medium 
of  this  sense. 

Sense  of  Hearing. — No  part  of  the  human  organization  exhibits  a 
greater  complexity  of  structure  than  the  hearing  apparatus.  Nor  will 
it  excite  wonder  that  it  is  so,  when  we  consider  how  extensively  hu- 
man beings  ai'e  related  to  the  external  world  and  to  each  other,  in  their 
duties,  their  interests,  and  their  pleasures,  by  this  function.  The  ex- 
ternal  ear  is  fashioned  into  various  elevations,  depressions,  and  curva- 
tures, peculiarly  fitted  to  catch  the  sonorous  waves  fi-om  all  directions. 
The  external  ineafus  conveys  them,  strengthened  by  reflection  from  the 
walls  of  the  canal,  and  modified  by  the  resonance  of  the  mass  it  encloses, 
to  the  memhrana  tynvpani.  This  membrane  is  not  essential  to  sound, 
for  its  perforation  or  desti'uction  is  not  followed  by  a  loss  of  the  sense ; 
but  it  serves  to  modify  the  sonorous  vibrations  which  are  to  be  commu- 
nicated to  the  chain  of  bones,  in  such  a  manner  as  to  be  thrown  into 
reciprocal  vibration,  though  it  cannot  reciprocate  any  sound  lower  than 
its  own  fundamental  note. 

The  chain  of  hones,  moved  by  their  muscles,  conducts  the  vibrations 
across  the  tympanum  to  the  internal  ear.  The  tensor  tympani,  in  the 
22 


254  PHYSIOLOGY 


function  of  hearing,  performs  an  office  analogous  to  that  of  the  his  in 
seeing.  Its  contraction  draws  down  the  handle  of  the  malleus,  render- 
ing  the  membrana  tympani  tense.  When  very  tense  it  cannot  recipro- 
cate low  sounds,  and  by  veri/  loud  sounds  it  may  be  excited  to  reflection, 
IH  which  state  the  membrane  is  too  tense  to  reciprocate  them.  Its 
natural  condition  is  rather  lax,  the  slate  in  which  it  c<in  reciprocate  the 
greatest  VcU-ietj-  of  sounds.  The  tensor  tj'uipani  muscle  conti-acts  more 
powerfully  as  the  sound  is  louder,  as  the  iris  does  upon  the  application 
of  the  stimulus  o^  light. 

The  tyinpanum  isolates  the  chain  of  bones,  and  allows  free  motion  to 
the  membrane  at  each  of  its  exti-eraities,  while  its  contained  air  rever- 
berates the  sound,  which  is  still  further  sti'engthened  and  modified  by 
reflection  from  the  neighboring  walls,  cells,  spaces,  and  cavities,  par- 
ticularly by  the  reflection  from  the  membrane  of  the  fenestra  ofalis 
and  fenestra  rotunda.  The  Eustachian  tube  serves  principally  to 
maintain  an  equilibrium  between  the  external  air  and  that  enclosed  in 
the  tympanum,  by  which  undue  tension  of  the  membrana  timpani  is 
prevented. 

The  uses  of  the  difl'erent  parts  of  the  labyrinth  ai'e  not  well  under- 
stood. It  is  supposed  that  the  semicircular  canals  regulate  the  per- 
ception of  the  direction  of  sounds,  while  the  cochlea  determines  the 
pitcJi  of  the  notes.  The  ^uid  contained  in  the  memhranous  portion 
of  the  labyrinth,  and  the  ear-stones,  otoconites^  which  float  in  it,  doubt- 
less increase  the  impression  on  the  sentient  nen'es  by  being  thi-own 
into  vibratory  motions,  while  tins  part  of  the  labyi'inth  itself  affords  a 
more  extended  surface  for  the  expansion  of  the  auditory  nerve. 

Philosophy  of  Sound. — The  whole  complex  stiTicture  of  the  au- 
ditory appai'atus  has  reference  to  two  princijjles ;  the  propagation  of 
sonorous  vibrations,  and  theh  multiplication  by  resonance.  In  some  of 
the  lower  anmiaLs  the  perception  of  sound  takes  place  by  means  of  a 
very  simple  contrivance,  consisting  essentially  of  a  sac  containing  a 
fluid,  and  having  a  nerve  spread  out  upon  it ;  the  membrana  t}'rapani, 
ossicula,  cochlea,  and  semich'cular  canals  being  absent. 

Sounds  are  said  to  be  propagated  by  reciprocation,  by  resonance,  and 
by  conduction.  An  example  of  the  first  method  is  found  in  two  strings 
of  equal  tension,  placed  side  by  side ;  if  the  one  be  thrown  into  vibra- 
tion, the  other  will  reciprocate  by  making  corresponding  vibrations. 
Resonance  occurs  when  a  sounding  body  is  placed  in  connection  with 
any  other,  of  which  one  or  more  parts  may  be  thrown  into  reciprocal 
vibrations,  although  the  tone  of  the  whole  be  diliereut,  or  if  the  medium 
be  incapable  of  producing  any  tone  at  all.  Thus,  if  a  tuning-fork,  while 
vibrating,  \e  placed  in  contac*.  with  a  sounding-boai'd   the  latter  will  di- 


THE    SPECIAL    SENSES. 


255 


vide  itself,  as  it  were,  into  a  number  of  parts,  each  of  which  will  recip- 
recate  the  original  sound  so  as  greatly  to  increase  its  intensity.  Sounds 
of  conduction  are  propagated  through  all  bodies,  solids  being  better 
conductors  than  fluids,  and  fluids  more  conductive  than  gases.  If  the 
ear  be  placed  at  one  extremity  of  a  log  or  a  long  board,  and  the  other 
end  be  struck,  the  sound  will  extend  along  or  through  the  whole  length 
of  the  material,  and  be  perceived  by  the  organ. 

A  more  definite  idea  of  sound  may  be  obtained  from  the  familiar 
illustration  of  the  common  church  bell. 

When  the  tongue,  a,  strikes  the  side  at  6,  it 
springs  out  to  c,  changing  entirely  the  form  of  the 
bell,  which  is  represented  by  the  dotted  line. 
When  the  bell  springs  back  to  its  original  form,  its 
sides  retract  and  expand  in  an  opposite  direction, 
as  a  vibrating  string  rebounds  beyond  its  centre,  or 
starting  point ;  and  so  alternately,  making  a  succes- 
sion of  sonorous  waves  of  air,  as  a  stone  thrown 
into  a  pool  causes  circular  rings  to  expand  in  all 
directions.  When  these  movements  of  the  air  become  sensible  to  the 
ear,  we  have  the  perception  of  sound. 

The  primitive  sounds  of  the  musical  scale  are  derived  from  the 
different  forces  or  kinds  of  vibration.  Thus,  when  a  bell  is  struck, 
the  first  full,  loud  sound  is  the  fundamental  or  key  note.  When  the 
force  of  the  blow  is  partially  spent,  there  is  a  different  degi'ee  of  mo- 
tion, producing  a  different  force  of  atmospheric  vibration,  and  occasion- 
ing a  modified  perception  of  sound  ;  and  when  the  viln-ations  have 
decreased  still  further  in  intensity,  a  third  primitive  sound  is  rec- 
ognized. 

A  musical  chord  is  the  combined  sound  of  several  sounds  produced 
simultaneously.  When  the  effort  is  pleasant  to  the  ear,  these  chords 
are  called  concords  ;  and  when  unpleasant,  discords.  The  most  pleas- 
ing concords  are  produced  when  the  greatest  number  of  vibrations  in  a 
given  time  occur  together;  and  the  most  disagi'eeable  discords,  when 
the  fewest  vibrations  take  place  simultaneously. 

A  good  idea  of  concord  may  be  gathered  from  the  following  illus- 
(ration : 

On    counting   the   waved    lines,   it  will   be  pj„  -j^og 

found  that  every  third  vibration  of  the  sound      ,  ,         , 

represented  by  the  upper  line,  and  every  sec-     ^j\/\/iV\A/\A/\/?\ 
ond  vibmtion  of  the  sound  represented  by  the     4vVV|\AV|WVjVWj\ 
under  line,  come   together,  the   conjunction 
being  denoted  by  the  dotted  cross-lines      According  to  the  greater  or 


256 


PHYSIOLOGY. 


less  fi'equency  of  these  coincident  vibrations,  are  the  S3unds  concord- 
ant or  discordant.  The  most  agreeable  concord  is,  of  coui-se,  that 
where  every  vibration  of  one  sound  and  eveiy  other  vibration  of  an- 
other sound  come  tocjether. 


The  Sense  of  Sight. — Vision  makes  us  acquainted  with  the  exist- 
ence of  light,  by  which  medium  the  mind  recognizes  the  form,  size, 
color,  position,  etc.,  of  bodies  that  transmit  or  reflect  it. 

The  roots  of  the  optic  nei-ves  unite,  before  entering  the  orbits,  into 
intimate  junctions,  called  chiasms,  from  ihese  chiasms  they  diverge 
and  enter  tlie  orbit  through  the  optic  foiamina,  part  of  the  fibres  of 
each  passing  to  the  opposi*^e  eye,  a  part  being  connecting  or  commisii- 
ral,  and  the  remainder  passing  to  the  eye  of  the  same  side.  This 
arrangement  seems  to  associate  the  two  eyes  in  a  single  act  of  vision, 
although  most  physiologists  regai'd  th«>  single  vision  with  two  eyes  as  a 
result  of  the  rays  of  light  from  a  luminous  object  falling  upon  parts  of 

the  retinfe  accustomed  to 


Fig.  129. 


act  together. 


OPTIC    CHIASM. 


Fig.  129  is  a  representation  ot 
the  course  of  the  fibres  of  the 
optic  nerve  in  the  chiasm,  a. 
Anterior  fibres,  commisural  be- 
tween the  t^To  retinse.  p.  Pos- 
terior fibres,  commisural  between 
the  thalami,  or  origin  of  the  optic 
nerves,  a.'  p.'  Diagram  of  the 
preceding. 


The  essential  pai'ts  of  the  eye  are,  the  expansion  of  the  optic  nerve, 
called  retina,  which  feels  the  impressions  of  light,  and  the  transparent 
refracting  media,  or  humors  of  the  eye,  which  transmit  the  light  so  as 
to  bring  it  to  a  focus  upon  the  retina.  The  sclerotic  forms  a  firm  sun- 
port  to  the  globe,  and  is  opake,  except  in  front,  where  it  becon  s 
transparent  for  the  admission  of  the  rays  of  light,  and  is  called  cornt  i. 
The  dark  pigment  called  choroid,  between  the  sclerotic  and  retina,  ab- 
sorbs the  raj-s  of  light  after  they  have  impressed  the  retina.  I'lie 
choroid  becomes  gradually  hghter  in  many  people  as  they  advance  in 
life,  and  in  the  Albino  it  is  entirely  wanting.  The  iris  is  a  vertical 
curtain-like  process  of  the  choroid,  hanging  across  the  cavity  of  the 
aqueous  humor,  and  its  centi'al  perforation  is  the  pupil.  The  conti-ac- 
tion  and  relaxation  of  the  circular  fibres  surrounding  the  orifice  of  the 
pupil,  as  the  rays  of  light  are  sti'onger  or  weaker,  regulate  the  impres- 
sion on  the  nei-vous  expansion.  When  the  iris  becomes  insensible  or 
weakened,  the  pupil  remains  permanently  dilated  and  vision  dull,  as 


VOICE    AND    SPEECH.  25i 

in  affections  of  tlie  optic  nerve,  compression  of  the  brain,  etc.  The  iria 
is  also  weakened  and  the  pupil  dilated  by  being  continued  too  long  in 
dark  or  deeply  shaded  situations.  The  pure  narcotics,  belladona,  hen- 
bane, etc.,  cause  a  dilatation  of  the  pupil  by  paralyzing  the  nervous  in- 
fluence. Under  exposure  to  very  strong  light,  and  in  acute  inflamma- 
tory affections  of  the  brain  the  pupil  is  i-eix^n-kably  contracted;  and 
also  during  the  stage  of  excitement,  v/hen  the  brain  is  jaboring  under 
the  influence  of  the  stimulating  nju'cotics,  as  opium,  camphor,  and 
alcohol. 

The  adaptation  of  the  eye  to  distances  is  a  phenomenon  not  yet  very 
well  explained.  Some  physiologists  consider  it  as  entirely  the  result 
of  habit  or  education,  while  others  s'ippose  the  perception  of  a  distinct 
image,  whether  the  object  be  lar  or  near,  is  owing  to  an  altered  posi- 
tion of  the  crystalline  lens  by  muscular  agency — an  opinion  strength- 
ened by  the  fact,  that  the  adjusting  power  of  the  eye  is  impaired  or 
lost  by  the  extraction  of  the  lens,  or  by  paralyzing  the  muscles  of  the 
ciliary  processes  and  iris  with  belladona. 

The  question  has  been  much  discussed,  why  objects  appear  erect  to 
us,  when  it  is  known  that  the  rays  of  light  fi'om  the  opposite  points  of 
a  luminous  object  cross  one  another  by  the  successive  refi-actions  they 
experience,  and  thus  make  the  image  on  the  retina  actually  inverted  ? 
But  no  satisfactory  solution  has  yet  been  offered,  and  many  regard  the 
phenomenon  as  the  result  of  education  and  experience. 


CHAPTER  III. 

OF  VOICE  AND   SPEECH. 


Voice  is  formed  in  the  larynx,  and  is  produced  by  the  simple  expul- 
sion of  air  from  the  lungs,  when  the  vocal  ligaments  or  cords  are  held 
in  a  certain  degree  of  tension.  Nearly  all  animals  possess  the  power 
of  making  voice-sounds.  Singing,  crying,  and  yelling  are  examples. 
Speech  is  the  modification  of  voice-sounds  in  the  cavity  of  the  mouth, 
constituting  articulation.  The  articulating  organs  are  the  tongue,  palate, 
lips,  and  teeth.  The  fauces  and  cavities  of  the  nose  modify  and  intensify 
both  voice  and  articulate  sounds  by  affording  a  resonant  surface.  Speech 
in  perfection  is  a  faculty  peculiarly  human,  although  many  animals — 
the  parrot  and  jackdaw,  for  examples-^are  cspable  of  uttering  words 
and  sentences  very  distinctly. 


258  PHYSIOLOGY 


All  the  vowels  are  voice-sounds,  being  made  without  any  change  in 
the  shape  or  pi^sitiou  of  the  vocal  organs  during  their  continuance. 
iS//07-^  vowel  soi.nds  are  distinguished  from  those  termed  long,  hroad, 
grave,  and  close,  by  the  impossibility  of  prolonging  them  for  any  appre- 
ciable length  of  time.  The  others  can  be  prolonged  as  long  as  expira- 
tion can  be  maintained.  The  consonants  are  articulate  sounds,  formed 
by  interruptions  in  the  vowel  sounds  produced  by  changes  in  the  posi- 
tion of  the  vocal  organs. 

The  English  Language  may  be  reduced  by  analysis  to  forty-four  nidi- 
meutal  sounds,  or  elements,  sixteen  of  which  are  vowels  and  t^venty- 
eight  consonants.  The  vowel  elements  are :  the  long,  short,  broad, 
and  grave  sounds  of  a,  as  in  ail,  at,  all,  aJi ;  the  long  and  short  sounds 
of  e,  as  in  ease,  end  ;  the  long  and  short  sounds  of  i,  as  in  isle,  ill ;  the 
long,  short,  and  close  sounds  of  o,  as  in  old,  on,  move ;  the  long,  short, 
and  broad  sounds  of  u,  as  in  turn,  tub,  full ;  and  the  double  vowel 
sounds  of  oi  or  oy,  in  oil,  coy,  and  ou  or  otv,  in  our,  how. 

Diphthongs  are  two  vowel  sounds  in  one  syllable ;  the  only  ones  in 
our  language  are  long  i,  as  in  mile,  and  long  u,  as  in  lure,  and  the 
sounds  of  oi  or  oy,  and  ou  or  ow.  Triphthongs  have  no  existence. 
They  are  said  to  be  the  union  of  three  vowel  sounds  in  one  syllable ; 
but  though  these  vowels  are  often  written  in  one  syllable,  one  or  more 
of  them  is  always  silent  in  the  pronunciation,  as  in  adieu,  which  is  pro- 
nounced as  if  ^^a•itt€n  adw. 

The  consonant  elements  are  :  the  name  sound  of  b,  as  in  bite ;  the 
soft  or  hissing  sound  of  c,  or  name  sound  of  s,  as  in  cent ;  the  hard 
sound  of  c,  or  name  sound  of  k,  as  in  cayne ;  the  name  sound  of  z,  as 
in  sufjice;  the  sound  of  sh,  as  in  ocean;  the  name  sound  of  d,  as  in 
dust ;  the  name  sound  of  t,  as  in  correct ;  the  name  sound  of  f,  as  in 
brief;  the  name  sound  of  v,  as  in  of;  the  soft  sound  of  g,  or  name 
sound  of  j,  as  in  ger7n ;  the  hard  or  guttural  sound  of  g,  as  in  gull ; 
the  sound  of  g  represented  by  zh,  as  in  rouge ;  the  aspirate  or  name 
sound  of  h,  as  in  hale ;  the  name  sound  of  I,  as  in  late ;  the  name 
Bound  of  m,  as  in  7nan  ;  the  na?ne  sound  of  n,  as  in  nun  ;  the  sound  of 
71  represented  by  ng,  as  in  link;  the  name  sound  of  jp,  as  in  page; 
the  smooth  sound  of  r,  as  in  far ;  the  trilled  sound  of  r,  as  in  rough ; 
the  name  sound  of  v;,  as  in  wool;  the  sound  of  .r,  represented  by  ks,  as 
in  Jlax;  the  sound  of  a:,  represented  by  ^r,  as  in  exist;  the  sound  of  y, 
represented  by  ye,  as  in  youth ;  the  aspirate  sound  of  th,  as  in  thin ; 
the  vocal  sound  of  th,  as  in  this;  the  sound  of  wh,  as  in  whale;  and 
the  sound  of  ch,  as  ki  church. 

In  a  strictly  philosophically  written  language,  each  distinct  element- 
ary sound  should  be  represented  by  a  distinct  character,  making  as  many 


VOICE    AND    SPEECH 


25& 


letters  as  there  are  vocal  and  articulate  elements.  But  in  the  English 
language  there  ai"e  only  twenty-six  letters  to  nearly  twice  as  many 
sounds  ;  and  while  some  of  the  letters  represent  but  one  elementary 
sound,  others,  as  a  and  c,  represent  four.  The  phonographic  reform, 
therefore,  is  clearly  founded  in  nature  and  in  physiology. 

The  vocal  apparatus  has  been  compared  to  various  musical  instm- 
ments,  in  wliich  strings,  tubes,  and  reeds  are  the  agencies  in  the  pro- 
duction of  sound,  as  the  violin,  flute,  and  clarionet.  The  analogy  is  not 
very  close  in  relation  to  either  separately,  but  the  vocal  machinery 
combines  many  properties  of  them  all. 

The  lower  vocal  cords  are  mainly  concerned  in  the  production  of 
sound;  if  the  upper  cords  are  removed  voice  continues,  but  is  rendered 
feeble ;  if  the  lower  are  destroyed,  it  is  entirely  lost. 

The  tones  of  voice  depend  on  the  varying  tension  of  the  vocal  cords. 
In  the  production  of  tones,  the  ligaments  of  opposite  sides  are  brought 
into  approaching  parallelism  with  each  other  by  the  approximation  of 
the  points  of  the  arytenoid  cartilages ;  in  the  intervals  they  are  again 
separated,  and  the  opening  between  them,  rhna  glottidis,  assumes  the 
form  of  the  letter  V. 


Fig,  130  exhibits  the  vocal  ligaments  Fig.  130. 

as  seen  superiov-ly.  G,  E,  H.  Thyroid 
cartilage.  N,  F.  Arytenoid  cartilages. 
3,  V,  S,  V.  Vocal  cords  or  ligaments. 
N,  X.  Crico-arytenoideus  lateralis.  V. 
k,  f.  Right  thyro-arytenoideus.  N,  1,  N, 
1.  Crico-arytenoldei  postici.  B.  B.  Crico- 
arytenoid ligament. 

The  muscles  which  stretch  or 
relax  the  vocal  ligaments  are 
alone  concerned  in  the  voice. 
The  muscles  which  open  and 
close  the  glottis  regulate  the 
amount  of  the  air  inspired  and 
expired,  and  belong  to  respha- 
tion.      These   muscles  are    the  larynx  from  above. 

seat  of  spasmodic  affections  producing  suffocation. 

The  pitch  of  the  tones  is  regulated  by  the  tension  of  the  vocal  cords. 
Its  volume  or  intensiiy  depends  on  the  capacity  of  the  lungs,  length  of 
the  trachea,  and  the  force  with  which  the  air  is  expelled,  and  the  flex- 
ibility of  the  vocal  cords.  In  the  male  the  vocal  cords  ai'e  longer  than 
in  the  female,  in  the  proportion  of  three  to  two,  which  renders  the 
male  voice  usually  an  octave  lower 


260  PHYSIOLOGY 


The  natural  compass  of  voice  in  most  persoiis  is  two  octaves,  or 
twenty-four  semitones.  Singers  are  capable  of  producing  ten  distinct 
intervals  between  each  semitone,  making  in  all  240  intervals,  requiring 
as  many  different  states  of  tension  of  tne  vocal  cords,  all  of  which  are 
producible  at  pleasure,  and  without  a  gi-eater  variation  of  the  length 
of  the  cords  than  one  fifth  of  an  inch.  One  of  the  most  w'onderful 
phenomena  of  vitality  is  the  facilit}  with  which  the  will  determines  the 
exact  degree  of  tension  necessary  to  produce  a  given  note,  when  the 
mind  has  formed  a  distinct  conception  of  the  tone  required. 

A  musical  note  is  a  prolonged  vowel  sound,  and  may  be  regarded  as 
the  natural  language  of  emotion,  or  the  expression  of  the  affectuous 
mind.  Speech  is  the  natural  expression  of  ideas  or  thoughts.  These 
two  kinds  of  natural  language  are  intimately  associated  in  the  human 
being,  so  that  there  is  music  in  well-spoken  thoughts. 

Ventriloquism  is  simply  the  power  of  imitating  the  voices  of  others, 
the  cries  of  animals,  and  the  sounds  of  inanimate  matter  so  closely  as  to 
produce  a  coanplete  vocal  illusion,  making  them  seem  to  come  from  any 
distance  or  direction,  or  through  any  kind  of  media.  Those  who  have 
this  imitative  power  well  developed,  must  possess  an  exti-aordinary 
flexibility  of  the  whole  vocal  apparatus. 


CHAPTER   IV. 

OF   THE   INDIVIDUAL   FUNCTIONS. 


Those  functions  which  relate  exclusively  to  the  growth,  develop- 
ment, and  preservation  of  the  individual  organism  are,  digestion,  circu- 
lation, respiration,  absorption,  nuti-ition,  secretion,  and  calorification. 
Some  phj'siologists  regard  imiervatioyi,  or  the  production  of  nervous 
influence,  and  that  propeity  of  the  tissues  called  endosmose  and  exos- 
mose,  by  which  fluids  and  gases  are  interchanged  through  th/?  structures, 
as  distinct  functions. 

I  think,  however,  the  term  function  is  not  properly  applied  to  those 
properties  or  processes  of  the  organism.  Innervation  literally  means 
the  existence  of  nervous  power;  its  production  must  depend  on  the 
f)ther  functions.  Endosmosis  and  exosmosis  -ire  rather  mechanical 
than  vital  processes,  as  they  take  place  in  unorganized  as  well  as 
organized  stmctures. 


THE    INDIVIDU.^L    FUNCTIONS. 


261 


Fi-  131. 


Fig^l31  is  an  ideal  repi'esent- 
ation  of  the  organs  of  digestion, 
opened  nearly  the  whole  length. 
1.  Upper  jaw.  2.  Lower  jaw. 
.3.  Tongue.  4.  Roof  of  the 
mouth.  5.  CEsophagus.  G. 
Trachea.  7  and  8.  The  paro- 
tid and  sublinguinal  glands- 
two  of  the  salivary  glands,  9. 
Stomach.  10,  10.  Liver.  11. 
Gall-cyst.  12.  The  duct  cor 
veyingf  the  bile  to  the  duode 
uum  (13,  13).  14.  Pancreas. 
15,  15,  15,  15.  Small  intestine. 
It).  Opening  of  the  small  intu 
the  large  intestine.  17,  18,  19, 
20.  Large  intestine.  21.  Spleen, 
22.  Upper  part  of  the  spinal 
column. 

Digestion. — The  first 
of  the  organic  functions 
is  the  conversion  of  aU- 
iiientaiy      matter      into 
chyle,  which  in  its  turn 
is  converted   into  blood. 
Tiie  first  process  of  the 
digestive  function  is  mas- 
tication,   by   which    the 
food  is  divided  into  fine 
particles    by  the  cutting 
and  gi'inding  action  of  the 
teeth.     The  presence  of 
aliment   and   the    act    ">f 
mastication ,   excite     the 
function   of  the  salivary 
glands  to  secrete  the  sol- 
vent  fluid  called   saliva, 
which  is  intimately  min- 
gled with  the  particles  of  alimentary  matter,  completing  the  process  of 
insalivation.      The  alimentary  substances,  comminuted  and  softened 
are  then  conveyed  into  the  stomach  by  the  act  of  swallowing,  called 
deglutition.     The  presence  of  food  in  the  stomach  excites  the  flow  of 
gastric  juice,  which  is   secreted  from  its  mucous  membrane.     The 
vessels  of  the  stomach  then  rec-eive  a  gi'eater  supply  of  blood,  and 
there  is  a  slight  increase  of  temperature.     The  solvent  property  of  the 
gastitc  juice  was  generaUy  conjee*  ired,  but  sometimes  denied,  until 


THE    DIGESTIVE    SYSTEM. 


262  PHYSIOLOGY. 


clearly  demonstrated  by  the  experiments  of  Dr.  Beaumont,  in  1833. 
In  consequence  of  a  gun-shot  wound  in  the  person  of  Alexis  St.  Martin 
healing  in  such  a  manner  as  to  leave  an  artificial  opening  into  the  stom- 
ach, Dr.  Beaumont  was  enabled  to  inti'oduce  various  aliments  directly 
into  the  stomach,  and  ascertain  the  chemical  or  solvent  property  of  the 
gastric  juice. 

The  gastric  juice  usually  manifests  an  acid  reaction  to  chemical  tests, 
but  chemists  do  not  agi-ee  very  well  as  to  its  actual  chemical  properties. 
According  to  the  analysis  of  Professor  Dunglison,  it  contains  free  muri- 
atic and  acetic  acids,  phosphates  and  muriates  of  potassa,  soda,  magnesia^ 
and  lime.  Blondlot  imputes  its  acidity  to  super-phosphate  of  lime, 
while  Professor  Thornton  and  MM.  Bernard  and  Barseswil  attribute  it 
to  the  presence  of  lactic  acid ;  an  acid  w^hich  Liebig  positively  denies 
the  existence  of  in  a  healthy  stomach.  These  diversities  in  the  results 
of  analyses  are  probably  due,  in  some  measure,  to  the  different  methods 
of  conducting  them,  in  part  to  the  different  proportions  or  kinds  of  saHne, 
alkaline,  and  earthy  matters  taken  into  the  system  with  the  food  and 
drink,  and  in  some  degree  to  differences  in  the  qualities  or  kinds  of  the 
aliments  themselves. 

The  active  principle  of  the  gasti'ic  juice  is  called  'pepsine ;  its  action 
is  analogous  to  tliat  of  a  ferment,  which  has  the  power  of  exciting 
chemical  changes  in  the  particles  of  other  substances  without  under- 
going decomposition  itself.  The  quantity  of  gastric  juice  secreted  is 
regulated  by  the  wants  of  the  system,  and  not  by  the  quantity  of  food 
taken.     Hence  all  excess  of  ingestion  is  a  source  of  injurious  imtation. 

Chymification  is  that  part  of  the  digestive  process  in  w^hich  the  nuti'i- 
tious  portion  of  the  aliment  is  reduced  to  a  pultaceous,  homogeneous 
mass,  called  chyme.  In  addition  to  the  solvent  action  of  the  gastric 
juice,  chymification  is  aided  materially  by  the  contraction  of  the  mus- 
cular coat  of  the  stomach,  whose  fibres  are  so  arranged  as  to  diminish 
its  diameter  in  all  directions,  and  keep  the  food  in  constant  motion  until 
it  is  thoroughly  permeated  by  the  gastric  juice,  the  pyloric  orifice  of 
the  stomach  being  closed  at  the  same  time  by  the  circular  fibres  acting 
there  as  a  sphincter. 

As  fast  as  the  alimentary  mass  becomes  chymified,  it  is  passed  along 
into  the  duodenum.  The  most  innulritious  particles  of  the  ingesta 
are  not  rendered  chymous,  but  are  reduced  to  a  condition  enabling 
them  to  pass  through  the  alimentary  canal  with  facilit}',  to  be  expelled 
as  excrementitious  matter.  Hence  the  fallacy  of  the  doctrine  lately 
advanced  by  Dr.  Edward  Johnson  in  his  works  on  Hydropathy,  and 
by  some  other  European  authors,  tliLt  the  focccs  were  wholly  a  secre- 
tion, an  error  which  must  have  originated  from  observations  made  on 


THE    INDIVIDUA.L    FUNCTIONS.  263 

persons  whose  diet  consisted  almost  wholly  of  animal  and  concentrated 
vegetable  food. 

In  the  duodenum  the  alimentary  substance  receives  the  pancreatic 
juice  from  the  pancreas.,  and  is  there  also  mixed  with  the  bile  fi-om 
the  liver.  The  pancreatic  juice  is  analogous  in  qualities  to  the  saliva, 
and  assists  further  to  attenuate  and  resolve  the  particles  of  chyme  into 
the  condition  best  adapted  for  conversion  into  chyle. 

Various  opinions  are  entertained  concerning  the  natm'e  and  uses  of 
the  bile.  Some  physiologists  regard  it  as  in  part  a  vital  secretion,  and 
in  some  waj  auxiliaiy  to  digestion.  The  common  notion  that  it  is  found 
in  the  stomach  in  a  healthy  state  is  erroneous.  The  stomach  cannot  en- 
dure and  will  not  tolerate  it.  When  accidentally  forced  there  by  reversed 
peristaltic  action,  the  operation  of  emetics,  or  other  morbid  conditions, 
it  produces  violent  tremblings,  spasms,  and  vomitings,  and  sometimes 
convulsions.  Others  regard  the  bile  as  a  mere  chemical  agent  in  sep- 
arating the  chyle,  or  nutritious  part  of  the  aliment,  from  the  general 
mass  of  chyme ;  and  others  still  look  upon  it  as  wholly  an  effete  or 
excrementitious  matter. 

The  fact  that  the  bile  is  secreted  from  venous  or  impure  blood,  with 
which  the  liver  is  supplied,  unlike  any  other  organ  in  the  body,  seems 
to  indicate  that  the  office  of  the  liver  is  to  filter  some  of  the  accumu- 
lated impurities  from  the  blood,  before  it  returns  to  the  heart,  and  the 
analyses  of  the  bile  pretty  conclusively  show  that  the  liver  is  the 
depurating  organ  for  certain  combinations  of  effete  carbon  and  hydrogen. 
Foreign  substances  have  actually  been  found  in  the  liver  very  soon  after 
their  reception  into  the  stomach ;  substances  which  can  never  be  found 
in  the  general  circulation  ;  a  ciixumstance  strongly  corroborative  of  the 
opinion  that  the  bile  is,  at  least  primarily,  an  excrementitious  fluid.  It 
may  be,  however,  secondarily  subservient  to  the  economy  of  the  di- 
gestive function,  by  mixing  with  the  innuti'itious  portion  of  the  aliment, 
and  lucubrating  its  passage,  and  by  mingling  with  the  oily  matters,  and 
favoring  their  solution  by  resolving  them  into  a  saponaceous  mass  ;  and 
also  by  its  alkaline  properties,  neutralizing  any  surplus  acid  matter. 

Fluids  taken  into  the  stomach  are  mostly  absorbed  fi"om  it  without  pass- 
ing into  the  intestinal  tube.  When  digestible  solid  and  liquid  aliments 
are  taken  into  the  stomach  together,  the  aqueous  portion  is  absorbed 
before  the  digestion  of  the  solid  matter  commences ;  but  indigestible 
substances  must  either  be  violently  expelled  by  vomiting  or  purging, 
or  more  quietly  thrown  off  by  the  excretories.  When,  therefore, 
their  impression  on  the  stomach  is  not  strong  enough  to  produce  violent 
resistance,  or  the  organic  instincts  are  palsied  in  a  measure  by  habit, 
they  must  necessarily  be  abso]-bed,  and  pass  unchanged  into  the  circu- 


2t>4  PHYSIOLOGY 


lation.     This  is  the  case  with  metallic,  mineral,  and  many  earthy,  alka 
line,  and  saline  matters,  with  all  medical  drugs,  with  alcohol  iu  all  its 
forms,  tobacco,  and  with  many  aiticles  employed  as  seasonings  or  con- 
diments. 

Chylijication  does  not  take  place  in  the  duodenum,  for  chyle  itself  is 
never  found  there.  A  still  further  process  is  required  to  elaborate  a 
fluid  which  is  to  replenish  the  blood  and  supply  all  the  structures. 
Another  change  is  thersf  jre  effected  by  the  lacteal  absorbent  vessels. 
The  lacteals,  or  chyle-ducts,  do  not  take  up  or  absorb  chyle  from  the 
alimentary  tube,  but  form  or  manufacture  it  from  the  chymous  m;iss ; 
nor  does  the  functional  action  of  these  vessels  perfect  or  complete  the 
process  of  chylification.  The  finishing  elaboration  takes  place  in  the 
viesenteric  glcw.ds,  numerously  distributed  along  the  course  of  the  lacteals, 
and  formed  by  their  enlai'gement  and  convolutions.  On  receiving  the 
final  action  of  the  mesenteric  glands,  the  chyle,  fitted  for  nutrition, 
passes  into  the  thoracic  duct,  and  thence  into  the  general  mass  of  blood. 

The  innutritious  portion  of  the  food,  mingled  with  and  lucubrated  by 
excrementitious  matters  in  the  form  of  bile,  and  such  fcecal  matters  as 
are  secreted  by  the  mucous  surface  of  the  intestinal  canal,  are  carried 
off  by  the  peristaltic  action  of  the  bowels.  The  peristaltic  motion  of 
tne  whole  alimentary  canal  is  produced  by  the  regular,  gradual  con- 
traction of  the  circular  muscular  fibres  from  above  downward,  which 
motion  is  assisted  and  invigorated  by  the  general  compression  on  the 
whole  surface  of  the  abdomen  produced  by  the  free  and  energetic 
action  of  the  external  abdominal  muscles. 

Vomiting  is  eftected  by  the  reversed  action  of  the  Tiiuscular  fibres, 
aided  by  the  sympathetic  and  powerful  conti-action  of  the  abdominal 
muscles. 

Hunger  and  thirst.,  the  sensations  of  which  are  refeired  to  the  stom- 
ach and  throat,  are  indications  of  the  wants  of  the  general  system. 
The  rather  ancient  doctrines  that  hunger  was  produced  by  gastric  juice 
in  the  stomach,  and  thirst  by  a  dry  condition  of  the  mucous  surface  of 
the  fauces,  are  clearly  erroneous.  Both  sensations  are  organic  instincts 
which  communicate  the  need  of  the  body  for  solid  and  liquid  aliment 
to  the  common  sensorium. 

Circulation. — The  circulating  system  -"-omprises  the  heart  as  its 
grand  central  organ;  the  arteries,  which  convey  the  ijlood  to  all  parts 
of  the  body ;  the  capillaries,  which  connect  the  arteries  and  veins ; 
and  the  veins^  which  return  the  blood  to  the  heart. 

Commencing  at  the  cenh-al  point,  the  blood  is  received  from  all 
pai'ts  of  the  venous  system  into  the  right  at  ride  of  the  heart:  tlie  auri- 


THE    INDIVIDUAL    FUNCTIONS.  265 

cle  contracts,  and  the  blood  is  forced  into  the  right  ventricle  ;  the  right 
ventricle,  contracting,  sends  it  into  the  ijulmonary  artery ;  this  artery 
divides  into  branches,  which  are  i-araified  through  the  substance  of  the 
lungs,  and  bring  the  blood  in  contact  with  their  innumerable  air  cells, 
where  it  throws  off  its  surplus  cai'bon,  and  probably  receives  oxygen 
or  electricity,  becomes  changed  from  dark  or  venous  to  fluid  or  arterial, 
and  is  returned  through  the  pulmonary  veins  to  the  left  auricle  of  the 
Iieart ;  fi'om  the  left  auricle  it  passes  into  the  left  ventricle,  and  from 
thence  it  passes  through  the  arteries  to  all  parts  of  the  body;  the  valves 
of  the  veins  and  of  the  different  cavities  of  tlie  heart  preventing  the  cur- 
reut  from  receding. 

The  whole  quantity  of  blood  is  estimated  at  about  one  fifth  of  the 
entire  w^eight  of  the  body,  which  is  thirty  pounds  in  a  person  weighing 
150  pounds.  The  cavities  of  the  heart  hold  about  two  ounces,  three 
fourths  of  which  is  discharged  at  each  contraction,  and,  counting  sev- 
enty pulsations  in  each  minute,  a  little  more  than  six  pounds  of  blood 
will  pass  through  it  in  this  time,  or  nearly  10,000  pounds  in  twenty-four 
hours.  The  whole  quantity  of  blood  probably  passes  through  the 
heart  once  in  four  or  five  minutes. 

The  frequency  of  the  heart's  contractions — in  other  words,  the  beats 
of  the  pulse — gi-adually  diminish  from  the  commencement  to  the  end 
of  life.  Immediately  after  birth  the  pulsations  are  100  to  130  ;  in  mid- 
dle life,  65  to  75 ;  and  in  old  age,  65  to  50. 

The  two  auricles  of  the  heart  contract  simultaneously,  as  also  do  the 
two  ventricles,  the  auricles  and  ventricles  alternating  with  each  other. 
The  contraction  of  each  cavity  is  called  its  systole ;  the  relaxation 
which  follows,  its  diastole.  The  systole  of  the  venti'icles  corresponds 
with  the  projection  of  blood  into  the  arteries,  causing  the  imlse.  The 
apex  of  the  heart,  being  near  the  walls  of  the  chest,  in  the  neighbor- 
liood  of  the  fifth  and  sixth  ribs  of  the  left  side,  communicates,  by  the 
motions  of  the  organ,  a  decided  shock  or  jarring  sensation,  which  is 
called  the  impulse  of  the  heart. 

The  sounds  produced  by  the  heart's  action  can  be  readily  detected^ 
By  placing  the  ear  on  the  front  part  of  the  chest,  two  sounds  will  be 
distinctly  heard,  following  each  other  in  rapid  succession  at  each  beat 
of  the  heart.  These  sounds  are  alternated  with  short  intervals  of  re- 
pose. The  first  sound  is  the  longest,  and  corresponds  with  the  systole 
of  the  ventricles,  the  pulse  in  the  arteries,  and  the  impulse  against  the 
walls  of  the  chest ;  the  second,  which  is  but  half  as  long,  corresponds 
with  the  diastole  of  the  ventricles.  The  first  sound  is  dull  and  pro- 
longed •,  the  second  is  short  and  sharp.  The  first  sound  is  produced  by 
the  rush  of  blood  through  the  comparatively  narrow  ?.':;'J«ts  of  the 
I~23 


266 


PHYSIOLOGY. 


aorta  and  pulmonary  artery,  and  its  passage  over  the  rough  internal 
surface  of  the  heart,  aided  by  the  muscular  contraction  of  the  ventri- 
cles and  the  heart's  impulse.  The  second  sound  is  evidently  occa- 
sioned by  the  sudden  shutting  down  of  the  semilunar  valves  at  the 
orifices  of  the  aorta  and  pulmonaiy  ai'tery. 

The  capillary  vessels  are  a  network  of  extremely  minute  vesselt* 
intermediate  between  the  arteries  and  veins.  This  structure  exists  ii 
all  organic  textures.  The  size  of  the  capillaries  is  proportioned  to  that  of 
the  red  particles  of  the  blood,  their  diameters  varying  from  ^55^  to  g^  of 
an  inch.  They  are  not  a  distinct  system  terminating  in  open  mouths, 
but  merely  fine  tubes  by  which  the  arteries  are  continued  into  the 
veins.  "^ 

Fig.  132. 


Fig.  132  represents  the  anastomoses  of  the  blood-vessels,  which  form  the  capinaries, 
as  seen  in  the  web  of  a  frog's  foot  by  the  aid  of  the  microscope.  1,  1.  The  veins.  2,  2, 
2.  The  arteries. 


In  the  capillary  vessels  all  the  organic  flinctions  take  place.  Their 
oJrculation  is  to  a  great  degree  independent  of  the  heart's  action,  and 
is,  no  doubt,  influenced  and  regulated  by  the  organic  nerves,  which 
preside  over  the  functional  process,  and  distribute  the  blood  to  the  va- 
rious parts  and  organs,  according  to  the  necessities  of  the  vital  economy. 
The  sum  of  th<.*  diameters  of  all  the  capillary  vessels  greatly  exveed:3 


THE    INDIVIDUAL    FUNCTIONS.  26? 

that  of  the  arteries  and  veins,  which  enables  the  blood  in  them  to  move 
elowly,  and  even  sometimes  take  a  retrogi'ade  direction  to  some  ex- 
tent, circumstances  favorable  to  the  perfect  nutrition  of  the  structures, 
the  separation  of  worn-out  material,  and  the  consolidation  of  new. 

In  its  passage  through  the  capillary  vessels  the  blood  loses  the  vivify- 
ing properties  and  fluid  color  it  received  in  the  lungs,  and  becomes 
dark,  impure,  and  charged  with  efiete  matter,  resulting  from  the  disin- 
tegration of  the  tissues.  All  the  excrementitious  or  waste  matters  not 
collected  into  the  excretory  apparatuses  of  the  several  depurating  or- 
gans, are  carried  along  by  the  capillaries  into  the  veins,  to  be  purified 
in  passing  through  the  liver  and  lungs. 

Respiration. — Respiration  is  the  function  by  which  the  blood  is 
aerated  or  purified.  It  consists  of  the  alternate  inspiration  and  expiration 
of  atmospheric  air.  The  process  of  breathing  has  a  two-fold  relation 
to  the  animal  economy.  1.  The  lungs,  as  depurating  organs,  eliminate 
from  the  blood  a  large  proportion  of  the  impurities  and  waste  matters 
which  it  acquires  in  the  capillaries,  particularly  its  excess  of  carbon.  2. 
The  lungs,  as  auxiliary  nutritive  organs,  digest  the  inspired  air,  and 
separate,  or  rather  form  from  it  a  principle  convertible  into  the  sub- 
stance of  the  blood.  Doubtless,  too,  they  receive  and  transmit  to  the 
nervous  system,  through  the  medium  of  the  blood,  a  constan^ly  replen- 
ishing stream  of  that  electric,  magnetic,  or  other  vital  property  on  which 
the  nervous  influence  depends. 

The  air  which  we  ordinarily  breathe,  uniformly  consists  of  about 
twenty-two  parts  of  oxygen,  seventy-seven  of  nitrogen,  and  one  of 
carbonic  acid  gas,  in  one  hundred.  Other  gaseous  matters  frequently 
exist,  to  a  greater  or  less  extent,  in  the  atmosphere,  from  local  causes, 
not  as  constituents,  but  as  accidental  admixtures,  if  we  except  ammonia, 
a  compound  of  nitrogen  and  carbon,  which  appears  to  be  ordinarily 
present  in  the  proportion  of  one  fourth  of  a  gi-ain  to  about  20,800  cubic 
feet.  The  constituent  proportions  of  the  atmosphere  are  found  not  to 
vary  perceptibly  in  different  latitudes,  nor  in  low  or  mountainous 
regions. 

The  air  expired  fi-om  the  lungs  is  found  to  have  lost  about  sixteen 
parts  of  its  oxygen,  and  gained  about  fourteen  per  cent,  of  carbon.  As 
carbonic  acid  contains  precisely  its  own  volume  of  oxygen,  fourteen 
of  the  sixteen  parts  of  oxygen  lost  in  the  lungs  may  he  employed  in 
converting  the  effete  carbon  into  carbonic  acid  gas,  in  which  state  it  is 
expelled,  and  the  remaining  two  parts  of  oxygen  may  serve  as  nutrient 
material.  But  as  carbonic  acid  fs  found  to  exist  already  formed  in 
the  veins,  and  as  animals  placed  in  hydrogen  or  nitrogen  still  contin">.e 


iibb  ^:iYsiOLOG\ 


to  evolve  carbouic  acid,  it  appears  cleai'  enough  that  (he  greater  part,  if 
not  all,  of  the  carbonic  acid  gas  expelled  from  the  lungs  is  formed  in 
the  tissues,  thus  leaving  the  gi-eater  part  or  all  of  the  oxygen  absorbed 
from  the  inspired  air  to  be  used  for  other  purposes  than  "burning  up 
the  carbon"  in  the  lungs.  This  decai'bonization  and  oxygenation  of  the 
blood  changes  it  from  a  dark  purple  to  a  bright  florid  color.  The 
oxygenation  of  the  blood  does  not  consist  of  the  circulation  of  oxygen 
a  the  blood  as  oxygen,  but  is  rather  a  process  of  aeriform  digestion,  by 
which  oxygen  is  converted  into  electricit)%  analogous  to  the  process  of 
alinientaiy  digestion,  by  which  food  is  converted  into  chyle. 

The  nitrogen,  which  forms  so  large  a  propoition  of  the  air  wo 
breathe,  is  sometimes  increased,  sometimes  diminished,  and  at  other 
times  unchanged  in  quantity  by  respiration,  which  seems  to  prove  that 
its  absorption  in  or  expulsion  from  the  lungs  depends  on  the  wants  of  the 
(•rganic  economy,  and  probably  is  regulated  by  the  sufficient,  excessive, 
(<r  deficient  supply  of  the  niti-ogenous  principle  of  the  food. 

The  precise  chemical  process  by  which  the  change  of  the  color  of 
the  blood  is  effected  in  the  lungs,  is  still  an  unsolved  problem.  It  has 
generally  been  imputed  to  the  presence  of  iron.  Liebig  supposes  iron 
to  exist  in  the  form  of  a  carbonate  of  the  protoxide  in  venous  blood ; 
and  that  in  the  lungs  the  carbonic  acid  is  given  off,  leaving  the  protoxide, 
which,  by  union  with  half  an  equivalent  of  oxygen,  is  converted  into 
the  peroxide,  and  that  this  peroxide  changes  the  venous  blood  into  ar- 
terial. Liebig's  theory,  however  ingenious  it  may  be,  has  been  dis- 
proved by  Mulder,  who  has  shown  that  the  color  is  retained  when  all 
the  iron  is  removed. 

Respiration  occurs  in  aquatic  animals  which  do  not  breathe  air.  In 
them  the  respu-atoiy  organs  are  membranes  prolonged  externally  into 
tufts  or  fringes,  called  gills,  each  one  of  which  is  supplied  with  aiteries 
and  veins,  during  the  chxulation  of  blood  thi'ough  which  aeration  is 
effected. 

In  air-breathing  animals  the  membrane  is  or  aeratl'ig  sm-face  is  re- 
flected internally,  forming  passages  or  chambers  \n  which  the  air  is  re- 
ceived, and  on  which  the  capillai-y  vessels  are  distributed.  Insects  have 
a  series  of  tubes  ramifying  through  the  whole  body,  and  carrying  air  to 
every  part. 

In  the  human  lungs  the  sides  or  walls  of  the  air  cells  ai-e  formed  of 
a  thin  transparent  membrane,  and  the  capillary  vessels  are  placed  be- 
tween the  walls  of  two  adjacent  cells,  so  as  to  be  exposed  to  the  action 
of  the  air  on  both  8idv3s.  The  number  of  the  air  cells  of  the  whole 
lungs  is  immense.  M.  Rochoux  has'  estimate!  them  at  six  hundred 
millions* 


THE    INDIVIDUAL    FUNCnONS. 


269 


Fig.  133. 


BRONCHIAL    TUBE    AND    AIR-Vr.SICX,ES. 


Fig.  i%i  represents  the 
bronchial  tube,  and  its  di- 
vision into  air  cells,  as 
much  magnified.  1.  A 
bronchial  tube.  2,  2,  2. 
Air  cells,  or  vesicles.  ?. 
A  bronchial  tube  and  veal 
cles  laid  open. 


The  capacity  of  the 
lungs  varies  greatly 
in  different  individ- 
uals. M.  Bourgery 
concludes    from    his 

inquiries  that  the  development  of  the  air  cells  continues  up  to  the  age 
of  thirty,  at  %vhicli  time  the  respiratory  capacity  is  greatest.  Accord- 
ing to  the  experiments  of  Mr.  Coathupe,  about  266J  cubic  feet  of  air 
pass  through  the  lungs  of  a  middle-sized  man  in  twenty-four  hours. 
At  the  average  number  of  sixteen  inspirations  per  minute,  the  amount 
of  air  received  at  each  inspiration  would  be  twenty  cubic  inches.  Mr 
Hutchinson  judges  the  capacity  of  the  lungs  by  "  the  quantity  of  air 
which  an  individual  can  force  out  of  the  chest  by  the  gi'oatest  voluntary 
expiration  after  the  greatest  voluntary  inspiration."  Dr.  Southwood 
Smith,  from  a  series  of  experiments,  estimates  the  voluire  of  air  re- 
ceived at  an  ordinary  inspiration  at  one  pint,  the  volume  ordinarily 
present  in  the  lungs  at  about  twelve  pints,  and  the  volume  expelled  at 
an  ordinary  expiration  at  a  little  less  than  a  pint.  He  also  concludes 
that  in  the  mutual  action  which  takes  place  between  the  air  and  blood, 
the  air  loses,  thirty-seven  ounces  of  oxygen  and  the  blood  fourteen 
ounces  of  carbon  every  twenty-four  hours.  The  lightness  of  the  lungs 
depends  on  the  residuaiy  air  they  contain,  and  when  the  lungs  have 
been  once  inflated  by  a  full  inspiration,  no  force  or  mechanical  power 
can  again  dislodge  the  air  sufficiently  to  make  them  sink  in  water.  It 
is  this  residuary  air  which  supports  life  a  few  minutes  in  cases  of  suf- 
focation, immersion,  etc. 

The  movements  of  the  respiratory  apparatus  are  partly  voluntary, 
for  the  purposes  of  being  subservient  to  voice  and  speech,  and  partly 
iiivoluutary,  for  the  purposes  of  aeration.  The  lungs  themselves  are 
entirely  passive  in  respiration.  When  tiie  walls  of  the  chest  are 
drawn  asunder,  and  the  thorax  dilated,  the  external  air  rashes  in  to  the 
air  cells,  distending  them  in  proportion  to  the  dilatation  of  the  thorax, 
and  keeping  the  surface  of  the  lungs  all  the  while  accurately  in  contact 
with  the  walls  of  the  chest  in  all  their  movements.  But  if  air  be  ad- 
mitted into  the  cavity  of  the  pleuiTi  outside  of  the  angs,  as  by  a  pene- 


270 


PHTSIOLOGY 


ti-ating  wound  of  the  thorax,  the  lungs  cannot  be  fully  distended  by  in- 
spiration, but  ^vill  icmain  partially  collapsed,  although  the  thorax  ex- 
pands, because  the  pressure  of  air  from  without  the  air  cells  balance? 
that  within. 

The  diaphragm,  by  extending  the  ribs,  and  pressing  doASTi  the  ab- 
dominal viscera,  is  the  principal  agent  in  inspiration ;  in  a  deep  inspira- 
tion the  intercosta.  muscles  assist  in  the  expansion  of  the  chest  by 
spreading  the  ribs,  aided  also,  to  some  extent,  by  the  muscles  of  the 
thorax  generally.  Exph'ation  is  mainly  accomplished  by  the  abdominal 
muscles,  whose  conti-action  draws  down  the  ribs  and  compresses  the 
viscera  up  against  the  relaxed  diaphragm,  thus  diminishing  the  cavity 
of  the  thorax  fi"om  below. 

Fig.  134.  Fif-  ^34  is  a  side  view  of  the  chest  and  abdo- 

men in  reepiration.  1.  Caviry  of  the  chest.  2. 
Cavity  of  the  abdomen.  3.  Line  of  direction  for 
the  diaphragm  Tvhen  relaxed  in  expiration.  4. 
Line  of  direction  when  contracted  in  inspiration. 
5,  6.  Position  of  the  front  walls  of  the  chest  and 
abdomen  in  inspiration.  7,  8.  Theu'  position  in 
expiration. 

The  connection  of  the  respiratoiy 
function  with  sensibility,  or  the  sense 
of  feeling,  is  an  interesting  and  as  yet 
almost  unoccupied  field  of  inquiry. 
According  to  the  experience  of  drown- 
ing persons — those  who  have  remained 
from  one  to  several  minutes  under 
water  without  breathing,  and  aftei-ward 
ijeen  resuscitated — there  is  no  pain 
after  the  complete  suspension  of  res- 
piration. Although  intellectual  con- 
sciousness remains,  and  mental  con- 
ceptions are  greatly  exalted  and  intens- 
ified, all  sensations  of  mere  bodOy  suf- 
fering are  absent.  The  anesthetic 
effects  of  ether  and  chloroform  appear 
to  bear  a  close  relation  to  the  extent  to  which  the  breathing  is  sus- 
pended. A  complete  unconsciousness  to  pain  is  attended  with  an  ex^ 
trernely  feeble  and  sometimes  almost  imperceptible  respiration. 


ACTIOW   OF   THE    DIAPHRAGM. 


Absorption. — ^The  absorbent  system  proper  comprises  two  sets  of 
vessels   witl    their  glandular  enlargements  and  convolutions — the  lac- 


THE    INDIVIDUAL    FUNCTIONS. 


271 


(AuLs  and  the  lymphatics.  The  lacteals  convey  nutritive  or  new  matter 
into  the  mass  of  blood,  to  replenish  the  tissues ;  the  lymphatics  take 
up  and  return  to  the  blood  the  surplus  nutrient  materials,  and  also  old 
or  waste  particles,  in  order  that  they  mny  be  used  in  the  secretions,  or 
got  rid  of  at  the  excretory  outlets.  The  function  of  the  lacteals  is 
called  external  absorption,  or  the  absorption  of  composition  ;  that  of  the 
lympliatics  is  called  internal  ahsorption,  or  the  absorption  of  decomposi- 
tion. External  absorption  also  includes  the  absorption  which  takes 
place  from  the  surface  of  the  body  and  mucous  membrane  of  the  res- 
j)iratory  passages,  as  well  as  that  ^vrform.ed  by  the  proper  lacteal  ves- 
sels from  the  mucous  surface  of  ilie  alimentary  canal.  Internal  ab- 
sorption, sometimes  called  interstitial,  also  comprehends  that  which 
takes  place  from  the  component  tissues  of  the  organs,  and  the  interior 
of  short  sacs,  as  well  as  that  performed  in  the  capillary  vessels. 

The  veins  belonging  to  the  external  division  also  act  the  part  of  ab- 
sorbent vessels,  but  in  a  very  different  manner  from  the  lacteals  or 
lymphatics ;  these  vessels  exercise  a  selecting  and  transmuting  power 
over  the  elements  subjected  to  their  action ;  hence  the  chyle  and 
lymph  are  always  found  to  possess  nearly  the  same  general  properties. 
On  the  contrary,  the  veins  imbibe  and  carry  along  unaltered  all  fluids 
or  substances  possessing  the  proper  degree  of  tenuity  to  move  in  the 
current  of  circulation.  It  is  well  known  that  many  poisons,  alcohol, 
tobacco,  the  virus  of  venomous  reptiles,  etc.,  exert  a  much  more  del- 
eterious effect  when  injected  into  the  areolar  tissue  under  the  skin, 
than  when  taken  into  the  stomach.  In  the  former  case  they  pass 
directly,  unchanged,  into  the  circulation ;  in  the  latter  event  they  are 
modified,  and  more  or  less  decomposed  by  the  action  of  the  absorbent 
vessels  before  entering  the  general  system. 

Alimentary  absorption  is  effected  mostly 
in  the  small  intestines.  The  lacteals  com- 
mence by  villi  in  the  mucous  surface,  each 
tube  beginning  in  a  single  villus  by  a  closed 
extremity  ;  the  trunk  arising  from  each  villus 
is  formed  by  the  confluence  of  a  number  of 
smaller  branches,  which  anastomose  freely 
with  each  other  in  the  form  of  loops,  as  in 
fig.  135,  never  commencing  in  open  exti"emi- 
ties. 

These  loops  are  embedded  in  a  mass  of 
cells  at  the  extremity  of  each  villus ;  these 


Fig.  135. 


LACTEAL   ORIGIN-. 


cells  exercise  the  selecting  or -transmuting 

power  over  the  nutritive  elements     when  full  their  contents  are  yielded 


272 


PHYSIOLOGi. 


to  the  absorbent  vessels,  cither  by  a  process  of  deliquescence  or  burst- 
ing, their  j)liice  being  sujjplied  by  fresh  cells,  and  so  the  process  is  con- 
tinued till  the  nutritive  material  is  exhausted;  after  which  the  villi, 
previously  turgid,  becomes  flaccid,  and  the  epithelium,  which  was  re- 
moved during  the  process  of  absorption,  is  renewed ;  the  lacteal  vessels 
then  become  the  interstitial  absorbent  vessels  of  the  intestinal  canal 
and  act  the  part  of  lymphatics. 


Fig.  136. 


Fig.  I''' 


CHYLinCATION. 


LTMPHATIC    ABSORPTION. 


Fig.  136  is  a  diagram  of  the  mucous  membrane  during  digestion  and  the  preparation 
of  chyle,  a.  A  villus,  turgid  and  erect ;  its  protective  epithelium  cast  olf  from  its  free 
extremity ;  its  absorbent  vessels,  lacteals,  and  blood-vessels  turgid,  b.  A  follicle  dis- 
charging its  epithelial  cells. 

Fig.  137  is  a  representation  of  the  same  mucous  membrane  when  chylification  is  not 
going  on.  a.  Protective  epithelium  of  a  villus,  b.  Secreting  epithelium  of  a  folliclo. 
c,  c,  c.  Primary  membrane,  with  its  germinal  spots,  or  nuclei,  d,  d.  e.  Germs  of  absorb- 
ent vesicles.    /.  Vessels  and  lacteals  of  villus. 


The  chyle  in  the  lacteals  is  almost  invariably  of  the  same  chemiccU 
composition,  however  diversified  the  character  of  the  food  from  which 
rt  hs  formed.  It  is  not,  however,  n\w  ays  of  the  same  vital  quality ;  for 
tlmt  which  is  made  of  animal  food,  when  taken  from  the  body,  under- 
goes putrefiiction  much  sooner — in  three  or  four  days — while  that  which 
is  selected  from  vegetable  food  resists  decomposition  out  of  the  living 
organs  for  several  weeks.  Its  milky  color  depends  on  the  presence  of 
minute  corpuscles,  called  chyle  globules.  Usually  it  contains  fatty, 
albuminous,  fibrinous,  and  saline  matters,  in  varying  quantities,  accord- 
ing to  the  ingesta. 

The  lyinphaiics  exhibit  no  essential  anatomical  difference  in  origin, 
structure,  or  arrangement  from  the   lacteals.     They  are  disti'ibuted 


THE    INDIVIDUA.L    FUNCTIONS.  ^a 

throughout  ahnost  every  part  of  the  body,  aud  very  humerouslj  upon 
the  skin. 

The  lymph,  an  ahnost  colorless  fluid,  which  tne  lymphatics  convey 
to  the  thoracic  duct,  very  closely  resembles  the  chyle,  the  main  differ- 
ence consisting  in  the  color  of  the  latter.  Its  source  is  a  matter  of 
conjecture.  Dr.  Carpenter  supposes  the  matters  absorbed  by  the 
lymphatics  to  consist  of  the  residual  fluid,  w^hich,  having  escaped  from 
the  blood-vessels  into  the  tissues  for  their  nutrition,  is  now  returned  to 
the  former.  Probably  they  also  contain  a  portion  of  the  decayed  and 
worn-cut  particles  of  the  structures.  The  lymph,  like  the  chyle,  con- 
tains peculiar  self-coagulating  corpuscles,  and  both  fluids  contain  the 
same  ingredients,  though  in  different  proportions,  for  the  organic  ele- 
ments are  niuch  more  abundant  in  the  chyle. 

The  glandular  laboratoi-ies,  through  which  the  lacteals  pass,  are  the 
ganglia  of  tlie  mesentery ;  and  those  of  the  lymph-vessels  are  th© 
lymphatic  glands.  In  these  ganglia  both  fluids  are  doubtless  still  fur- 
ther changed,  elaborated,  and  fitted  for  circulation,  nutrition,  or  expul- 
sion. That  these  ganglia  exercise  a  supervisory  function  over  the 
economy  of  nutrition,  acting  as  sentinels  to  prevent  the  introduction  of 
an  enemy  into  the  vital  domain,  is  evinced  by  the  fact  that  when  any 
foreign,  injurious,  or  poisonous  element  gains  admission  into  the  ab- 
sorbent vessels,  whose  presence  in  the  genei'al  circulation  would  be 
rmmediately  dangerous  to  life,  these  glands,  in  the  language  of  some 
physiologists,  "take  on  inflammation"  to  arrest  its  progi'ess.  In  less 
ambiguous  phrase,  the  glandular  follicles  contract  their  diameters,  ob- 
struct the  passage,  attract  an  additional  supply  of  blood,  and  thus  hold 
the  aggressor  in  check  until  the  reinforcement  of  vital  power  can  so 
change,  modify,  or  destroy  the  invading  foe,  that  its  elements  may 
pass  along  with  impunity  or  with  greatly  diminished  danger  to  the 
organism. 

The  extremities  of  the  veins  are  tl:e  principal  absorbents  for  taking  up 
the  really  effete  and  decomposed  m.ntters  of  the  decaying  tissues,  as 
well  as  the  accidental  impurities  of  the  body ;  although  the  lymphatics 
sometimes  take  up  excrementitious  matters,  as  bile,  pus,  venereal  and 
other  virus  brought  in  contact  with  them. 

Absorption  from  the  skin  has  been  called  accidental,  because  the  fluids 
pass  in  by  simple  imbibition.  The  rapidity  of  this  absorption  is  mainly 
influenced  by  the  condition  of  the  blood-vessels,  being  most  active  when 
they  are  most  empty,  and  least  so  when  they  are  full.  When  the 
epidermis  is  removed,  as  by  a  blister,  the  external  integument  absorbs 
with  great  rapidity.  Frequent  bathing,  followed  by  friction,  increaaoa 
it"!  iib-orbing  powers. 


274  P  ]i  Y  S 1 0  L  0  a  Y 


Absorption  hy  imbibition  is  effected  by  both  veins  and  lymphatics- 
In  the  mucous  membrane  of  the  lungs  and  stomach,  the  thin  fluids  ai"e 
taken  up  by  the  veins,  and  it  may  be  stated  as  a  general  law  of  the  ab- 
sorbent system,  that  wherever  a  thin  fluid  is  placed  in  contact  with  an 
extended  surface,  it  will  be  taken  up  by  those  vessels  which  present 
the  largest  surface  and  the  thinnest  walls.  It  is  difficult,  however,  to 
explain  the  absorption  of  fluids  fi'om  serous  cavities  on  the  principle  of 
imbibition  alone. 

Probably  the  most  clear  and  correct  general  view  of  the  function  of 
absorption  may  be  p^-psented  in  the  following  summary :  The  venous 
exti'emities,  acting  as  absorbent  vessels,  take  up  the  greater  portion  of 
useless,  injurious,  or  worn-out  matters ;  the  lymphatic  vessels  return 
the  unused  or  surplus  recrementitious  matters,  and  also  serve  as  auxil- 
iary vessels,  or  special  provisions  to  guard  against  obsti'uctions  when 
the  functions  of  the  veins  are  overtasked  or  imperfectly  peiibrmed. 
The  elements  of  the  blood  in  the  capillaiy  system  ai'e  exhaled  tlu'ough 
the  coats  of  the  vessels,  and  there  undergo  certain  chemico-vita' 
changes.  Such  elements  as  are  needed  to  repair  the  waste,  aod  buik 
up  the  stinictures  of  the  body,  are  assimilated  and  be'come  a  component 
part  of  the  body ;  other  elements  are  separated,  and  so  re-combined  as 
to  form  the  secretions,  and  waste  paiticles  are  caiTied  back  into  tlie  cir- 
culation to  be  changed  or  thrown  off^. 

If  the  processes  of  alimentation  and  exlialation  overdo  those  of  ab- 
sorption and  depuration,  accumulation  takes  place  in  the  cellular"  mem- 
brane or  serous  cavities,  of  adipose  or  watery  matter,  and  obstruction 
exists  in  the  form  of  corpulency  or  dropsy.  Hence  obesity  is  as  truly 
an  abnormal  or  diseased  state  as  dropsy. 

Nutrition.—  Nutrition,  more  properly  termed  assimilation,  is  the 
actual  accretion  of  the  alimentary  matter  to  the  organism — the  comple- 
tion of  the  class  of  nutritive  functions.  The  food,  masticated  and  insal- 
ivated in  the  mouth,  acted  upon  by  the  gastric  juice  in  the  stomach, 
and  the  pancreatic  juice  in  the  duodenum,  still  further  elaborated  in  its 
passage  through  the  lacteals  and  mesenteric  glands,  and  finally  oxygen- 
ated in  the  lungs,  is  not  yet  fitted  for  nuti'itiou.  The  nutrient  process 
is  not  accomplislied  until  the  alimentary  matter  is  subjected  to  the 
finishing  action  of  the  capillary  vessels.  It  is  here  converted  into  tlie 
congenial  elements  of  the  several  structures,  becoming  a  component 
part  of  their  substance. 

Though  the  arterial  blood  supplies  the  nutrient  material  to  every 
part  and  s-ructure  of  the  body,  yet  this  blood  does  not  contain  all  the 
proximate  elements  of  the  body  as  suh.     For  example,  gelatin,  whick 


THE    INDIVIDUAL    FUNCTIONS.  276 


enters  so  largely  into  the  composition  of  the  animal  structures,  is  never 
found  in  the  blood  in  the  state  of  gelatin.  This  shows  again  the  power 
of  the  living  organism  not  only  to  decompose  and  recompose  the  ele- 
ments of  sustenance,  but  even  to  ti'ansmute  one  substance,  whici> 
chemistry  regards  as  a  simple  element  mto  another. 

The  processes  by  which  the  various  changes  of  matter  take  place  in 
the  capillary  system  have  been  the  subject  of  much  chemical  research 
and  speculation  in  modern  times.  But  here,  as  in  all  cases  where  the 
operations  of  a  living  principle  are  approached,  chemistry  is  and  must 
of  necessity  be  at  fault.  Chemistry  may  reduce  and  refine,  divide  and 
subdivide  all  the  forms  of  organic  matt  ">i-  to  their  ultimate  elements,  or 
(o  a  certa'n  set  of  ultimate  results  oi  substances,  by  a  process  of  de- 
structive nalysis.  It  may  readily  destroy  the  evidence  of  the  life  prin- 
ciple, but  the  chemist's  skill  can  never  recombine  the  elements  so  as 
to  restore  or  reproduce  the  manifestation  of  vitality.  All  attempts, 
therefore,  to  explain  the  phenomena  of  life  by  the  demonstration  of 
chemical  problems,  are  to  be  regarded  only  in  the  sense  of  analogies. 
Experiments  have  shown  that  saline  ingi-edients,  dissolved  in  water 
may  be  decomposed  by  an  electric  sti'eam.  If  a  solution  of  salts  be 
placed  in  a  glass  tube  having  a  membranous  covering  at  its  extremities, 
an  electric  current  will  not  only  separate  their  constituent  elements,  but 
deposit  some  of  them  on  the  outside  of  the  membrane.  Reasoning 
analogically,  we  may  suppose  that  the  organic  nerves  transmit  the 
electric  principle,  which,  like  the  continuous  operation  of  a  galvanic 
battery,  separates  the  materials  of  the  blood  into  their  simplest  form-s, 
enabling  the  play  of  organic  affinities  to  attach  each  particle  of  matter 
to  a  congenial  particle,  and  thus  replenish  or  augment  the  structures. 
Each  atom  of  matter  is  evidently  j^olarized,  that  is,  possessed  of  points 
or  properties  of  attraction  and  repulsion  toward  all  surrounding 
atoms,  which  enable  it  to  assume  determinate  relations  of  aggregation 
or  separation  toward  all  other  atoms  of  the  same  or  of  different 
matter. 

To  this  view,  that  the  organic  nerves  are  necessary  to  the  nutritive 
process,  it  may  be  objected  that  nutrition  is  just  as  perfect  in  vegetables, 
which  have  nothing  analogous  to  a  nervous  system.  But  animal  ni>- 
trition,  unlike  vegetable,  requires  sensation,  locomotion,  and  mind  to 
appreciate,  move  after,  and  judge  of  the  materials  of  nutrition ;  and 
the  office  of  a  distinct  nutritive  nervous  structure  is  to  associate  the 
operations  of  mind  and  the  special  senses  with  the  voluntary  muscles, 
fls  well  as  to  energize  the  involuntary  muscles,  in  the  performance  o 
this  function.  WeiH3  animals,  like  vegetables,  "fixed  to  one  peculiar 
spot,"  and  thf  :r  snly  fuv.ctional  economj'  -'to  draw  nutrition,  propagate, 


276  PHYSIOLOGY. 


and  rot,"  there  would  be  no  necessity  for  either  a  motory,  or  sensory, 
or  mental  nervous  system. 

Mere  increase  of  bulk  is  not  nutrition.  Morbid  depositions  of  matter 
which  is  not  assimilated  may  take  place,  as  in  tubercles,  wens,  encysted 
dropsy,  etc.,  and  the  emhonpoinl  of  persons  who  are  called  "high 
livers,"  though  indicative  of  excessive  alimentation,  denotes  defective 
rather  than  excessive  nutrition  When  the  whole  body  is  loaded  with 
fktty  accumulations,  assimilation  is  never  as  perfect,  nor  the  structures 
as  firm,  round,  nnd  elastic,  nor  the  body  as  powerful  and  enduring,  nor 
as  capable  of  sustaining  depletion  and  j)rolonged  fasting,  as  in  a  moder- 
ately lean  condition  of  the  system. 

In  those  abnoj-mal  growths  called  hypertrophy^  there  is  an  actual  in- 
crease of  substance  identical  with  the  hyperti'ophed  tissue  or  organ ; 
while  in  the  opposite  state,  atrophy,  there  is  an  absolute  deficiency  of 
assimilated  matter.  In  the  former  case  the  nourishment  of  the  stnic- 
ture  is  gi-eater  than  the  waste  ;  in  the  latter  the  waste  is  gi-eater  than 
the  replacement. 

Cancerous  and  fungous  growths  proceed  by  a  similar  process  of  ceU- 
development  to  that  of  the  original  structures,  but  fijom  some  disturbing 
cause,  the  nuti'ient  particles  are  arranged  according  to  a  new  and  ab- 
normal scale  of  chemical  affinities. 

Many  speculations  have  been  indulged  respecting  the  time  in  which 
the  whole  body  is  renewed,  the  extremes  of  the  calculations  having 
generally  been  four  and  seven  years.  The  period  must  vary  greatly, 
according  to  habits  of  life,  amount  of  exertion,  kind  of  food,  etc. 
Probably  many  bodies  are  renewed  in  a  much  less  time  than  four 
years. 

The  coagulation  of  blood  out  of  the  body  affords  a  good  illusti'ation 
of  the  law  by  which  the  primary  atoms  are  arranged  in  the  building 
up  of  the  tissues,  as  represented  in  the  ^ut. 

In  Fig.  133,  A  represents  the  blood- 

corpuscles  as  seen  on  their  flat  sur- 

°'  face  and  edge.    B.  Congeries  of  blood- 

j^    ^1  corpuscles  in  columns.     In  coagulat- 


(jr)W_J  >J5\B  ^^'  ^^^  corpuscles  apply  themselves 

_ ./^  //  /^^^^BWl  ^°  each  other,  so  as  to  resemble  piles 


If 


of  money. 


Though  the  blood  is  the  im- 
mediate source  of  all  nutrition, 
many  stractures,  as   the   ten- 

compuacuLEs  of  the  BLoor  ^^^  a^^  ligaments,  do  not  re- 

ceive red  blood.     The  coloring 


THE    INDIVIDUAL    FUNCTIONS.  277 


matter  which  surrounds  the  corpuscles,  therefore,  is  not  essential  to 
the  nuti-itive  quality  of  blood.  Many  fishes,  reptiles,  and  insects  have 
no  red  blood.  Dr.  Carpenter  has  made  the  following  convenient  table, 
showing  the  distribution  of  the  constituents  of  haman  blood  in  living 
and  in  dead  bodies. 


Living  Blood. 


Dead  Blood. 


Fibrin,  ■\ 

Albumen,     v  Ii  solution,  forming  Liquoi  Sanguinis. 

Salts,  S 

Corpuscles, — Suspended  in  Liquor  Sanguima. 

Fibrin,  ? 

Corpuscles,  \  Crassamentum,  or  clot. 

Albumen,      >  t        i  ^-        /• 

^  ,  >  In  solution,  torramg  serum. 

Salts,  S 


Secretion. — Secretion  literally  means  sej^^araiiow ;  but  the  process 
by  which  a  new  substance  is  produced  by  a  re-arrangement  of  the 
elementary  matters  contained  in  the  blood  is  one  oi  formation.  Seci-e- 
tion,  therefore,  is  not  the  separation  but  the  production  of  a  proximate 
element  from  the  blood.  Each  organ  or  sti'ucture  secretes  or  forms 
its  own  peculiar  fluid,  serving  some  special  purpose  in  the  animal 
economy.  The  mucus  and  serous  fluids  poured  out  on  the  surfocea 
of  mucous  and  serous  membranes,  are  regarded  as  exhalations,  mere 
exudations  by  the  process  of  exosmose,  rather  than  secretions. 

All  the  cavities  of  the  body  which  open  externally,  as  those  of  the 
nose,  mouth,  alimentary  canal,  trachea,  bladder,  and  uterus,  are  lined 
with  a  mucous  membrane,  which  secretes  or  exhalo-s  a  bland,  slimy 
fluid,  called  mucus.  This  mucus  serves  to  moisten  and  lubricate  their 
surfaces,  facilitate  the  passage  of  crude  matters,  and  protect  them 
p  jainst  the.  action  of  acrid  and  instating  agents. 

All  the  internal  surfaces  of  cavities  not  opening  externally,  as  those 
of  the  abdomen,  chest,  heart,  brain,  and  joints,  are  lined  with  a  serous 
membrane,  fi-om  which  secretes  or  exhales  a  thin  watery  fluid,  called 
serum,  whose  office  is  to  facilitate  the  motions  of  their  surfaces. 

Some  of  the  secretions  are  wholly  recrementitious,  being  for  the  use 
of  the  animal  economy,  as  the  saliva,  chyle,  gastric  juice,  and  synovia; 
others  are  wholly  exc  ementitious,  being  mere  waste  material,  as  sweat, 
urine,  bile,  and  foeces.  Some  of  the  excrementitious  secretions  are 
made  subservient  to  organic  purposes,  as  the  bile  and  ear-wax ;  and 
Bome  of  the  organs  secrete  a  nutrient  and  expel  an  effete  material  at 
Ihe  same  time,  as  the  'iings  and  skin. 


278 


PHYSIOLOGY. 


Fig.  139. 


GLAINDULAR 
SECRETION. 


There  are  tln-ee  forms  of  secreting  organs.  The 
simplest  form  is  that  of  the  animal  membrane,  which 
is  abundantly  supplied  wjth  blood-vessels,  and  cov- 
ered with  an  epithelium,  as  the  serous  and  synovial 
membranes ;  the  next  form  is  the  inversion  or  de- 
pression of  the  membrane,  constituting  the  follicle ; 
and  the  last  is  the  gland,  an  aggregation  of  fol 
licles. 

Fig.  139  represents  the  follicles,  multiplied  and  clustered  to- 
gether upon  efierent  ducts  common  to  several  of  them,  the  duct 
converging  to  form  the  main  excretory  duct,  the  whole  constitut- 
ing a  secreting  gland. 


The  important  agents  in  secretion,  as  well  as  in  nutrition,  are  cells, 
which  are  developed  upon  the  lining  membrane  of  the  follicles  and 
tubes,  and  which  elaborate  the  matter  of  secretion  from  the  blood,  and 
pour  it  into  the  excretorj''  duct.  The  cells,  as  in  the  case  of  uuti'ition, 
are  constantly  being  cast  off  and  reproduced. 

The  follicular  secretions  are  divided  into  the  mucous  and  cutaneous. 
Of  the  former  character  are  the  ordinary  follicles  of  mucous  mem- 
branes, and  the  numerous  glandulae  of  the  intestinal  canal ;  the  simple 
and  the  compound  gastric  follicles  of  the  stomach,  which  secrete  the 
gastric  juice ;  the  glands  of  Brunner  in  the  duodenum;  the  glands  of 
Peyer  in  the  jejunum  and  ilium,  which  are  supposed  to  secrete  the 
puti-escent  elements  of  the  fceces ;  the  follicles  of  LieberJciihn,  distrib- 
uted through  the  whole  intestines,  but  especially  numerous  in  the  small 
intestines,  and  which  secrete  a  thick,  tenacious  mucus ;  the  large  fol- 
licles in  the  cacum  and  rectum,  producing  slight  elevations  on  their 
surfaces;  the  glands  of  Duvergny  and  Nabothi,  in  the  vagina  and 
cervix  of  the  utei-us  in  the  female  ;  and  the  glands  of  Ccnvper  and  the 
prostate,  in  the  male,  The  tonsils  also  are  considered  as  a  collection 
of  lubricating  mucous  folliclea- 

The  cutaneous  division  includes  the  meibomian  follicles,  which  are 
seated  in  the  tarsal  cartilages,  and  secretes  the  gummy  fluid  that  lubri- 
cates the  edges  of  the  eyelids ;  the  ccruniinous,  which  secretes  the 
thick  resinous  substance  called  ear-wax ;  the  sebaceous,  which  pour 
out  an  adipose  matter  upon  the  skin ;  and  the  sudoriferous,  which  se- 
crete the  propor  2>crs]nr able  matter. 

The  sweat  glands  have  been  estimated  by  Mr.  E.  Wilson  at  about 
siven  millions.  As  theii'  secretion  is  usually  evaporated  as  fast  as 
fbrmed,  most  of  the  perspirable  matter  passes  off  in  the  form  of  in- 
sensible persj)iration.     Perspimtion  is  scnsiblt   \u\y  when  excessive,  or 


THE    INDIVIDUAL    FUNCTIONS.  279 

when  it  accumulates  upon  the  skin  by  a  moist  state  of  the  atmosphere. 
In  the  armpit  is  a  peculiar  description  of  glandules,  called  odoiiferous 
or  miliary^  which  secrete  an  odor-ous  matter  characteristic  of  that  part 
of  the  body.  This  odorous  principle  is  said  to  differ  in  animals  suf- 
ficiently to  afford  a  test  by  which  their  blood  can  be  distinguished.  A 
few  months  ago  I  had  a  patient  under  .treatment  in  whom  the  odor 
from  the  axiUary  glands  was  so  strong  and  fetid  as  to  make  his  presence 
disagreeable,  especially  in  a  warm  room.  It  has  been  alleged  that  the 
blood  of  the  female  can  be  distinguished  from  that  of  the  male  by  the 
peculiar  odor  from  this  source ;  an  opinion  which  I  am  inclined  to 
think  1ms  more  fancy  than  fact  about  it. 

The  glandular  secretions  are  the  lachrymal,  or  tears,  fi-om  the  lach- 
rymal gland,  which  lubricates  and  cleanses  the  conjunctiva;  the  sali- 
vary, formed  by  the  jJci/'otid,  submaxillary,  sublingual,  and  jjancrealic 
glands ;  the  bile,  found  in  the  liver ;  the  urine,  found  in  the  kidneys ; 
the  spermatic  secretion  of  the  testes,  and  the  inammary  secretion  of  the 
breasts.  The  milk  is  more  affected  by  the  food  and  drink  of  the 
mother  than  any  other  secretion,  and  also  by  strong  passions  or  emo- 
tions of  the  mind.  Instances  have  been  known  in  which  a  single  violent 
fit  of  passion,  or  other  paroxysm  of  excitement,  has  so  changed  the 
quality  of  the  milk  as  to  destroy  the  life  of  the  nursing  child  in  an  hour. 

The  spleen,  svpra-renal  capsules,  thymus  and  thyroid  glands,  have 
been  called  vascular  glands,  or  glandiform  ganglia,  although  they 
form  or  secrete  no  peculiar  fluid,  and  have  no  excretory  duct.  Phys- 
iologists generally  regard  them  as  reservoirs  for  an  excess  of  blood  in 
neighboring  organs,  the  spleen  being  the  diverticulum  for  the  stomach 
and  liver,  or  the  portal  circulation ;  the  thymus  to  the  lungs  in  fcetai 
life,  the  thyroid  to  the  brain,  and  the  supra-renal  capsules  to  the 
kidneys. 

The  Excretory  Organs. — Those  organs  which  perform  the  ex- 
cretory part  of  the  secretory  function  are  the  lungs,  skin,  liver,  bowels, 
and  kidneys.  All  the  excretory  organs  are  capable  of  vicarious  func- 
tion, doing  the  work  of  each  other  to  a  gi*eat  extent,  though  the  lungs 
and  liver,  skin  and  kidneys,  most  intimately  reciprocate  in  fiinctionai 
duty.  The  lungs  and  liver  are  the  special  de]rarating  organs  for  the 
surplus  carbon  and  hydrogen ;  the  skin  and  kidneys  foi-  the  niti-ogenous 
products  of  decomposition ;  and  the  bowels  throw  off  the  more  complex 
proximate  elements  of  waste  matters  and  foecal  secretions. 

The  depurating  as  well  as  nuti'ient  function  of  the  lungs  has  already 
been  considered. 

The  skin  is  not  only  a  cleansing  organ,  but,  like  the  lungs,  a  brenthing 


280  PHYSIOLOGY. 

organ ;  for  it  really  absorbs  oxygen,  and  throws  off  cai-bonic  acid  gas. 
Next  to  the  lungs  the  skin  is  the  most  extensive  as  well  as  important 
detergent  sh-ncture  of  the  body.  The  amount  of  solid  matter  eliminated 
from  the  body  through  this  cmunctory  is,  on  the  average,  about  100 
grains  per  day.  The  amount  of  fluid  thrown  off  is  more  vai'iable,  de- 
pending on  external  temperature,  quantity  of  drink,  activity  of  the 
kidneys,  etc.  The  estimates  of  the  ti-anspiration  from  the  cutaneous 
and  pulmonary  surface  in  twenty-four  hours  are  from  1|  lb.  to  5  lbs., 
nearly  three  fourtlis  of  this  amount  passing  fi-om  the  skin. 

The  lirer  secretes  the  matter  of  bile  from  the  venous  blood.  The 
object  of  the  biliary  secretion  evidently  is  to  eliminate  certain  impurities 
from  the  body  in  the  form  of  compounds  of  carbon,  hydrogen,  and  ni- 
trogen, and  also  to  deterge  the  blood  of  a  portion  of  any  excess  of  alkali 
that  may  be  absorbed  by  the  venous  exti*emities. 

Liebig  has  fabricated  a  singularly  inconsistent  hypothesis,  which  has 
satisfied  himself  and  all  others  who  are  satisfie^^.  to  echo  his  arguments 
without  taking  the  trouble  to  examine  th  ^m,  that  the  bile  is  a  nuti'itive 
product,  and  that,  consequently,  whatever  will  tend  to  the  formation 
of  bile,  or  any  of  the  proximate  elements  usually  found  in  bile,  is  a 
useful  and  nuti'itive  substance.  Liebig  reasons  in  this  wise.  The  bile 
is  composed  of  several  certain  proximate  elements.  One  of  these  is 
called  taurine.  This  taurine  is  the  only  compound  or  proximate  ele- 
ment found  in  the  bile  which  contains  nitrogen.  Now  theine  and 
caffeine,  the  active  principles  of  tea  and  coffee,  are  found,  on  chemical 
analysis,  also  to  contain  a  very  small  quantity  of  nitrogen ;  ergo,  tea 
and  coffee,  though  injurious  stimulants  to  the  nerves,  may  be  useful  to 
the  liver  by  furnishing  the  niti-ogenous  element  of  the  taurine  of  the 
bile !  Such  reasoning  is  exti'emely  absurd,  and  the  error  is  a  most 
palpable  one.  It  consists  in  mistaking  a  waste  material  for  an  aliment ; 
a  depurating  process  for  a  nuti'itive  one.  As  well  might  one  mistake 
putrid  flesh  for  wholesome  food,  because  it  contains  cai'buretted  hydro- 
gen, which  is  also  found  in  the  foeces,  or  excrementitious  matters  of 
the  bowels. 

The  kidneys  eliminate  from  the  system  a  large  proportion  of  effete 
saline,  alkaline,  and  earthy  pai'ticles,  and  ihc  gi*eatest  portion  of  the 
surplus  niti'Ogen.  The  average  amount  of  urine  excreted  in  twenty- 
four  hours  has  been  estimated  at  from  thirty  to  forty  ounces.  CY  course 
it  depends  gi'eatly  on  the  activity  of  the  skin,  amount  of  fluid  taken  into 
the  stomach,  moist  or  dry,  hot  or  cold  state  of  the  atmosphere,  etc. 
The  amount  of  solid  organic  matter  expelled  daily  by  this  emunctory 
has  a  close  relation  to  the  activity  and  corresponding  waste  of  the  mus- 
cular tissue,  and  this  is  determined  wi-h  considei-able  accuracy  by  th» 


THE    INDIVIDUAL    FUNCTIONS.  281 

amount  of  urea  in  the  urine  ;  a  test,  however,  of  no  jtractical  vahie  in 
treating  diseases. 

The  "brick  dust"  sediment,  "chall<y  deposits,"  and  "albuminous" 
appearance  of  urine,  are  dependent  to  a  very  great  extent  on  the  chai'- 
acter  and  purity  of  the  food  and  drink.  The  long-continued  employ- 
ment of  what  ai*e  very  absurdly  called  "medicated  waters,"  containing 
carbonates  of  lime,  soda,  iron,  and  magnesia,  chloride  of  soda,  sulphates 
of  lime  and  magnesia,  muriate  of  lime,  sulphur,  sulphuretted  hydrogen, 
iodine,  hydriodates  of  soda  and  potash,  etc.,  as  well  as  ail  very  hard 
fmd  impure  water,  is  a  common  cause  of  gi'avel,  stone,  calculous  con- 
cretions, etc.,  and  a  prolific  source  of  diseases  of  the  kidneys  and 
bladder. 

The  total  suspension  of  the  urinary  secretion  is  attended  wilh  rapidly 
fatal  results,  the  patient  manifesting  symptoms  like  those  produced  by 
narcotic  poisons. 

The  boivels  are  the  emunctories  for  such  innutiitious  portions  of  the 
food  as  do  not  pass  into  the  chxulation,  and  are  not  taken  up  by  the 
lymphatics  or  venous  extremities,  and  can-ied  to  other  depurating 
organs ;  and  also  such  waste  and  worn  out  particles  as  are  secreted  ia 
the  form  of  faeces.  The  quantity  and  character  of  the  dejections  de- 
pend much  on  the  nature  of  the  ingesta.  As  the  contents  of  the  ali- 
mentary canal  pass  along,  their  fluid  portion  is  gradually  withdrawn, 
and  they  acquire  a  firmer  consistence;  they  also  become  more  foecal  in 
character  as  the  putrescent  elements  of  the  blood  are  secreted  by  tho 
various  glandules  along  the  intestinal  ti'act. 

Calorification. — Many  speculations  have  been  indulged  by  chem- 
ists and  physiologists,  in  relation  to  the  production  of  animal  heat. 
Since  the  publication  of  Liebig's  elaborate  work  on  Organic  Chemistry, 
the  notion  has  become  generally  prevalent  among  the  scientific  circles, 
and  from  them  it  has  been  promulgated  among  the  non-scientific 
people,  that  the  production  of  animal  heat  is  a  mere  chemical  process, 
the  lungs'  serving  as  a  stove  or  fire-place,  and  the  carbonaceous  sub- 
stances of  the  food  serving  as  fuel  "  to  be  burned  in  the  lungs."  Accord- 
ing to  this  theory,  fattj^  substances,  animal  oils,  and  other  matters  co-n- 
taining  a  large  proportion  of  carbon,  are  not  only  useful  but  absolutely 
necessary  to  keep  up  the  recpisite  degree  of  animal  temperature. 
The  position  seems  to  me  as  almost  self-evidently  absurd,  and  it  has 
certainly  led  many  persons  into  the  most  egregioi  s  blunders  practically, 
and  at  the  expense,  too,  of  their  own  common  sense  and  common  ob- 
servation. 

All  the  organic  ftmctions  of  th  j  body — l.i'^  vital  processes— are  in 


282  PHYSIC  LOGY. 


one  sense  chemicjal.  They  are  not,  however,  such  chemical  decom- 
positions and  re-combinations  as  are  performed  in  a  chemical  laboratory 
They  are  not  such  as  the  chemist  can  ever  demousti-ate  or  imitate. 
They  not  only  change  the  relative  proportion  of  elementary  mattei-s 
but  jibsolutely  transmute  elements  into  each  other,  reduce  several  of 
what  we  call  elements  to  one,  and  separate  one  into  several.  All  the 
chemico-vital  processes — resph-ation,  digestion,  circulation,  secretion 
etc. — are  attended  with  the  eliminatio"  of  heat;  in  other  words,  latent 
caloric  becomes  sensible  by  these  changes  of  matter.  But  all  the 
organs,  by  vhtue  of  their  own  specially  presiding  centres  of  nervoute 
influence,  ai-e,  to  some  extent,  self-regulating  in  their  temperature, 
while  the  entire  body  possesses  a  general  self-regulating  power.  The 
principal  organ  whose  function  serves  as  a  universal  regulator  and 
equalizer  of  animal  temperature,  is  the  skin.  A\Tien  in  vigorous  and 
healthy  condition  it  throws  oft"  the  surplus  heat,  or  retains  the  deficient, 
according  to  the  necessities  of  the  organism.  There  is  no  need  of  a 
fire  and  boilere  to  warm  up  the  blood,  as  the  water  is  heated  by  the 
machinery  of  a  steam-engine,  and  for  this  simple  reason  I  think  nature 
has  not  provided  them. 

The  error  lies  here.  Liebig  and  his  followers  have  mistaken  an 
excremeutitious  or  cleansing  process  for  a  nutiitive  or  supplying  one. 
They  have  misconceived  the  function  by  which  the  body  rids  itself  of 
waste  matters,  and  called  it  a  useful  and  indispensable  condition  of 
vitality.  They  have  supposed  the  chemical  process  by  which  nature 
throws  oft'  the  eftete  carbon  tluough  the  lungs  to  be  a  method  of  fur- 
nishing animal  heat.     This,  I  think,  can  easily  be  made  manifest. 

According  to  the  theory  of  animal  heat  I  am  controverting,  fat,  suet^ 
tallow,  lard,  maiTow,  grease,  butter,  blubber,  and  fixed  oils,  should  con- 
stitute healthful  food ;  and  such  is,  indeed,  the  conclusion  of  Liebig's 
followers.  But  ihe  common  experience  of  all  mankind  is  against  it. 
Common  observation  says  that  these  aiticles,  though  to  some  extent 
sufterable,  ai"e  not  strictly  wholesome ;  and  further,  medical  men  gen- 
erally disallow  these  articles  to  their  patients  when  they  ai'e  very  much 
reduced  with  disease,  at  the  same  that  the  animal  temperature  is  very 
low,  and  requires  such  food,  if  ever.  Again,  corpulent  persons,  who 
are  surchai-ged  with  carbon,  do  not  beai'  cold  better  than  lean  persons, 
who  have  little ;  in  fact  they  are,  other  cu'cumstances  being  equal, 
more  sensitive  to  it. 

But  if  fabs  and  oils  are  usefiil  as  fuel  for  the  pulmonary  w.u'ming- 
pan,  because  of  their  larger  proportion  of  carbon,  alcohol  would  be 
useful  in  the  same  way,  on  exactly  the  same  principle.  Accordingly, 
etiango  as  it  may  seem,  we  find  Pereira,  in  his  able  chemical  work  on 


THE    INDIVIDUAL    FUNCTIONS.  283 

Food  and  Diet,  adopting  alcohol  as  an  alimentary  principle !  Alcohol 
an  aliment,  a  food,  a  nuti'itive  material!  Can  any  thing  be  more 
ridiculous  ? 

Now  alcohol  contains  more  carbon  than  most  kinds  of  animal  or  veg- 
etable food,  except  animal  oils  or  fats ;  and,  in  the  chemical  theory  we 
are  considering,  ought  to  be  just  as  useful  as  an  "element  of  respii-a- 
tion ;"  and  so  by  a  single  vagary  of  modern  science  we  are  thrown 
back  to  the  errors  of  four  thousand  years  ago.  Pereira  says  :  "Alco- 
hol, therefore,  is  n.  fuel  in  the  animal  economy,  and  by  its  oxidation  in 
the  lungs,  must  evolve  caloric,  and  serve  to  support  the  temperature 
of  the  body."  Now  let  us  hear  his  argument:  "Alcohol  is  an  element 
of  respiration.  Common  experience  favors  this  view.  Coachmen 
and  others  take  it  in  cold  weather  to  keep  them  wai'm,  and  it  is  fami- 
liarly used  to  prevent  what  is  commonly  called  '  catching  cold.'  In 
cases  of  extreme  suffering  and  exhaustion  from  excessive  exertion 
and  privation  of  food,  the  cautious  and  moderate  dietetical  use  of  spirit 
has,  on  many  occasions,  proved  invaluable.  In  Captain  Bligh's  account 
of  the  sufferings  of  himself  and  companions,  in  consequence  of  the 
mutiny  of  the  crew  of  the  Bounty  (in  the  South  Seas,  in  1787-9),  he 
observes :  '  The  little  rum  we  had  was  of  great  service ;  when  our 
nights  were  particularly  distressing,  I  generally  served  a  teaspoonful  or 
two  to  each  person,  and  it  was  joyful  tidings  when  they  heard  of  my 
intentions.' " 

Here  the  pernicious  effects  of  a  positive  poison  are  mistaken  for  the 
useful  results  of  natural  aliment !  As  long  ago  as  1787,  the  opinion 
was  generally  entertained  that  "a  little  rum"  was  a  sort  of  elixir  vitae, 
warming  the  bod}^  when  cold,  cooling  it  when  hot,  drying  it  when  wet, 
and  wetting  it  when  dry,  as  well  as  sustaining  it  when  famished,  and 
regulating  it  when  full.  More  enlightened  observation  has  discarded 
these  absurdities,  and  it  is  to  be  regretted  that  they  should  be  revived 
again  by  medical  philosophers. 

Though  Pereira  asserts  and  tries  to  prove  the  utility  of  alcohol  in 
the  animal  economy,  he  allows  it  is  injurious  at  the  same  time,  thus 
involving  his  theory  in  still  greater  confusion.  He  says :  "  Though 
alcohol  evolves  heat  in  burning  [in  the  lungs],  it  is  an  obnoxious  fuel." 
Does  not  this  admission  prove  that  the  heat  evolved  by  the  use  of 
alcohol  is  simply  the  result  of  the  effort  of  the  organism  to  get  rid  of  it? 
This  would  be  the  heat  of  fever  or  inflammation ;  a  heat  much  more 
calculated  to  wear  out  and  prematurely  exhaust  the  animal  economy 
than  to  support  it.  And  this  view,  I  venture  to  say,  is  confirmed  by 
all  human  experience. 

Moreover,  against  Pereira's  far-brought  testimony  in  favor  of  the 


I 


284  PHi'STOLOGY. 


dietetic  use  of  rum,  we  can  quote  any  amount  of  controverting  evidence. 
Liebig  himself  admits  that  "the  development  of  heat  in  the  bodj'',  after 
the  use  of  wine,  increases  without  the  manifestation  of  a  coiTespond- 
ing  amount  of  mechanical  force.  A  moderate  quantity  of  wine  in 
women  and  children  unaccustomed  to  its  use,  produces  a  diminution 
of  the  force  necessary  for  voluntary  motions.  Weariness,  feebleness 
in  the  li7nhs,  and  droicsiness,  plainly  show  that  the  force  available  for 
mechanical  purposes,  in  other  words,  the  change  of  matter,  has  been 
diminished."  Rev.  Mr.  Scoresby  testified  before  a  committee  of  the 
British  House  of  Commons,  in  1834  :  "  My  principal  experience  has 
been  in  severely  cold  climates,  and  there  it  is  observable  that  there  is  a 
very  pernicious  effect  in  the  reaction  after  the  use  of  ardent  spu'its. 
In  the  case  of  a  storm,  or  other  sudden  difficulty,  T  should  most  deci- 
dedly prefer  the  water- drinkers  to  those  who  w^ere  under  the  influence 
of  any  stimulant.''^  Sh-  John  Ross  testifies  that:  "Having  in  the 
Arctic  regions,  in  his  own  pei-son,  experienced  the  beneficial  effects 
of  abstaining  W'holly  from  spirituous  drinks,  he  proposed  to  his  men 
that  they  should  try  the  same  experiment,  which  was  done  with  the 
most  gratifying  results.  When  men  under  hard  and  steady  labor  are 
given  their  usual  allowance  of  gi'og,  they  become  languid  and  iaint, 
losing  then'  strength  in  reality,  while  they  attribute  that  to  the  contin- 
uance of  their  fatiguing  exertions.  He  who  will  make  the  correspond- 
ing experiments  on  two  equal  boat's  crews,  running  in  a  heavy  sea, 
w^ill  soon  be  convinced  that  tlie  water-drinkers  will  far  outdo  the 
others."  Dr.  Rush  says :  "  The  temporary  warmth  produced  by 
spiritous  liquors  is  always  succeeded  by  increased  chilliness,  rendering 
the  body  still  more  liable  to  be  affected  and  injured  by  cold."  These 
authorities  could  be  extended,  but  we  have  ah*eady  enough  for  our 
purpose.  All  the  facts  we  can  find  which  bear  at  all  on  this  subject,  go 
to  prove  most  indubitably  that  alcohol  is  in  every  sense  exactly  the 
opposite  of  an  "  element  of  respiration."  It  is  indeed  a  "  fuel  in  the 
animal  economy,"  in  the  same  sense  in  which  any  accidental  combusti- 
ble substance  creates  a  flame  which  burns  our  dwelling-house  to  the 
ground. 

The  whole  argument,  pro  and  con,  will  apply  equally  to  animal  fnta 
and  oils,  with  this  qualification.  Greasy  matters,  though  composed 
mostly  of  waste,  useless,  and  excrementitious  materials,  which  have 
accumulated  in  the  cellular  repository,  because  the  process  of  aliment- 
ation Wiis  increased  beyond  that  of  elimination,  are  not  strictly  poisonous. 
They  cont-ain  doubtless  a  very  small  quantity,  yet  very  impure  quality', 
of  substances  convertible  into  nutriment.  But,  as  food,  they  are  to  be 
regarded  as  next  to  venous  blooJ  in  grossness  and  impurity. 


THE    INDIVIDUAL    FUNCTIONS.  286 


They  contain  about  eighty  per  cent,  of  carbon ;  hence,  when  freely 
tiiken  into  the  system,  the  lungs,  as  the  principal  excretory  organ  for 
elfete  carbon,  has  an  additional  duty  to  perform  in  throwing  it  off. 
This  increased  Libor  is,  as  a  matter  of  course,  attended  with  an  in- 
creased temperature  of  the  body,  simply  because  there  is  a  gi'eater 
amount  of  matter  than  is  natural  or  necessary  to  be  disposed  of.  But  this, 
v^  in  the  case  of  alcoh£>l,  is  an  ox*:raneous,  useless,  exhausting  labor, 
which  wears  out  the  machinery  of  life  with  inordinate  rapidity.  If 
the  excessive  quantity  of  carbon  is  constantly  supplied  in  the  diet,  the 
organisrai  must  prematurely  wear  out,  or  break  down  with  disordered 
action.  If  fatty  matters  are  only  occasionally  eaten,  the  temporary  in- 
crease of  temperature  will  be  followed  by  depression  and  debility, 
precisely  as  with  alcohol,  though  much  less  in  degree.  The  lungs, 
however,  do  not  "burn  up" — oxidate — all  the  surplus  carbon  of  grease, 
oils,  gravies,  etc.,  for  we  see  in  most  persons  addicted  to  their  free  use, 
pimples,  blotches,  eruptions,  swellings,  boils,  and  cancero4is  ulcerations, 
with  evidences  of  bad  blood,  torpid  brains,  and  glandular  obstiiictions, 
clearly  traceable  to  this  habit,  and  curable  by  its  discontinuance.  I^he 
principal  injurious  effect,  therefore,  of  animal  oils  and  fVits  is  not  from 
their  large  quantity  of  carbon,  but  from  their  intrinsically  impure  char- 
acter. In  all  pure,  Healthful,  and  natui^  alimentary  substances,  the 
system  can  appropriate  what  carbon  it  requires,  and  dispose  of  the 
remainder  without  injury,  obstruction,  or  excitement,  be  the  quantity 
contained  in  the  alimentary  article  more  or  less.  All  the  grains,  escu- 
lent roots,  and  fruits,  as  well  as  the  flesh-meat  of  animals,  contain 
exactly  the  right  proportions  of  carbon  in  their  composition  for  perfect 
nutrition,  respiration,  and  animal  heat,  however  much  theu'  respective 
quantities  of  carbon  may  vary.  They  are  also  universally  allowed  to 
be  "  easily  digestible,"  and  innocuous  to  the  stomach  in  all  normal  con- 
ditions of  the  digestive  powers.     Not  so  with  greasy  matters. 

Pereira  himself  says,  directly  in  the  face  of  his  argument  in  favor 
of  the  use  of  grease  for  the  benefit  of  the  lungs  :  '"^  Fixed  oil  or  fat  is 
more  difficult  of  digestion,  and  more  obnoxious  to  the  stomach,  than 
any  other  alimentary  principle."  Can  any  body  tell  why  an  alimentary 
article  which  is  so  necessary  to  the  Jungs  should  be  so  obnoxious  to  the 
stomach,  unless  nature  has  made  a  very  great  blunder  ?  The  whole 
theory  of  a  respiratoiy  alimentary  principle  seems  to  me  preposterous 
in  the  extreme. 

It  is  further  urged,  in  favor  of  this  wild  conclusion  from  a  false  start- 
mg  point,  that  people  in  very  cold  climates,  the  Esquimaux,  for  example, 
consume  immense  quantities  of  blubber  oil,  tallow  candles  when  they 
can  get  them,  fatty  matters  of  all  kinds  that  they  arc  able  to  procure,  as 


286  PHYSIOLOGY. 


well  as  enormous  quantities  of  flesh  or  fish,  as  they  can  catch  it;  and 
si'nply  because  they  do  these  things,  and  live  in  a  cold  climate  where 
they  can  get  little  else,  the  inference  is  drawn  that  it  is  necessary 
they  should  so  eat  to  get  carbon  in  the  body,  to  be  "  burned  in  the 
lungs"  to  support  the  animal  temperature.  It  is  veiy  true  that  a  cold, 
rigorous  climate  enables  the  digestive  organs  to  bear  what  would  de- 
stroy life  very  soon  in  a  warm  climate.  It  is  also  true  that  these 
blubber-oil  eaters,  and  all  the  ti'ibes  of  men  whose  dietetic  habits  are 
similar,  are  a  very  inferior  race,  and  in  them  nothing  is  developed 
Bcai'cely,  save  the  mere  animal  nature ;  hence  theu*  stomachs  have  all 
the  nervous  power  almost  of  their  whole  constitutions.  More  than 
this,  their  animal  nature  is  itself  actually  inferior  in  muscular  power 
to  that  of  those  tribes  and  races  of  men  whose  general  regimen  is 
comparatively  free  from  fats  and  animal  oils. 

From  all  the  arguments  and  facts  I  am  able  to  gather,  the  conclusion 
is  unavoidable,  that  this  notion  of  pouring  carbon  into  the  stomach  to 
support  respiration  and  manufacture  animal  heat,  is  just  as  absurd  as 
the  common  fallacy  of  heating,  peppering,  and  stimulating  the  stomach 
with  spices,  pills,  and  spirits,  to  aid  digestion.  Moreover,  the  tlieory 
of  the  combustion  of  carbon  in  the  lungs  sufficiently  to  heat  up  the 
body  is  positively  disproved  by  the  fact  that  most  of  the  carbonic  acid 
expelled  from  the  lungs  is  really  formed  in  the  tissues  distant  from  the 
lungs. 

There  's  no  doubt  that  the  oxygenation  of  the  tissues  throughout 
the  system,  and  the  combination  of  oxygen  with  carbon,  are  sources 
of  animal  heat,  in  common  with  all  the  organic  functions  and  chemical 
changes  which  take  place  in  the  body.  All  the  conditions  requisite  to 
the  due  regulation  of  the  animal  temperature  ai*e  good  digestion,  free 
respiration,  vigorous  cumulation,  proper  assimilation,  and  perfect  depu- 
ration, in  two  words — good  health. 

The  ordinary  temperatm'e  of  the  human  body  ranges  from  98**  to 
100°  Fahr.,  varying  but  very  few  degi-ees  above  or  below  when  the 
suiTounding  atmosphere  is  greatly  elevated  or  depressed,  nor  under 
the  most  violent  fevers  or  extreme  states  of  debility  and  emaciation. 
That  cutaneous  respiration  is  subservient  to  the  maintenance  of  the 
equal  temperature  of  the  body,  is  evident  from  the  fact  that  if  the  hair 
of  animals  be  shaved  off,  and  the  bare  skin  covered  with  varnish,  the 
temperature  instantly  faUs. 

Endosmose  and  Exosmose. — Dutrochet  dfscovered  and  Liebig 
has  demonstrated  certain  facts  in  relation  to  the  interchange  of  dissim- 
ilar fluids  in  dirtei-ont  parts  of  tl'f  anima.  struct-n*?    which  facts  to- 


TEMPERAMENTS.  287 


gether  have  been  called  the  laws  of  endosmosis  and  exosriosis.  Accord- 
ing to  a  principle  of  these  laws,  whenever  any  animal  membrane  has 
one  of  its  sm-faces  in  contact  with  a  different  fluid,  an  interchanire 
takes  place ;  a  part  of  the  fluid  on  the  outside  passes  to  the  inner  sur- 
face, while  a  portion  of  the  fluid  on  the  inside  passes  through  and 
mixes  with  that  on  the  outer  surface,  the  interchange  continuing  until 
both  fluids  become  similar.  The  term  endosmose  means  imhihiiion, 
and  is  applied  to  the  cuirent  passing  from  without  to  within ;  exosmose 
means  transudation,  and  is  applied  to  the  passage  of  the  fluid  from 
within  to  without. 

If  a  solution  of  any  salt,  or  of  sugar,  is  poured  into  a  glass  tube 
closed  below  by  a  piece  of  bladder,  the  particles  of  the  solution  per- 
meate the  pores  of  the  bladder,  but  do  not  pass  through  it.  If  the 
tube  thus  filled  is  placed  in  a  vessel  containing  distilled  water,  the  fluid 
gradually  rises  within  the  tube,  and  sometimes  to  the  extent  of  several 
inches,  while  at  the  same  time  it  is  found  that  a  portion  of  the  solution 
has  passed  from  the  interior  of  the  tube  to  the  water  external  to  it. 

It  is  said  that  in  order  to  have  these  phenomena  manifest,  the  fluids 
must  be  of  different  deyisities,  and  that  there  must  also  be  an  affinity 
betl^veen  the  membrane  and  the  fluid,  or  no  current  will  take  place. 
Gases,  as  well  as  fluids,  are  diffused  among  each  other,  even  through 
the  compound  textures. 

These  properties  of  the  tissues,  which  are  also  possessed  by  some  in- 
organic substances,  as  thin- plates  of  slate  or  of  baked  clay,  are  ex- 
tremely important  in  relation  X)  the  treatment  of  diseases,  especially  in 
cleansing  the  body  from  di'ug-medicines  and  other  impurities,  circum- 
stances which  wiU  be  noticed  more  particularly  in  the  therapeutic 
department  of  this  \Vork. 

Note. — The  reproductive  function  will  be  considered  in  Part 
VIII. 


CHAPTER  V. 

OF    TEMPERA>MENTS. 


Temperaments  are  peculiarities  of  organization.  Marked  differ- 
ences in  individuals,  occasioned  by  the  disproportionate  development 
of  some  one  or  more  of  the  systems  or  tissues,  have  been  noticed 
since  the  earliest  times.  Galen  distinguished  these  differences  into  the 
sanguine,  phlegmatic,  lymphatic,  and  melancholic  temperaments,  a  dis- 
section based  on  the  supposed  prepcvaderance  of  some  one  of  the  fcur 


288 


PHYSIOLOGY 


elements — air,  water,  fire,  and  earth.  Vari<*is  divisions  of  the  temper- 
aments have  been  proposed  by  modern  physiologists.  Dr.  Caldwell 
oases  the  three  principal  temperaments  on  the  three  principal  cavities 
of  the  body;  the  cerebral  ov  mental  temperament,  existing  when  the 
cranium  is  most  capacious,  the  sanguine  whe'^  the  chest  is  large,  and 
the  hjmphat'ic  when  the  ahdomcn  predominates. 

The  temperaments  usually  recognized,  and  which  are  as  satisfactory 
as  any  other  classification  for  practical  purposes,  are  the  nervous,  san- 
guine, bilious,  and  lymphatic.  The  nervous  and  sanguine  are  the  irri- 
table or  aclive  temperaments ;  the  bilious  and  lymphatic  are  tlie  inirr^^ 
tabic  or  torpid  temperaments.  The  former  dispose  to  more  rapid 
motion  and  greater  activity,  with  less  power  of  endurance ;  the  litter 
are  less  easily  excited  to  action,  but  more  powerful  and  enduring.  The 
former  enjoy  or  suffer  with  the  gi'eatest  intensity ;  the  latter  are  inca- 
pable of  the  same  extremes  of  feeling.  When  all  the  systems  and 
parts  of  the  body  are  equally  developed,  the  temperament  is  called 
balanced. 


Fig.  140. 


Fie.  141. 


NERVOUS  TEMPERAMENT 


SANGUINE  TEMPERAMENT. 


The  Nervous  Temperament. — This  temperament  is  dependent 
on  a  large  development  of  the  brain  and  nervous  system,  and  when 
strong  or  pure,  is  marked  by  angular  points  in  the  body  and  sharpness 
of  features,  large  head,  small  bones  an3  muscles,  and  generally  delicate 
features,  as  represented  in  fig.  140. 

The   Sanguine  Temperament. — The  sanguine,  or  arterial  tern- 


T  E  M  P  E  Ft  A  M  E  N  T  IS. 


289 


perament  of  some  authors,  depends  on  a  large  development  of  the  cir- 
culating system,  more  especially  the  lungs  and  arteries.  Its  signs  are 
broad  shoulders,  an  animated,  lively  countenance,  florid  complexion. 
blue  eyes,  sandy,  yellowish,  or  brown  hair,  and  a  smooth,  harmonious 
combination  of  the  general  form  and  features,  as  seen  in  fig.  141. 


"Fig.  142. 


BILIOUS    TKMPERAMENT. 


LYMPHATIC    TEMPERAMENT. 


Bilious  Temperament. — The  bilious,  sometimes  called  nervous 
temperament,  is  produced  by  the  structural  preponderance  of  the 
bones,  muscles,  and  veins.  It  is  known  by  large,  full  muscles,  promi- 
nent, swelling  veins,  dark  hair  and  eyes,  dark,  brown,  or  yellow  com- 
plexion, as  in  fig.  142. 

Lymphatic  Temperament. — The  lymphatic,  or  digestive  tem- 
perament, is  occasioned  by  the  large  development  of  the  abdominal 
viscera,  particularly  the  digestive  organs.  It  is  denoted  by  a  general 
rotundity  or  fullness  of  the  body,  dull,  pale  appearance  of  the  skin, 
and  a  disposition  somewhat  inclining  to  indolence.  It  is  represented  in 
fig.  143. 


The  several  temperaments  are  combined  in  all  conceivable  propor- 
tions, but  are  seldom  so  perfectly  balanced  that  one  or  two  will  not 
prevail  over  the  others,  and  give  a  manifest  direction  to  the  individual 
character.  Black  hair  and  eyes,  red  cheeks,  and  a  ye.lowish  neck,  in- 
dicate an  equal  combination  of  the  sanguine  and  bilious;  sharp  features* 
I — 2.5 


290 


PHYSIOLOGY. 


rod  (jbeeks,  thin  flesh,  light  hair,  and  blue  eyes,  ind.iate  a  balance  be- 
tween the  sanguine  and  nervous ;  sharp  features,  with  a  lean  body  and 
a  dark  complexion,  indicate  a  balance  between  the  nervous  and  bilious ; 
and  heavy,  round  form  and  features,  with  a  dtn-k  complexion,  denote  a 
combination  nearly  equal  between  the  bilious  and  lymphatic. 


CHAPTER  VI. 


RACES   OF   MEN. 

The  division  of  the  human  ftimily  into  races  or  classes,  each  dis- 
tinguished by  certain  striking  peculiarities  in  the  shape  of  the  head, 
and  in  the  structure,  color,  and  arrangement  of  the  skin,  hair,  and 
eyes,  though  strictly  belonging  to  the  science  of  ethnology,  is  a  subject 
constantly  becoming  more  interesting  to  the  physiologist,  from  its  inti- 
mate connection  with  the  developmer  t  of  men,  and  the  improvement 
and  advancement  of  humanity. 

A  cliissification  of  mankind  into  lead'ng  classes  must  of  course  involve 
distinctions  purely  arbitrary ;  for  the  races  may  be  distinguished  into 
two  or  twenty,  or  any  number  between,  as  the  marks  of  difference  aro 
more  or  less  prominent. 

The  division  of  Blumenbach,  who  makes  five  principsd  races,  is  as 
useful  and  satisfactory  as  any  other  can  be.  These  are  named  the 
Caucasian,  Mongolian,  Etkicjnc,  American,  and  Malay. 


Fig.  144. 


CAUCA8IAJS    RACE 


The  Caucasian  Race.  —  The 
Caucasian  race  is  remarkable  for 
the  highest  ])hysiologicaI  develop- 
ment, personal  symmetry  and  beau- 
ty, and  intellectual  attainments.  The 
■jhief  families  of  this  race  are  the 
Caucasians  proper,  and  the  German- 
ic, Celtic,  Arabian,  Libyan,  Nilotic, 
and  Hindostanic  branches. 

In  this  race  tlie  skin  is  generally 
fair,  the  hair  fine  and  long,  and  of 
various  colors,  tlie  skull  large,  round- 
ed, and  oval,  and  the  forehead  broad 
or    prominent,    lai'ge    and    elevated. 


RACES    OF    MEN, 


291 


The  face  is  relatively  smaE  and  well-proportioned,  the  nose  arched, 
the  chin  full,  and  the  teeth  vertical. 

In  this  variety  or  race  of  men  we  find  the  farthest  remove  from 
the  animal  in  brain,  features,  and  hau%  with  a  superiority  of  intellectual 
and  moral  power,  love  of  the  arts,  science,  and  peltry.  The  progi'esa 
of  the  human  family  seems  to  be  made  wholly  through  this  race. 

The  Mongolian  Race. — The  Mongolian  Fig.  145. 

*  variety  includes  the  Mongol  Tartars,  Turks, 
and  the  Chinese  and  Po^flr  tribes,  which  in- 
habit a  vast  extent  of  the  eaith's  surface,  and 
constitute  about  half  of  the  population  of  the 
globe.  In  physiological  characteristics  the 
Mongolians  manifest  considerable  variety. 
The  hair  is  black,  long,  and  straight,  the 
beard  scanty,  the  skin  commonly  of  an  olive 
tint,  the  eyes  black,  the  nose  broad  and  short, 
the  cheek-bones  broadband  flat,  the  skull  ob- 
long, but  flattened  so  as  to  give  it  a  square 
appeai'ance,  and  the  forehead  low. 

In  moral  development  this  race  is  decidedly 
inferior;  their  intellectual  powers  are  more  imitative  than  inventive, 
and  they  possess  but  little  strength  and  originality  of  mind. 

The  Ethiopic  Race, — The  Negroes  of  Central  Africa,  the  Caffres 
and  Hottentots  of  South  Africa,  the  Natives  of  Australia,  and  tho 
Islanders  of  the  Indian  Archipelago  and  the  Pacific  Ocean,  constitute 
the  principal  families  of  the  Ethiopic  or  black  race. 


MONGOLIAN    RACE. 


The  black  variety  of  mankind  have 
complexions  of  jetty  hue,  black,  woolly 
hair,  eyes  large,  black,  and  prominent, 
nose  broad  and  flat,  thick  lips,  and  wide 
mouth.  The  head  is  long  from  the 
ears  back,  and  narrow;  the  forehead 
is  low,  narrow,  and  retreating;  the 
cheek-bones  prominent,  the  jaws  and 
teeth  projecting,  and  the  chin  small. 
A  long,  protruding  heel,  and  a  flat 
shin-bone,  often  distinguish  this  variety. 

In  disposition  they  are  easy,  indo- 
lent, cheerful,  fond  of  sensual  pleasure, 
and  lovers  of  children,  fond  of  gaudy 


Fig.  146. 


ETHIOPIC    OR    BLACK    RACE. 


292 


PnTSIOLOGY. 


Fig.  147. 


show,  biit  vei-y  improvident.   In  intellect  the  race  varies  much,  but  the 
majority  of  its  tribes  are  low  in  this  respect.     There  are,  however, 
many  instances  in  which  individuals  of  tliis  race  have  exhibited  respect 
able  talont. 

The  American  Race. — The  Indian  tribes,  or  ''Red  7?2en,"  who 
once  occupied  origiu.dly  nearly  the  whole  of  North  and  South  America, 
south  of  the  s«tietli  degree  of  north  latitude,  constitute  this  variety. 

The  people  of  this  race  vary  consider- 
ably in  complexion,  but  are  mostly  of  a 
reddish-brown  color.  The  hair  is  long, 
straight,  and  black,  the  beard  deficient, 
the  eyes  black  and  deep  set,  brows 
prominent,  forehead  receding,  promi- 
nent aquiline  nose,  high  cheek-bones, 
small  skull,  rising  high  at  the  crown, 
and  the  back  part  flat,  large  mouth, 
hard,  rough  features,  with  fine,  straight, 
symmeti-ical  frames.  They  ai'e  averse 
to  cultivation,  and  slow  in  acquiring 
knowledge,  sedate,  proud,  restless,  sly. 


AMERICAN    RACE. 


revengeful,    fond    of  war,    and   wholly 


destitute  of  mai'itime  adventure,  and  are  rapidly  disappearing  from  the 
earth  before  the  all-conquering  march  of  the  Caucasian. 


Fig.  148. 


$-.% 


The  Malay  Race. — This  variety  of  the  human  family  inhabit 
Borneo,  Java,  the  Phillipine  Islands,  New  Zealand,  the  Polynesian 
Islands,  and  a  part  of  Madagascar. 

The  Malays  have  tawny  or  dai'k  brovvn 
skins,  coarse,  black  hair,  large  mouth, 
broad,  short  noses,  seeming  as  if  broken 
at  the  root,  projecting  upper  jaws,  and 
protmding  teeth.  The  forehead  is  broad 
and  low,  the  crown  of  the  head  high.  The 
moral  character  of  the  Malays  is  of  an  in- 
ferior order.  They  are  active,  ingenious, 
and  fond  of  maritime  pursuits,  and  exhibit 
considerable  intellectual  capacity.  Yet  this 
race  is  constantly  giving  way  before  Euro- 
pean civilization,  and  has  already  disap- 
peared from  New  Holland  and  Van  Dio- 
MAi.AV  RACF  men's  Land 


RACES    OF    MEN.  293 


If  the  opinion  is  correct  that  the  sti'onger  race  continually  overgrows 
all  the  rest,  and  gradually  obliterates  them  from  the  earth,  the  Cauca- 
sians are  surely  destined  eventually  to  "possess  the  land."  The  his- 
tory of  the  whole  human  race  thus  far  indicates  that  such  is  the  onier 
of  nature, 

Origin  of  the  Races. — Whether  ^je  various  races  of  men  hav 
each  had  separate  origins,  or  whether  they  are  descendants  of  a  com- 
mon pair,  modified  by  habits  of  life,  climate,  and  external  conditions, 
my  limits  will  not  permit  me  to  discuss.  Dr.  Pritchard,  after  a  labored 
investigation,  came  to  the  conclusion  of  the  original  unity  of  the  races 
of  the  human  family.  Other  authors  have  examined  the  subject  appa- 
rently as  critically,  ana  settled  down  upon  the  opinion  of  the  original 
diversity  of  the  races. 

Dr.  Carpenter  remarks :  "It  is  a  question  of  great  scientific  interest, 
as  well  as  one  that  considerably  affects  the  mode  in  which  we  treat  the 
races  that  differ  from  our  own,  whether  they  are  all  of  one  species, 
that  is,  descended  from  the  same  or  from  similar  parentage,  or  whether 
they  are  to  be  regarded  as  distinct  species,  the  first  parents  of  the  sev- 
eral races  having  had  the  same  differences  among  themselves  as  those 
now  exhibited  by  their  descendants." 

No  doubt  the  question  of  the  natural  inferiority  of  a  race  or  tribe  of 
the  family  of  mankind  really  does  affect  the  manner  in  which  (hey  are 
dealt  with  by  their  superiors,  and  materially  modifies  the  state  of  their 
consciences  in  relation  to  the  use  or  abuse  of  the  weaker  by  the 
stronger,  still  this  might  makes  no  right,  nor  does  this  question  furnish 
any  reason  why  the  more  powerful  race  should  malti'eat  the  more 
feeble.  I  admit  that  the  process  of  extennination  is  going  on,  accord- 
ing to  the  irreversible  laws  of  nature,  from  the  highest  human  being  to 
the  lowest  animal.  I  believe  that  the  stronger  animals  will  exterminate 
the  weaker,  that  man  will  eventually  run  out  of  existence  the  stronger 
animals,  and  that  the  superior  tribe  of  the  human  family  will  fina.ly  oblit- 
erate all  traces  of  the  existence  of  all  the  others;  still  I  cannot  see  in  the 
operations  of  this  law  any  reason  for  oppressing,  or  even  for  not  sti-iving 
for  the  development  of  all  men,  yes,  of  all  animals,  according  to  their 
capacities  and  conditions.  So  long  as  inferior  men  do  exist,  our  duty 
to  them  is  plain  enough.  No  one  pretends  that  we,  the  stronger, 
have  any  right  to  rid  the  earth  of  their  presence  by  violence,  or  in 
any  other  way  except  that  "  ordained  by  Heaven."  So  far  as  Nature 
is  concerned,  she  will  see  that  her  laws  on  the  subject  are  fiiithfully 
executed,  without  our  special  interference.  As  far  as  the  feebler 
races  are  capable  of  development  ara  improvement,  they  are  entitlec 


294  PHYSIOLOGY. 


to  the  same  consideratjon  as  those  who  are  more  ?;ighly  endowed  in 
organization. 

Theory  of  Populatio>-. — Philosophers  have  not  yet  been  able  to 
agree  upon  any  satisfactory  theory  of  population.  Mr.  Malthus  has 
contended  that  population  has  a  tendency  to  increase  faster  than  the 
means  of  subsistence,  unless  some  exti'aordinary  counteracting  causes 
be  interposed.  On  this  assumption,  "war,  pestilence,  and  famine," 
may  be  hailed  as  special  Godsends  to  keep  the  race  down  to  the  level 
of  the  means  of  subsistence ;  but  it  places  the  Creator  in  an  attitude 
from  which  our  reason  revolts.  Mr.  Doubleday,  on  the  other  hand, 
has  lately  met  the  positions  of  Mr.  INIalthus  with  an  opposite  theory. 
He  has  undertaken  to  show  that  poverty  is  the  principal  cause  of  a 
rapid  increase,  and  that  a  good  degree  of  the  comforts  of  life  "deadens 
the  principle  of  increase."  He  sustains  the  fii-st  clause  of  his  proposi- 
tion by  adverting  to  the  fact  that  poor  folks  have  the  most  children, 
and  th^  latter  part  by  quoting  the  well-known  historical  data,  that 
wealthy  and  luxurious  famiMes  frequently  run  out,  as  have  done  wealthy 
and  luxurious  nations.  The  doch'ines  of  both  of  these  gentlemen  are 
too  narrow  and  superficial. 

Great  wealth  and  extreme  poverty  are  equally  in  violation  of  the 
"natural  constitution  of  man."  That  God  who  fashioned  the  earth, 
made  it  capable  of  yielding  sustenance  enough  for  all  the  beings  created 
in  His  own  image.  If  men  have  got  at  variance  with  themselves,  and 
wan-ed  upon  each  other;  if  some  have  usurped  too  much  of  the  domain 
of  our  common  mother,  Earth,  and  others  have  not  where  to  lay  their 
heads ;  if  men  have  deranged  their  proper  social  relations,  perverted 
the  laws  of  their  own  organization,  and  entailed  upon  themselves  and 
society  innumerable  j^^rryiitted  evils,  let  us  pause  long  before  w^e  charge 
all  these  results  to  special  providences  or  natural  tendencies. 

The  actual  productiveness  of  the  earth  is  incredible  to  those  who 
have  never  examined  the  subject.  Under  the  best  systems  of  agricul- 
ture and  dietetics,  Ireland,  where  now  eight  millions  of  human  beings 
starve,  could  healthfully  sustain  one  hundred  millions,  and  the  soil  of 
the  U  lited  States  is  capable  of  producing  inore  than  food  enough  for 
E.H  tha  inhabitants  now  existing  on  the  globe. 


4 


PART     III. 


HYGIENE. 

The  hygienic  agencies — absurdly  called  "non-naturals"  in  medical 
books — comprise  the  whole  and  ample  materia  medica  of  the  true 
hydropath.  They  are  air,  light,  water,  food,  temperaiure,  exercise, 
sleep,  clothing,  and  the  passions.  These  agencies,  variously  modified 
and  intensified,  I  believe,  are  capable  of  producing  all  the  really  reme- 
dial effects  in  all  diseases  which  the  whole  pharmacopoeia  of  allopathy, 
with  its  thousand  drugs  and  destructives,  can  produce,  and  without  any 
of  the  evil  or  injurious  results  always  attendant  upon  the  operation  of 
the  latter ;  while  to  sustain  the  vital  machinery  in  its  most  vigorous  and 
enduring  condition,  in  other  words,  to  preserve  health,  we  have  but  to 
employ  or  apply  them  according  to  established  and  invariable  laws. 

In  claiming  for  those  agencies  by  which  every  part  and  organ 
of  every  living  animal  and  vegetable  in  existence  is  nourished,  built  up, 
sustained,  and  finally  changed  and  decomposed,  by  which  the  integrity 
of  every  sti'ucture  and  function  is  maintained  during  life,  and  resolved 
into  its  primitive  elements  and  (onditions  on  the  cessation  of  the  life- 
principle,  a  complete  and  perfect  materia  medica,  I  mean  as  far  as 
regards  functional  dei-angcment,  which,  indeed,  constitutes  ninety-nine- 
hundredths  of  the  diseases  of  society.  Mechanical  injuries,  displace- 
ments of  parts,  organic  lesions,  etc.,  coming  appropriately  under  the 
management  of  the  surgeon,  may  and  often  do  require  mechanical 
agencies  of  some  sort. 

I  am  aware  that  few  practicing  hydropaths  take  this  ultra  ground. 
Some  of  them  administer  anodynes  occasionally;  some  bleed  now  and 
then ;  some  call  in  the  aid  of  blue  pill  and  cathartic  potions  under  par- 
ticular circumstances ;  others  give  a  little  brandy  on  emergencies,  oc 
the  absurd  notion  of  "keeping  up  the  vital  powers  till  nature  has  time 
to  rally;''  and  others  deal  out  "a  little  homeopathy"  ever  and  anon. 
I  am  most  thoroughly  convinced  ^.hat  all  of  these  "auxiliaries"  are  un- 
necessaiy;  most  of  them  much  worse  than  useless.     Their  apparent 


296  HYGIENE. 


necessity,  I  contend,  has  its  source  in  the  igtwrance  of  the  practitioner. 
He  does  not  fully  understand  the  philosophy  of  vitalitj-,  the  intrinsic 
character  of  disease,  nor  the  scope  and  pnwer  of  these  hygienic  agen- 
cies, if  he  regards  them  as  at  f^iult  or  insufficient.  I  grant  that  occa- 
sional dosing  may  be  the  best  some  hydropaths  can  do.  I  consider  him 
justifiable  in  acting  according  to  his  understanding.  It  may  hapi)en, 
too,  that  he  has  not  all  the  appliances  of  hydropathy  at  command,  or 
the  patient  will  not  submit  to  them.  Under  such  circumstances  I  do 
not  say  that  it  is  not  expedient  to  give  drugs.  But  I  do  maintain  that 
a  full  knowledge  of  all  the  remedial  resources  of  hygiene,  with  the 
possession  of  all  the  means  afforded  by  such  knowledge,  enables  the 
hydropath  to  dispense  with  drug  medication  entirely. 

I  have  known  and  carefully  noted  the  particulars  of  many  cases 
where  the  professed  hydropath  has  resorted  to  drugging,  or  bleeding, 
or  external  irritants,  and  in  every  such  case  there  w^as  manifest  igno- 
rance or  error  in  the  management  of  water,  diet,  exercise,  sleep,  tem- 
perature, or  of  the  voluntary  habits,  or  in  relation  to  some  other 
hygienic  agent  or  condition.  I  have  known  some  patients,  while  under 
judicious  water-treatment,  in  their  impatience  to  force  nature  a  little 
faster  than  she  was  willing  to  go  of  her  own  accord,  dose  themselves 
now  and  then  with  stimulants,  bitters,  herb  teas,  nervines,  or  laxatives, 
and  whatever  seeming  advantage  immediately  resulted,  I  have  alwaj's 
found,  as  far  as  I  have  been  able  to  "compare  notes,"  that  those  who 
did  nothing  of  the  kind,  other  circumstances  being  equal,  would  get 
the  best  health  in  the  end. 


CHAPTER   I. 

OF   AIR. 


Vital  Property  of  Air. — The  physiology  of  the  respiratory 
fuuction  explains  the  relation  of  an  abundant  supply  of  pure  fresh  air 
to  the  maintenance  of  health  and  the  attainment  of  longevity.  Fresh 
air  in  the  lungs  is  so  immediately  essential  to  life  that  most  animals,  in 
less  than  one  minute,  when  deprived  of  it,  suffocate,  become  uncon- 
scious, and  appear  to  be  dead,  rea  death  occurring  in  a  few  minutes 
if  air  is  not  supplied. 

Oxygen,  which  has  been  called  "vital  air,"  is  undoubtedly  the  vivify- 
ing princijjle  of  the  atmosphere.     Ca-'ion.  niti'ogen,  and  hydrogen  are 


AIR.  297 

generally  considered  poisonous  in  relation  to  the  lungs,  but  they  are 
rather  negative  than  positive  agents,  being  merely  incapable  of  support- 
ing respiration.  When  persons  or  animals  are  confined  in  a  close  room, 
they  continue  to  breathe  until  the  oxygen  of  the  enclosed  air  is  ex- 
hausted, \."hen  death  inevitably  results.  The  flame  of  a  lamp  or  candle 
will  also  expire  when  the  oxygen  is  consumed,  this  gas  being  as  essen- 
tial to  combustion  as  to  respiratior*.  In  dry  wells,  deep  vaults,  and 
other  situations  where  carbonic  acia  gas,  or  other  irrespirable  airs,  are 
liable  to  accumulate,  the  introductioL  of  a  lighted  taper  is  an  important 
orecaution.  If  the  flame  be  extinguished,  it  would  be  dangerous  to  lifo 
^o  enter,  for  breathing  cannot  take  place  where  combustion  ceases. 
Carbonic  acid  gas,  being  heavier  than  common  atmospheric  air,  settles 
to  the  bottom  of  a  pit  or  room,  while  nitrogen  and  hydrogen,  being 
lighter,  ascend  to  the  top;  therefore  in  a  room  vitiated  by  a  large  col- 
lection of  persons,  or  from  want  of  ventilation,  the  purest  air  is  foimd 
in  the  middle  of  the  apartment.  A  dog  has  been  suffocated  by  carbonic 
acid  gas  in  a  room  where  a  man,  standing  erect,  felt  no  inconvenience. 

Quantity  of  Respired  Air. — Physiologists  reckon  that  an  ade- 
quate supply  of  air  for  an  ordinary  man  to  breathe  each  minute  is  from 
seven  to  ten  cubic  feet.  A  hundred  persons  confined  in  a  room  thu'ty 
feet  in  length,  breadth,  and  height,  containing  nearly  30,000  cubic  feet, 
would  render  the  whole  air  unfit  for  respiration  in  about  five  hours. 
Imperfect  ventilation,  therefore,  in  crowded  assemblies,  churches, 
school-rooms,  theatres,  factories,  and  workshops,  especially  in  the 
evening,  when  many  ^amps  or  gas-burners  are  employed,  is  a  common 
source  of  debility  and  disease.  An  ordinary  gas-burner  consumes  as 
much  oxygen  as  four  adult  persons ;  but  the  loss  of  oxygen  is  not  alone 
the  cause  of  injury  resulting  from  large  gatherings  of  people  in  ill- 
ventilated  places,  for  the  irrespira.'le  air  thrown  out  from  the  lungs  is 
rendered  still  more  noxious  by  the  exhalations  from  the  skin. 

The  artificial  habit  of  lessening  the  breathing  capacity  by  means  of 
stays,  corsets,  and  tight  dresses,  is  now  happily  passing  away,  although 
the  wasp-like  waists  which  deform  so  many  of  the  gentler  sex  still 
adorn  the  "fashion  plates"  of  the  magazines,  and  caricature  the  female 
form  in  most  of  the  fashionable  shop-windows.  Could  the  women  of 
America — ^I  say  nothing  of  ladies — fully  appreciate  the  importance  of 
dress  as  connnected  with  respiration,  and  the  relation  of  this  function 
to  their  own  health  and  happiness  and  the  welfore  of  their  offspring, 
the  monthly  importation  of  Parisian  cuts,  tui-ns,  twists,  fits  and  misfits, 
would  soon  je  substituted  by  "  short  dresses./'  loose  as  well  as  short,  or 
?u!ri{'t]iing  V   the  way  of  clothing  that  wil  er.iiancipate  the  lungs 


298 


HYGIENE. 


Fig.  149 


KATURAL    WAIST. 


Fi-.  150. 


from  oppression  "most  foul,  strange,  and  unnat- 
ural." A  reform  in  female  dress  would  not  only 
set  free  the  breathing  appamtus,  but  would  confer 
an  incalculable  benefit  on  the  huma«i  race  in  another 
respect.  It  would  enable  the  wealthy  classes  to 
devote  more  attention  to  more  useful  subjects,  and 
think  less  of  the  frivolities  of  ever-changing  and 
never  satisfying  fashions ;  and  diminish  the  demand 
upon  the  kind  of  work — sewing  by  day  and  by 
night — which  is  now  ruining  the  constitutions  of 
thousands  of  poor  and  industi'ious  females,  and 
sending  them  rapidly  to  premature  gi'aves. 

Fig.  149  is  a  representation  of  the  female  chest 

in  the  natural  state,  unconstrained  in  the  least  by 

the  clothing.    The  person  who  fails  to  discover  the 

efise,  grace,  beauty,  and  symmetry  of  the  figure 

as  contrasted  with  that  of  a  modern  belle, 

must  have  a  taste  as  artificial  as  any  man- 

tua-maker  could   desire.     It  is  perfectly 

certain  that,  just  to  the  extent  that  any 

female  diminishes  the  cu'cumference  of 

the  body  around  the  lungs,  just  in  that  ratio 

will  she  lessen  the  number  of  her  days, 

])rovided  she  does  not  die  of  violence  or 

disease,  which  is  a  hazai'd  she  must  also 

encounter. 

Observe  the  stiff,  constrained,  uncom- 
fortable, and  uncomely  appearance  of  a 
fashionable  lady  (fig.  150).  It  is  really 
painful  to  look  upon  such  a  self-constituted 
burlesque  on  humanity. 

UNNATURAL    WAIST. 

If  there  are  any  young  ladies  whose  excess  of  approbativeness  in- 
duces them  to  strain,  and  labor,  and  suffer,  to  produce  "  small  tapering 
waists,"  so  as  to  look  "delicately  fashionable,"  or  "fashionably  deli- 
cate," for  the  purpose  of  attracting  the  admiration  of  the  other  sex, 
let  me  assure  them  that  they  are  destined  to  a  sad  failure.  Notice 
they  may,  indeed,  obtain,  but  admiration  in  that  way,  never.  I  have 
never  heard  a  young  man  speak  of  the  habit  except  in  terms  of  ridi- 
cule ;  and  I  have  never  heard  any  man  speak  of  it  except  in  language 
of  reprobation  for  its  manifestly  injurious  consequences,  and  contempt 
fur  its  ridicuVuF  appoarnnco. 


AIE. 


298 


Fig.  151. 


VENUS    DE    MEDICIS. 


The  contrast  appears  still  sti'onger  when 
the  diminutive  circle  of  the  waist  which 
beautifies  the  belle  is  placed  by  the  side  of 
the  broad,  expanded  chest,  which  renders 
the  woman  vigorous  and  healthy,  and  conse- 
quently a  help  meet  for  man — fig.  151.  Suc> 
was  the  model  of  female  beauty  ere  sacre 
ligious  hands  had  marred  its  fair  proportions, 
and  wherever,  among  the  inhabitants  of  all 
parts  of  the  earth,  we  find  long-lived  mothers 
and  grandmothers,  we  are  sure  to  find  full, 
round  chests  and  capacious  lungs. 


Purity  of  Respired  Air. — Equal  in 
importance  with  the  quantity  of  the  air  wo 
breathe  is  its  purity.  It  is  melancholy  to 
reflect  on  the  hard  necessity  which  compels 
multitudes  to  live,  or  rather  stay,  in  the  sweltering  garrets  and  infec- 
tious cellars  of  cities,  or  on  the  cupidity  of  landlords  who  provide  such 
tenements,  or  on  that  dereliction  of  duty  in  municipal  authorities  which 
permits  their  existence.  Much  of  the  evil,  however,  rnay  have  its 
source  in  ignorance. 

Few  sanatory  circumstances  are  less  regarded  tiian  those  nuisances 
which  fill  the  air  with  noxious  effluvia.  I  know  of  no  reason  whj*- 
Boston  and  Philadelphia  should  be  more  healthy  than  New  York 
unless  it  is  because  the  air  of  Boston  is  not  continually  filled  with  the 
poison  of  tobacco  smoke,  and  the  Philadelphians  have  little  or  no  under- 
ground population.  In  every  hygienic  aspect.  New  York  is  the  favored 
locality.  It  is  true  New  York  suffers  a  large  influx  of  foreigners,  the 
fatality  among  whom  considerably  swells  its  bill  of  mortality.  But  this 
alone,  viewed  in  connection  with  its  superior  advantage  in  position,' 
does  not  account  for  the  difference,  for  according  to  the  statistics  of  the 
present  year,  the  mortality  of  New  York  is  twenty-five  per  cent, 
greater  than  that  of  Philadelphia,  and  twelve  and  a  half  per  cent, 
greater  than  that  of  Boston ;  equal,  in  fact,  to  New  Orleans  and  other 
uouthern  cities  usually  regarded  as  sickly. 

Nearly  all  cities— New  York  especially— are  full  of  air-infecting 
nuisances,  not  as  generally  diffused  as  tobacco  smoke,  but  as  intensely 
poisonous  in  certain  localities,  as  distilleries,  cow  stables,  swill-milk 
factories,  hog-pens,  soap  factories,  slaughter-houses,  bone-boiling  estab- 
lishments, tallow-melt' ng  pkces,  graveyards,  etc.,  fi'om  which  are  con- 
stantly emanating  s(:^ams  of  cor.^agioi    an^  death.     I  do  not  believe 


300  II  Y  G  1 E  N  E. 

there  is  a  single  city  on  earth,  certainly  not  in  the  United  States, 
where  the  people  would  endure  or  tolerate  these  pestilences,  were 
they  fully  enlightened  on  the  subject. 

It  is  utterly  iniijossible  for  the  lungs  to  be  fully  expanded  in  a  very 
impure  atmosphere,  because  the  air  passages,  i]-»-itated  by  the  extra- 
neous particles,  spcismodically  contract  to  keep  them  out.  The  conse- 
quence of  this  is,  those  pei-sons  who  reside  permanently  in  an  atmos- 
phere charged  with  foreign  ingi-edie  Jts  or  miasms,  find  their  lungs 
contiimally  contracting,  unless  this  tendency  is  counteracted  by  a  con- 
stant vocal  or  muscular  exercise  calculated  to  invig  -nte  the  whole 
respiratory  apparatus  and  expand  the  chest. 

Chance  of  Air. — The  remarkable  benefits  frequently  experienced 
when  the  inhabitants  of  crowded,  dusty  cities  rusticate  in  the  country 
for  a  few  days,  or  wdien  invalids  exercise  themselves  in  traveling,  and 
amuse  themselves  with  a  variety  of  new  scenery,  has  caused  some 
physiologists,  who  have  a  reputation  for  considerable  intelligence,  to 
imagine  that  the  advantage  w^as  in  the  change  itself  more  than  in  the 
better  quality  of  the  countiy  air.  It  is  quite  a  prevalent  notion  that 
human  beings  require  changes  of  food,  drink,  and  air,  merely  as 
changes.  Such  notions  have  no  foundation  in  philosophy.  If  the 
food,  or  drink,  or  air,  or  all,  is  physiologically  the  hest^  it  can  never  be 
improved  by  any  change  during  the  whole  period  of  life  ;  but  if  in  any 
respect  it  is  imperfect,  a  change  to  a  better  quality  would  be  beneficial. 
Dr.  Dunglison,  who  is  a  standard  author  in  the  profession  on  hygienic 
mattei-s,  thinks  there  is  so  much  virtue  in  "  modifitdtions  of  different 
atmospheric  influences,"  that  a  change  from  a  hetter  to  a  worse  air  ^ 
better  than  no  change  at  all.  His  language  is  (Elements  of  Hygiene, 
page  125) :  "The  change  from  a  better  to  a  worse  air  has  even  been 
found  serviceable.  In  Edinburgh,  the  inhabitants  of  the  most  airy 
parts  of  the  New  Town  frequently  send  theh  children,  when  laboring 
under  hooping-cough,  to  the  Cowgate,  a  filtliy  street,  which  runs  at 
right  angles  under  one  of  the  mrgest  thoroughfares  in  the  Old  Town, 
and  in  which,  at  a  certain  hour  of  the  night,  the  inhabitants  eject  al 
the  offensive  accumulations  from  their  houses,  to  be  washed  away  bj 
the  water  of  the  reservoirs,  let  on  for  the  purpose."  It  is  passing 
strange  that  any  medical  man  of  the  present  day,  of  high  rank  and 
acknowledged  authority  in  his  profession,  should  be  so  blinded  by  false 
theories  as  to  commend  a  custom  so  abominable,  simply  because  some 
ignorant  persons  \7ere  foolish  onougl.  to  pmctii  e  it ! 

Positions    am     Habii  i    affectin       Respikation. — Sedentary 


AIR.  301 

habits,  unless  frequently  alternated  with  vigorous  and  prolonged  exer- 
cise, weaken  the  abdominal  muscles,  and  thereby  lessen  the  activity 
of  the  breathing  process. 

Intense  mental  application,  if  long-continued,  powerfully  diminishes 
the  respiratory  function.  No  person  in  deep  thought,  with  the  brain 
laboring  at  its  utmost  capacity,  breathes  deep  and  free ;  hence  editors, 
particularly  those  who  are  closely  conjfined  to  their  sanctums,  are 
jn-overbially  short-lived.  Many  of  them  are  worked  to  death  in  five 
or  six  years,  who,  had  they  attended  properly  to  their  respiratory 
functions,  both  pulmonary  and  cutaneous,  could  have  held  out,  under 
the  same  amount  of  labor,  three  or  four  times  as  long.  All  veiy  stu- 
dious persons,  especially  those  given  to  abstruse  investigations — the 
exercise  of  the  reflective  intellect — should  never  fail  to  exercise  the 
whole  body  daily,  and  the  arms,  shoulders,  and  abdominal  musclatj 
several  times  a  day.  Riding  on  horseback,  climbing  mountains,  run- 
ning up  and  down  stairs,  dancing  the  tight  rope,  swinging  on  the  hand 
ladder,  throwing  the  dumb  bells  or  grace  hoops,  playing  ball,  bowling, 
sawing  wood,  planing  boards,  etc.,  are  examples  of  appropriate  exercises. 
Rotary  motions,  with  both  arms  extended,  making  the  hands  simulta- 
neously describe  as  large  a  circle  as  possible,  striking  the  elbows  or 
backs  of  the  hands  together  behind  the  back,  or  attempting  so  to  do, 
are  excellent  exercises  when  the  person  is  stoop-shouldered,  and  the 
chest  contracted  from  malformation  or  by  artificial  means. 

All  crooked  or  constrained  bodily  positions  affect  respiration  injurious- 
ly. Reading,  writing,  sitting,  standing,  speaking,  or  laboring,  with  the 
ti'unk  of  the  body  bent  forwai'd,  is  extremely  hurtful,  by  overstretch- 
ing *he  muscles  of  the  back,  compressing  the  lungs,  and  pushing 
downward  and  backward  the  stomach,  bowels,  and  abdominal  muscles. 
In  all  mechanical  or  manual  labor  occupations,  the  body  should  always 
be  bent,  or  lean,  on  the  hip  joints ;  the  trunk  should  always  be  kept 
"as  straight  as  an  Indian." 

Catching  Cold. — The  general  misapprehension  in  regard  to  the 
theory  of  "catching  cold,"  frequently  produces  the  very  evil  that  is 
most  feared.  More  colds  are  taken  in  overheated  than  in  too  cold 
pkces,  and  still  more  are  owing  to  vitiated  air.  "Backwoodsmen,"  who 
sleep  all  winter  long  in  shanties  through  which  the  snow-flakes  pass 
freely,  are  seldom  troubled  with  what  are  called  "colds  and  coughs." 
Too  close  confinement  to  hot  air  in  ill-ventilated  rooms  renders  the 
body  preternaturally  susceptible  to  atmospheric  changes.  Infants  and 
young  children  are  generally  badly  managed  in  this  respect  in  this 
country.  They  are  often  made  sickly,  puny,  peevisli,  and  effeminate, 
26 


802  HYGIENE. 


by  keeping  the  doors  and  windows  too  close,  and  the  sufferer  too  much 
in  doors,  as  though  the  breath  of  heaven  was  unfriendly  to  human  life. 

Purifying  tke  Air. — There  is  one  method  of  pm-ifying  the  air 
which  is  accessible  to  all  persons  in  all  pkces.  In  sleeping  and  other 
apartments,  where  thorough  ventilation  is  impossible,  the  air  may  be 
rapidly  changed  and  materially  freshened  by  opening  all  the  doors  and 
windows,  and  then  swinging  one  door  violently  forward  and  backward. 
It  is  a  good,  indeed  a  necessary  practice  in  the  cases  of  invalids  who 
occupy  close  and  secluded  rooms,  ana  who  are  una-ble  to  walk  out. 

Sleeping  Rooms. — Sleeping  rooms  are  generally  miserably  venti- 
lated. Air  of  a  pure  quality,  and  abundant  in  quautitj^  is  much  more 
important  during  our  sleeping  than  in  om*  waking  hours;  but  the  com- 
mon habits  of  the  people  are  to  provide  large,  spacious  eating  and  sitting 
rooms,  and  small,  close  sleeping  apartments.  No  one  should  sleep  in 
a  room,  in  summer  or  in  winter,  with  all  the  windows  and  doors  tightly 
closed.  Windows  can  at  all  times  be  opened  more  or  less  at  the  bottom 
or  top,  or  the  door  placed  a  little  ajai',  so  as  to  permit  the  ingress  of  fresh 
air,  without  admitting  any  injurious  current.  I  have  known  invalids 
with  bronchitis,  consumption,  and  other  diseases,  in  this  city  of  a  thou- 
sand intelligent  physicians,  suffer  horribly,  by  being  confined  in  a  close, 
sultry  room,  in  a  hot  July  day,  per  advice  of  the  doctor! 

Bed-curtains  are  rather  worse  than  a  useless  appendage.  If  used 
at  all,  they  should  never  be  drawn  tightly  around  the  bed.  The  head 
should  never  be  raised  very  high  during  sleep,  as  that  position  oppresses 
the  lungs;  nor  should  the  sleeper  incline  toward  the  face,  with  the 
shoulders  thrown  forward.  A  late  supper,  by  filling  the  stomach,  pre- 
vents, in  the  horizontal  posture,  the  descent  of  the  diaphragm,  hinders 
free  breathing,  and  induces  congestion  of  the  brain,  dreaming,  night- 
mare, etc. 

Stoves  and  Fireplaces. — Grates  and  fireplaces  secure  a  much 
better  ventilation  than  stoves  of  any  description.  Stoves  are  regarded 
by  some  as  constituting  "the  gi-eat  nuisance  of  America;"  and  there 
is  no  question  that,  as  usually  managed,  they  do  actually  vitiate  all  the 
air  of  tho  room.  Air-tight  stoves  require  the  most  careful  attention  to 
ventilation,  and  indeed  no  stove  should  be  used  in  any  place  where 
there  is  not  resource  or  provision  for  the  free  admission  of  external  air. 

Lamps,  Candles,  Gas-Burners,  etc. — As  all  the  means  by  which 
a  room  is  lighted  in  tho  ei  ening  are  so  many  methods  of  consuming 


AIR.  303 

the  oxygen,  and  rendering  the  ah*  h'respirable,  it  is  well  to  bear  in 
mind  that  the  amount  of  ventilation  must  have  a  due  relation  to  the 
number  of  hghts  employed.  In  small  rooms,  and  in  sleeping  rooms 
where  a  lamp  is  kept  burning  through  the  night,  and  in  rooms  occu- 
pied by  invalids,  attention  to  this  circumstance  is  especially  important. 
In  this  connection  I  will  allude  to  another  very  common  source  of 
vitiated  air — smoky  lamps.  It  may  astonish  those  who  have  never 
seen  this  evil,  to  be  told  that  persons  can  have  their  organs  of  sense  so 
dulled  and  torpified  as  to  sit  a  whole  evening  in  a  room  with  two  or 
three  oil  lamps,  each  sending  up  a  column  of  black  smoke,  and  filling 
the  room  with  a  rank,  suffocating  odor,  and  yet  not  appear  to  be  the 
least  offended  or  incommoded.  Yet  such  things  are  not  uncommon  in 
our  cities ;  and  many  who  work  evenings  by  the  light  of  smoky  lamps, 
often  get  weak  eyes  as  well  as  impure  blood  as  the  result. 

Public  Conveyances. — It  may  be  traveling  a  little  out  of  tho 
record,  for  me  to  speak  of  the  bad  air  of  steamboats,  railroad  cars, 
stages,  omnibuses,  and  other  conveyances ;  but  being  a  constant  suf- 
ferer from  this  source,  I  may  perhaps  be  justifiable  in  glancing  at  it. 
especially  as  it  is  a  public  evil  as  well  as  a  private  grievance.  It  would 
seem  at  first  thought  that  any  method  of  passing  through  the  air  at  the 
rate  of  fifteen  or  twenty  miles  an  hour,  ought  to  secure  the  passenger 
fresh  air  in  abundance.  The  theory  is  beautiful,  but  it  fails  in  practice. 
Wherever  we  go,  the  tobacco-nuisance  follows  us.  We  feel  its  nar- 
cotic miasm  rank  in  every  sti-eet  of  the  city,  and  if  we  go  into  the 
countiy  it  goes  with  us.  To  be  sure,  "No  smoking  abaft  the  wheels," 
is  conspicuously  displayed  on  the  Sound  and  River  steamers;  "No 
smoking  inside  the  cars,"  is  said  or  intended  on  the  cars ;  while  on  the 
numerous  ferry-boats  conveying  constant  streams  of  people  to  and 
ft'om  the  gi'eat  emporium,  it  is  gently  intimated,  '■'■Gentlemen  are  par- 
ticularly requested  not  to  smoke  on  this  side  of  the  boat;"  still  it  fdways 
happens  that  the  evidence  of  smoking  pervades  every  part  of  the  boat 
or  car.  Those  who  stand  outside  of  the  not-to-be-smoked-in  apart- 
ment, around  the  gangways,  on  the  platform,  and  at  either  end,  con- 
trive in  some  way  or  other  to  make  the  whole  company  smell  the 
weed,  whether  they  will  or  no.  And  in  the  stages  and  omnibuses 
no  one  thinks  of  smoking  inside  without  permission,  but  the  driver, 
and  one  or  two  puffers  on  his  seat,  can  easily  give  the  passengers  a 
"comfortable  smoke,"  particularly  uncomfortable  to  some  if  the  wind 
be  against  them. 

There  is  yet  another  evil  which  ought  to  be  remedied.  There  is 
usually  in  omnibuses,  stages,  and  railroad  ears,  a  few  persons  who  cs;>' 


304  II  Y  a  I  £  N  E. 

not,  or  think  they  CHiniot,  bear  fresh  ah-,  when  *.he  weather  is  cool  or 
damp.  To  suit  their  whim,  all  the  windows  are  closed,  and  the  com- 
pany perhaps  for  an  hour  or  two  sit  inhaling  over  and  over  again  the 
confined  air,  all  the  while  becoming  more  vitiated.  The  rules  of  venti- 
'fltion  apply  to  all  rooms  and  apartments  alike,  whether  in  dwelling- 
houses  or  ti'aveling  vehicles 


CHAPTER   TI 

OF  LIGHT. 


Relation  of  Light  to  Organization — The  hygienic  import- 
ance of  light  is  not  sufficiently  undei*stood  by  the  people,  nor  its  reme- 
dial influence  sufficiently  regarded  by  physicians.  Whether  it  be  a 
distinct  imponderable  entity,  a  property  of  electi'icity,  or  something 
else,  it  would  be  idle  here  to  speculate ;  but  it  is  certain  that  the  light 
which  this  eaith  derives  from  the  sun  and  the  fixed  stai's,  has  a  power- 
fully modifying  influence  on  all  the  functions  of  its  animal  and  vege- 
table kingdoms. 

Some  plants  thrive  best  when  exposed  to  sti'ong  sunlight,  others  in  a 
moderate  light,  and  others  when  considerably  shaded,  yet  all  of  them, 
without  exception,  require  a  good  degree  of  the  influence  of  light  to 
become  hardy,  firm,  and  vigorous.  Those  which  grow  in  deeply- 
shaded  situations  or  dark  cellars  ai'e  comparatively  colorless,  slender, 
and  friable.  Light  is  the  cause  of  color  in  all  bodies  ;  it  is  entirely  re- 
flected by  white  surfaces,  and  completely  absorbed  by  black. 

Many  insects  and  fishes  while  living  are  constantly  lumhious,  in  con- 
sequence of  the  rays  of  light  being  constantly  emitted  from  various 
points  of  their  bodies ;  the  fire-fly  emits  its  sparks  from  two  oval  spots 
at  the  side  of  the  thorax ;  in  the  glow-worm  a  })hosphoresoent  bril- 
liancy issues  from  its  abdominal  rings ;  luminous  insects  are  supposed 
to  absorb  light  during  the  day,  like  the  Bononian  stone,  and  impart  it  in 
the  evening. 

Physiological  Influences  of  Light. — Plants  absorb  carbon, 
and  give  out  oxygen  or  vital  air  in  the  light;  bvt  during  the  night  this 
process  is  reversed,  so  that  they  absorb  oxygen,  and  give  out  carbon; 
hence  it  is  injurious  and  even  dangerous  to  sleep  at  night  in  a  situation 
\vhich  is  closely  surrounded  with  dense  foliage,  and  not  well  ventilated. 


LIGHT  30o 

The  nutritive  process  is  materially  checked  in  all  vegetables  and  animals 
when  deprived  of  light  for  a  considerable  time  ;  in  this  case  vegetables 
are  said  to  become  etiolated,  a  condition  analogous  to  that  called  ancemiay 
or  hypcemia,  in  man — a  state  of  debility,  bloodlessness,  and  inanition.  In 
some  of  the  lower  animals  the  process  of  metamorphosis  is  arrested 
by  deprivation  of  the  solar  iniluence.  The  tadpole,  for  example,  in- 
stead of  developing  into  the  frog,  either  continues  to  gi'ow  as  a  tadpole, 
or  degenerates  into  some  kind  of  monstrosity;  and  the  specimens  of 
human  monstrosities,  developed  abnormally,  in  consequence  of  the 
absence  of  a  due  degree  of  "Heaven's  first-born,"  are  neither  few 
nor  far  between  in  the  underground  tenements  of  large  cities. 

The  operation  of  light  on  the  animal  organism  has  always  been 
recognized  as  urging  to  exercise,  and  increasing  the  activity  of  both 
the  bodily  and  mental  powers;  while  its  absence  or  privation  disposes 
to  indolence  and  obesity.  Animals  are  more  readily  fattened  when 
kept  in  obscurity,  because  the  diminished  activity  of  the  depurating 
functions  favors  the  accumulation  of  adipose  matter.  Poultry  are  often 
confined  in  dark  places  to  augment  their  store  of  oil ;  and  the  heads 
of  geese  and  turkeys  are  sometimes  covered  by  a  hood,  or  their  eyes 
put  out,  in  order  to  procure  from  them  fat  and  greasy  livers,  as  choice 
morsels  for  depraved  epicures. 

Almost  the  entire  population  of  our  large  cities,  who  occupy  back- 
I'ooms  and  rear  buildings  where  the  sun  never  shines,  and  cellars  ana 
vaults  below  the  level  of  the  ground  on  the  shaded  side  of  narrow 
streets,  is  more  or  less  diseased.  Of  those  who  do  not  die  of  acute 
diseases,  a  majority  exhibit  unmistakable  marks  of  imperfect  develop- 
ment and  deficient  vitality ;  and,  in  fact,  as  w^ith  animals  and  vegetables 
in  like  circumstances,  often  run  into  deformities  and  monstrosities,  noi 
more  reproachful,  however,  to  those  parents  who  propagate  under 
such  disadvantages,  than  disgi*aceful  to  that  city,  state,  or  national  gov- 
ernment which  either  compels  or  permits  any  class  of  its  citizens  to  live 
in  such  abodes. 

These  facts  show  us  that  ligl  t,  and  an  abundant  supply  of  it,  is  ii:  • 
dispensable  to  a  due  development  of  all  organized  bodies. 

Therapeutic  Considerations. — Medical  men  have  always  no- 
ticed that  diseases  of  all  kinds,  from  the  most  trifling  toothache, 
quinsy,  or  rheumatism,  to  the  severest  attack  of  fever,  scrofiila,  or 
consumption,  are  much  less  manageable  in  low,  dark  apartments. 
A.nd  it  is  notorious  that,  during  the  prevalence  of  epidemics,  as  the 
cholera,  the  shaded  side  :^f  a  nan  5W  sti-e  >t  invariably  exhibits  the 
greatest  ratio  of  fatal  cases. 


306  HYGIENE. 


"  The  observations  of  Dr.  Edwards,  on  the  influence  of  light  in  pro- 
mo^ing  the  perfect  development  of  animals,  led  him  to  conclude  that 
m  climates  where  nudity  is  not  incompatible  with  health,  exposure  of 
the  whole  surface  of  the  body  to  light  is  favorable  to  the  regular  con- 
formation of  the  body;  and  he,  therefore,  has  suggested  insolation  in 
the  open  Jiir  as  a  means  calculated  to  restore  healthy  conformation  to 
children  affected  with  scrofula,  whose  deviations  of  form  do  not  appear 
CO  be  incurable." 

Pereira  says ;  "  As  in  bright  solar  light  we  feel  more  active,  cheer- 
ful, and  happy,  while  obscurity  and  darkness  give  rise  to  a  gloomy  and 
depressed  condition  of  mind,  so  we  employ  isolation  in  the  open  air  as 
a  mentnl  stimulus  in  melancholy,  lowness  of  spirits,  and  despondency  " 

Sanatory  Ikferences. — The  inferences  deducible  from  the  fore- 
going considerations  ai'e  sufficiently  obvious.  All  persons,  in  order  to 
acquire  and  maintain  the  best  condition  of  health  and  strength,  should 
te  frequently  exposed  to  the  light  of  the  sun,  except  when  oppressively 
hot.  Children  are  generally  maltreated,  more  especially  in  cities,  in 
being  kept  almost  entirely  excluded  from  sunshine.  Many  good  moth- 
ers are  more  fond  of  the  delicate  faces  and  pale  complexions  of  their 
little  ones,  than  intelligent  in  relation  to  their  physiological  welfare.  A 
little  sun-browning  occasionally  of  their  faces,  necks,  hands,  and  feet, 
and,  finally,  of  their  whole  bodies,  would  not  only  render  their  devel- 
opment more  perfect  and  enduring,  but  tend  to  the  production  of  the 
gi'eatest  symmetry  and  beauty  in  manhood  and  womanhood.  Parents 
should  not  be  too  careful  in  putting  umbrella-hats  and  bonnet-sun- 
shades on  the  heads  of  their  children  every  time  they  run  out  of 
doors. 

Almost  all  persons,  young  or  old,  who  live  in  cities,  can  invigorate 
the  skin  and  improve  the  genera'  health,  by  fi-equent  exposures  of  the 
whole  body  to  the  air  of  a  well-lighted  room,  applying  moderate  fric- 
tion to  the  surface  at  the  same  time.  Light  as  well  as  air  is  generally 
excluded  from  the  sm'face  by  too  much  or  too  tight  clothing,  which  evil 
Buch  exposures  in  some  degree  would  counteract. 

Dwelling-houses  ought  to  be  constructed  with  esprcial  reference  to 
ight.  Those  rooms  which  are  most  occupied  should  be  the  best  light- 
ed, as  the  kitchen  and  sitting-room.  The  sun  should  be  allowed  free 
access  to  the  yard  and  out-grounds.  Shade-trees  and  shrubbery,  use- 
ful to  some  extent  around  the  dwelling,  should  never  be  so  thick  as  to 
shut  the  direct  rays  of  the  sun  out  entirely.  The  influence  of  light  in 
dissipating  and  decomposing  noxious  vapors  and  deleterious  gases,  whicb 
collect  in  and  around  low  grounds  and  dark  pla:es,  is  very  great. 


DRINK,  307 

The  sudden  exliilaration  and  invigoration  experienced  by  the  pent- 
up  denizens  of  our  large  towns,  when  they  go  from  their  dim  count 
mg-rooms,  gloomy  offices,  and  basement  workshops,  to  rusticate  a  few 
days  in  mountainous  regions,  is  due  nearly  as  much  to  the  greater 
stt-ength  of  tho  oatural  light  as  to  the  greater  purity  of  the  air. 


CHAPTER  III. 

OF  DRINK. 


Nature's  Beverage. — Nature  has  provided  no  other  dnnk  for 
man,  nor  for  animals,  nor  for  vegetables,  than  pure  water ;  and  no 
animal  but  man  seeks  any  other  either  as  a  beverage  or  as  medicine 
Its  value  as  a  beverage  is  in  all  cases  in  proportion  to  its  purity.  In 
plants  water  is  employed  as  a  vehicle  to  convey  the  nutrient  element* 
absorbed  by  the  roots  throughout  their  various  sti'uctures.  In  animals 
provided  with  a  stomach  for  receiving  aliment,  it  is  the  medium  by 
which  the  materials  of  nuti'ition  are  conveyed  to  all  parts  of  the  body, 
and  the  waste  matters  carried  away.  Milk,  which  constitutes  the  prin- 
cipal food  of  the  young  mammal  until  the  teeth  are  developed,  contains 
about  ninety  parts  of  water  in  a  hundred,  and  though  often  employed 
as  a  leverage  by  adults,  is  properly  regarded  as  food.  All  the  diluent 
preparations,  which  fill  so  large  a  space  among  medical  prescriptions, 
owe  their  whole  powers  of  dilution  to  the  water  alone. 

Is  Man  a  Drinking  Animal  ? — The  question  whether  man  is  by 
nature  a  drinking  animal,  or  whether  the  water  required  for  his  organ- 
ism is  sufficiently  supplied  in  his  natural  food,  has  been  raised  within 
the  kst  half  century.  Dr.  Lambe,  of  England,  has  very  ably  argued 
the  negative  of  the  first  position  named ;  but  the  majority  of  dietetic 
wi-iters  hold  the  opposite  opinion.  It  is,  however,  perfectly  certain — 
and  the  fact  has  been  proved  by  the  direct  experiments  of  Dr.  Alcott 
and  others — that  those  who  adopt  a  regimen  exclusively  vegetable,  and 
make  a  large  proportion  of  their  food  to  consist  of  succulent  fruits  and 
watery  vegetables,  c^n  be  healthfully  sustained  and  nourished  without 
water-drinking.  It  is  also  certain  that  those  who  eat  much  animal 
food,  use  salt,  spices,  and  greasy  dishes  freely,  and  who  have  to  employ 
a  large  proportion  of  concentrated  farinaceous  substances — which  is 
indeed,  the  genei-al  plan  of  the  dietarj^  sj^s'em  of  civilized  society — 


508  YGIENE. 

requii'e  a  large  amount  of  water  to  carry  off  the  saline  particles  ai  J 
other  impurities,  and  allay  the  artificial  fever  which  they  produce.  \a 
either  case  the  thirst  is  the  safe  rule  of  practice. 

Quantity  a>d  Times  of  Water-Drinking. — Writers  are  re- 
markably discordant  in  their  notions  as  to  the  quantity  of  water  a  per- 
son should  take  into  the  stomach,  and  also  as  to  the  times  for  taking  ii. 
Some  think  we  should  drink  as  little  as  possible ;  others  are  of  opinion 
that  we  should  swallow  all  we  can  ;  one  class  of  writers  recommends 
all  drinking  to  be  done  between  meals,  and  another  class  advises  us  to 
drink  abundantly  at  meals.  It  is  easy  to  discover  the  sources  of  these 
discrepancies.  Writei's  are  too  apt  to  deduce  general  inferences  fi'om 
individual  peculiarities.  What  is  precisely  right  for  one  person  may 
be  exactly  wi'ong  for  anotlier.  If  the  dietetic  and  other  voluntary 
habits  of  all  people  were  strictly  physiological,  we  could  give  tliem  all 
a  rule  without  exceptions,  and  the  same  rule.  But  the  quantity'  of 
water  useful  or  necessary  depends  on  all  the  habits  of  life,  amount  of 
exercise,  quality  of  food,  the  employment  of  stimulants,  condiments, 
etc.  The  kind  of  occupation  also  affects  the  question ;  for  example,  a 
person  laboring  in  a  dry,  warm  atmosphere  will  require  more  drink 
than  one  working  in  a  cool,  moist  air. 

The  amount  of  water  contained  in  the  various  alimentary  substances 
in  common  use,  shows  the  relation  which  the  quantity  of  the  water 
necessaiy  to  employ  as  drink  bears  to  the  kind  of  food.  Thus,  in  one 
hundred  parts  (rejecting  fractions)  water  constitutes,  of  gum  arable  17 
sugar-candy  10,  aiTOw-root  ]  8,  wheat  14,  lye  16,  oats  20,  barley  13 
maize  13,  peas  16,  beans  14,  lentils  15,  potatoes  75,  turnips  92,  carrots 
87,  beets  87,  artichoke  79,  white  cabbage  92,  black  bread  32,  beef  tea 
98,  blood  80,  fi-esh  lean  meat  of  beef,  mutton,  veal,  pork,  deer,  chicken, 
and  pigeon  74  to  78,  cod,  hadi^ock,  sole,  cai'p,  and  ti'out  79  to  82,  ox's 
liver  68,  calf's  sweet-bread  70,  white  of  egg  68,  yolk  of  egg  85,  cow's 
milk  87,  human  do.  87,  goat's  do.  86,  ass's  do.  91,  ewe's  do.  85. 

The  quantity  of  water  contained  in  aliments,  however,  does  not  de- 
termine their  nutritive  power,  for  some  substances,  as  butter  and  hog's 
lard,  contain  scarcely  any  water,  yet  are  capable  of  supplying  the  body 
with  much  less  nourishment  than  milk,  which  is  about  seven  eighths 
water. 

As  to  the  best  times  for  drinking,  it  is  not  difficult  to  give  a  general 
rule;  but  people  who  live  variously  must  vary  it  accordingly.  Un- 
questionably the  best  time  for  water-drinking,  as  a  habit,  is  when  the 
stomach  is  entirely  empty — on  first  rie'mg  in  the  morning,  and  half  an 
hour  or  an  hour  before  meals      Persons  who  take  habitually  a  tumbler 


DRINK.  309 

of  puro  water  at  those  times,  and  eat  plain  food,  will  seldom  expe- 
rience much  thirst ;  but  those  who  employ  thirst-provoking  aliments 
or  seasonings  should  assuage  that  thirst  by  water-drinking,  even  at 
meals.  Th^lj^  are  many  morbid  conditions  of  the  system  in  which  it 
is  advisable  to  drink  freely,  even  at  meals,  and  without  regard  to  thirst, 
Jnut  these  will  be  more  appropriately  considered  hereafter.  One  rale, 
however,  of  almost  universal  application  for  dietetic  or  remedial  pur- 
poses is,  never  to  drink,  either  at  meals  or  at  other  times,  to  the  extent 
ol  producing  any  decidedly  uncomfortable  heaviness,  distention,  or  op- 
pression of  the  stomach.  Those  who  have  weakened  their  digestive 
powers,  and  rendered  the  sensibility  of  the  nervous  system  morbidly 
acute  by  the  use  of  tea,  coffee,  etc.,  should  accustom  the  stomach  to 
the  impression  of  cold  water  gradually,  beginning  with  only  a  part  of 
a  tumbler,  and  increasing  the  quantity  as  the  tone  of  the  digestive 
organs  improves. 

Temperature  of  Drink  —Cool,  but  not  very  cold  water  appeal's 
to  be  most  perfectly  adapted  to  all  the  purposes  of  the  animal  economy. 
Without  doubt  the  human  system  possesses  a  wide  range  of  adaptabil- 
ity, and  can,  provided  the  general  habits  are  reasonably  correct,  be 
very  well  sustained  on  water  rather  warm  or  veiy  cold.  It  is  well 
known  that  in  the  hot  season,  particularly  in  our  cities,  many  laborers 
die  very  soon  after  drinking  freely  of  iced-water.  This  matter  ought 
to  be  well  understood,  for  there  is  surely  no  necessity  for  any  one  to 
die  in  this  ^vay.  It  is  not  the  iced-water  alone  that  destroys  them, 
but  this  proves  an  exciting  cause  when  the  system  has  been  brought 
into  an  unfavorable  state  of  vital  resistance.  I  never  knew  or  heard 
of  any  person  dying  or  being  seriously  injured  by  the  free  use  of  iced- 
water — ^as  free  as  the  thirst  demanded — who  was  temperate  and  sim- 
ple in  all  his  eating  and  drinking  habits.  All  who  are  fatally  injured  by 
ilrinking  iced-water,  as  fiir  as  I  have  been  able  to  observe,  or  can  learn 
from  others,  are  among  those  who  use  some  kinds  or  combinations  of 
dietetic  articles  which  provoke  a  great  degi-ee  of  factitious  thirst;  for 
example,  baker's  bread,  and  butter,  stale  salted  meat,  as  ham  or  cod- 
fish, old  cheese,  plum-pudding,  etc.  Of  course  such  persons  feei  a 
necessity  for  drinking  freely,  and  as  iced-w^ater  seems  a  grateful  anti- 
dote to  the  feverishness  artificially  produced  in  the  stomach,  they  are 
apt  to  indulge  injuriously.  There  is  no  safety  for  such  persons,  except 
in  either  eating  wholesome  food,  which  does  not  provoke  thirst,  or  in 
drinking  water  of  a  moderate  temperature.  But  the  great  danger  is 
with  those  who,  in  addition  to  the  bad  diet  just  mentioned,  add  the 
poison  of  intoxicating  drinks.     In  fact,  very  few  die  in  consequence  oi 


810  HYGIENE. 


irinkiug  cold  water  in  hot  weather,  except  those  more  or  less  addicted 
to  alcoholic  stimulants — probably  not  more  than  one  in  ten.  The  tend- 
ency of  all  forms  of  alcoholized  beverages — from  soft  wines  and  ales  to 
small  beers  and  porters,  and  from  hai'd  ciders  and  rough  brandies  to 
harsh  rums  ancj  strong  gins — is  to  weaken  and  paialj'ze  the  nerves  of 
the  stomach ;  and  when  these  exhausted  nerves  are  suddenly  chilled 
by  a  large  draught  of  cold  water,  it  is  not  wond  i^nul  that  reaction  does 
not  take  place,  nor  that  death  ensues. 

Artificial  Drinks. — Under  this  head  I  purpose  to  speak  briefly 
of  a  variety  of  made-up  drinks,  some  of  which  are  intended  as  luxu- 
ries, others  as  medicines.  "  Ardent  spirits,  malt  liquors,  wine  and 
cider,"  specially  anathematized  by  name  and  nature,  and  deservedly 
excommunicated  fi*om  use  and  fellowship  by  the  total  abstinence  soci- 
eties, I  need  not  dweU  upon.  They  ai'e  poisons,  in  every  sense  inim- 
ical to  the  human  constitution ;  in  fact,  deleterious  to  every  organizea 
thing  in  existence,  and  are  produced  only  fi-om  the  decay,  destniction, 
and  decomposition  of  the  products  of  organized  matters.  They  d« 
serve  commemoration  only  for  the  mischiefs  they  have  done,  and  ex 
ecration  only  for  the  miseries  they  are  now  inflicting  on  human  society 
I  cannot,  however,  refrain  from  uttering  a  word  of  lamentation  in  this 
place,  and  expressing  my  regret  and  astonishment  that  there  should  be 
any  found  in  this  enlightened  day  and  countiy,  and  among  tlie  leaders 
of  mankind,  especially  among  medical  gentlemen  and  Chi'istian  minis- 
ters, who  profess  to  guide  the  body  to  health  and  the  soul  to  heaven — 
w^ho  profess  to  take  true  science  and  the  Bible  as  their  guides,  yet  who 
not  only  indulge  in  the  intoxicating  bowl  themselves,  but  even  com- 
mend it  to  their  fellow-creatures  !  Surely  the  number  of  clergymen 
who  have  fallen  from  their  pulpits  in  consequence  of  misinterpreting 
Paul's  advice  to  Timothy,  and  the  number  of  physicians  who  have 
filled  drunkard's  graves,  ought  to  admonish  them  that  "wine  is  a 
mocker,  and  strong  drink  is  raging." 

Tea  possesses  sti'ong  nervine  and  moderate  narcotic  properties,  and 
considerable  astringency,  due  to  the  presence  of  tannin.  All  the 
properties  of  tea  are  subject  to  much  vai'iation.  Usually  the  green 
teas  possess  more  astringency  than  the  black ;  they  are  also,  as  found 
in  our  markets,  to  a  great  extent  adulterated  with  coloring  matter, 
commonly  Prussian  blue.  The  less  injurious  effects  of  blacK  teas 
evidently  depend  on  their  pui-er  quality  and  weaker  strengtn,  as  a 
concentrated  exti'act  of  either  is  powerfully  and  equally  poisonous.  It 
is  amusing  to  read  the  conflictijig  testimonies  of  medical  authors  re- 
si>pcting  the     perative  effects  of  f  ?a  as  a  beverage,  ar  \  wc  sometimes 


DRINK.  311 

find  conflicting  opinions  expressed  by  the  sam5  author.  Thus  says 
Pereira :  "  Strong  green  tea  produces  on  some  constitutions,  usually 
those  popularly  known  as  nervous,  very  severe  effects.  It  gives  rise 
to  ti-emor,  anxiety,  sleeplessness,  and  most  distressing  feelings.  On 
others,  however,  none  of  these  symptoms  ai-e  manifested.  Part  of 
the  ill  eflects  sometimes  ascribed  to  tea  may  be  owing  to  the  use  of  so 
much  aqueous  liquid,  to  the  temperature  of  the  liquid,  to  milk  and 
sugar  used  with  it,  or  to  the  action  of  tannin  on  the  digestive  liquid. 
But,  independently  of  these,  tea  possesses  a  specific  and  marked  in- 
fluence over  the  functions  of  the  brain,  not  referable  to  any  of  the 
circumstances  just  alluded  to.  The  influence  of  tea,  especially  the 
green  variety,  over  the  nervous  system,  is  analogous  in  some  respects 
to  that  of  foxglove,  for  both  green  tea  and  foxglove  occasion  watchful- 
ness, and  act  as  sedatives  on  the  heart  and  blood-vessels." 

This  appears  to  read  plain  enough,  but  in  the  next  preceding  para- 
graph the  same  author  has  told  us .  "  Notwithstanding  the  extensive 
employment  of  tea  in  this  country,  it  is  no  easy  matter  to  ascertain  its 
precise  eflect  on  the  constitution." 

Professor  C.  A.  Lee,  of  this  city,  says:  "A  very  strong  decoction 
of  green  tea,  or  the  extract,  speedily  destroys  Hfe  in  the  inferior  ani- 
mals, even  when  given  in  very  small  doses.  The  strongly-marked 
effects  of  tea  upon  persons  of  a  highly  nervous  temperament,  in  caus- 
ing wakefulness,  ti'emors,  palpitations,  and  other  distressing  feelings, 
prove  also  that  it  is  an  agent  of  considerable  power,  and  should  not  be 
used  to  any  great  extent  by  persons  of  such  a  habit.  It  not  unfre- 
quently  occasions  vertigo  and  sick  headache,  together  with  a  sinking 
sensation  at  the  pit  of  the  stomach  shortly  after  eating.  It  is  also  op- 
posed to  an  active  nutrition,  and  should,  therefore,  be  used  with  great 
moderation  by  tliose  who  are  very  thin  in  flesh." 

These  facts  are  usefuito  us,  but  the  medical  prescription  can  be 
greatly  improved  upon.  If  the  extreme  effects  of  tea  are  manifested 
by  the  susceptihle  constitutions,  the  principle  is  clear  enough  that  all 
constitutions  suffer  from  it,  though  in  a  less  ""egree.  Instead  of  recom- 
mending "nervous"  and  "thin"  persons  to  use  it  with  moderation,  the 
true  physician,  who  values  truth  too  highly  to  compromise  it  with  false 
customs,  will  advise  its  total  disuse. 

Schwaan  found  by  experiment  that  tannin,  wlien  mixed  with  arti- 
ficial digestive  liquids,  threw  down  a  precipitate,  and  rendered  the 
fluids  inert.  The  effect  of  the  tannin  upon  the  gastric  juice  may  ac- 
count in  part  for  its  influence  in  promoting  indigestion. 

It  is  certain  that  females,  on  account  of  their  in-door  occupations 
nir>re  sedentary  habits,  suffer  incom[)arabIy  more  from  this,  rlieir 


312  HYGIENE. 


favorite  beverage,  than  males  do ;  and  I  am  inclined  to  think  that  the 
hot  water  is  nearly  or  quite  as  deleterious  as  the  herb,  as  the  infusion 
is  usually  drank.  From  a  pretty  close  observation,  too,  I  am  fully  sat- 
isfied that  the  general  prevalence  of  "female  weaknesses" — a  phrase 
including  an  extensive  and  formidable  class  of  ailments — are  in  a  great 
measure  atti'ibutable  to  warm  teas. 

Almost  every  kind  of  herb  that  grows,  except  those  which  are 
really  nutritious,  or  are  violently  poisonous  to  the  stomach  and  bowels, 
preternaturally  excites  the  action  of  the  kidneys  and  urinary  oigans ; 
or,  to  speak  more  physiologically,  the  kidneys  are  the  excretory  oriiaus 
mtended  to  throw  off  a  great  part  of  such  foreign  or  ^vaste  material  as 
is  contained  in  infusions  and  decoctions  of  herbs.  Very  warm  drinks 
are  in  themselves  debilitating  to  the  stotnach,  but  the  addition  of  tlio 
pro}>erties  of  the  tea  or  other  herb  burdens  tlie  kidneys  and  urinary 
apparatus  with  an  unnatural  amount  of  labor  continually.  These  or- 
gans, kept  constantly  over-excited,  must  become  debilitated,  and  j)re- 
ternaturally  irritable ;  and  this  condition  of  debilit}'  and  irritability  ex- 
tends sympathetically  to  all  the  surrounding  viscera;  finally,  the 
abominid  muscles  themselves  become  relaxed,  and,  with  the  general 
nervous  exhaustion  produced  by  the  active  nervine  and  narcotic  j)rop- 
erties  of  the  tea  throughout  tlie  system,  a  foundation  is  laid  fur  tiuj 
whole  train  of  maladies,  displacements  of  organs,  and  disordered  func- 
tions, which  are  so  general  among  females  of  the  present  day. 

The  history  of  these  complaints,  and  the  history  of  artificial  bever- 
Hges,  paiticulai'ly  the  employment  of  hot  tea  and  coffee,  show  that 
ihere  has  been  an  intimate  connection  between  the  origin,  progress, 
and  prevalence  of  those  diseases  and  these  beverages.  Fifty  or  an 
liundred  years  ago  these  complaints  were  comparatively  rare.  IMoth- 
ers  in  those  days  did  not  commence  tea- drinking  in  childhood;  their 
bodies  were  nearly  developed  and  their  constitutions  well  forioe  I 
before  their  mothers  allowed  them  to  indulge  in  enervating  slops. 
But  now  tea-drinking  commences  sometimes  before  the  period  of 
childhood — in  babyhood.  I  have  seen  a  regular  tea-toper  in  a  baby 
under  two  years  of  age.  It  is  very  common  in  these  days  for  chil- 
dren of  five  and  six  years  of  age,  little  girls  especially,  to  drink  their 
two  cups  of  tea  or  coflfee  morning  and  evening.  Is  it  wonderful  that 
in  early  youth  they  are  precocious  in  infirmities,  and  become  chlorotic 
or  cachectic,  and  complain  of  spinal  irritation,  mismensti-uation,  ner- 
vous debility,  and  a  train  of  local  affections  wholly  unknown  in  simple 
or  in  savage  life  ? 

Coffee  possesses  the  same  nervine  and  narcotic  properties  as  tea, 
without  its  nstringency.     It  nsnally  acts  as  a  laNarive  to  the  bowels  for 


DRINK.  313 

awhile  in  those  unaccustomed  to  its  use  ;  ;)ut  its  long-continued  em- 
I^loyment  always  results  in  constipation.  Its  operative  effects  ai-e,  in 
most  persons,  rather  more  exciting  and  disturbing  to  the  meiital  and 
orgfmic  functions  *han  those  of  tea.  Most  persons  who  accurately  no- 
tice their  feelings  under  its  influence,  find  a  greater  derangement  of 
the  digestive  functions  and  the  secretion  of  the  liver,  than  results  from 
the  use  of  tea.  From  all  the  testimony  I  can  gather  from  medical 
and  dietetical  writers,  coupled  with  some  degree  of  personal  observa- 
tion, I  should  judge  it  to  be  more  directly  injurious  to  the  digestive 
process,  and  more  exhausting  to  the  general  nervous  energy,  than  tea, 
fmd  less  injurious  to  the  kidneys  and  pelvic  viscera. 

Medical  authorities  are  as  self-conti-adictory  in  regard  to  coffee  aa 
they  are  about  tea.  Pereira  says  :  "  Employed  moderately,  I  believe 
it  to  be  a  wholesome  and  slightly  nutritive  beverage."  But  in  the 
same  paragi-aph  Pereira  continues  :  "The  immoderate,  use  of  coffee  is 
said  to  produce  various  nervous  disorders,  such  as  anxiety,  tremor, 
disordered  vision,  palpitation,  and  feverishness."  Professor  Lee  speaks 
like  a  man  who  loves  a  good  cup  of  the  exhilarating  decoction.  He 
says :  "  We  should  consider  that  cordials  and  stimulants  are,  at  least 
occasionally,  useful,  and  that,  whether  useful  or  not,  mankind  always 
have,  and  probably  always  will,  make  use  of  theni.  But  of  all  those 
which  have  hitherto  been  inti'oduced,  none,  perhaps,  combine  so  many 
excellent  with  so  few  evil  qualities  as  that  of  coffee.  To  moderately 
nutritive  properties  it  adds  those  of  a  mild  and  cordial  stimulant,  with- 
out producing  those  peculiar  narcotic  effects  which  so  often  accompany 
the  use  of  strong  green  tea." 

The  eulogy  of  Dr.  Lee  is  out-eulogied  by  Abd-al-Kadir  Anasari 
Djezeri  Hanbali,  son  of  Mahomniet :  "  O  cofi'ee !  thou  dispellest  the 
cares  of  the  gi-eat ;  thou  bringest  back  those  who  wandei*  from  the 
paths  of  knowledge.  Coffee  is  the  beverage  of  the  people  of  God, 
and  the  cordial  of  His  servants  who  thirst  for  wisdom.  When  cofffeo 
is  infiised  into  the  bowl,  it  exhales  the  odor  ofinusk,  and  is  of  the  color 
of  ink.  The  truth  is  not  known  except  to  the  wise,  who  drink  it 
from  the  foaming  coffee-cup.  God  has  deprived  fools  of  coffee,  who, 
with  invincible  obstinacy,  condemn  it  as  injurious." 

Chocolate,  though  destitute  of  the  nervine  properties  of  tea  and 
coff"ee,  contains  a  large  proportion  of  fat  or  oil,  called  butter  of  cacao, 
wliich  is  difficult  of  digestion,  and  particularly  injurious  to  dyspeptic 
stomaclis.  Chocolate  is  prepared  from  the  seeds  of  the  thcohroma 
cacao,  a  native  plant  of  the  West  Indies  and  Central  America.  The 
kernels  of  the  roasted  seeds  are  ground  in  a  mill,  whose  sole  rests  on 
a  heated  iron  plate,  by  which  they  are  made  into  a  brown  pasty  mass, 
1—27 


B14  HYGIENE. 


then  sweetened  with  sugar  or  honey,  mixed  more  or  less  with  sago, 
flour,  or  starch,  and  generally  flavored  with  vanilla  or  cinnamon. 

Chickory,  or  suckory,  is  a  preparation  of  the  roasted  roots  of  a  plant 
called  wild  succory,  or  u-ild  cndine,  which  is  cultivated  in  HoUcnd, 
Belgium,  and  Germany.  It  is  used  to  adulterate  coffee,  and  a  spu- 
rious article  is  sold  for  chickory,  made  of  roasted  peas  and  beans,  dam- 
aged corn,  and  coffee  husks,  and  colored  with  Venetian  red  or  Arme- 
nian bole. 

Cocoa  is  another  preparation  of  the  seeds  of  the  theobroma  cacao ; 
it  is  somewhat  less  greasv  than  chocolate,  but  has  no  other  advantage. 

There  are  a  great  variety  of  acidulous  drinks  in  popular  use.  Most 
of  them  are  prepared  juices  of  fruits  and  sugar,  as  lemonade,  apple-tea. 
Bottle  soda-water,  as  generally  prepared,  is  merely  a  mixture  of  car- 
bonic acid  gas  in  sweetened  water.  These  beverages,  in  a  hygienic 
point  of  view,  ppssess  but  little  importance.  The  only  reason  that  the 
appetite  demands  them  is,  because  the  sense  of  tciste  is  so  torpified  by 
stimulating  food  and  seasonings,  that  it  cannot  relish  simple  water ; 
still,  they  cannot  be  considered  quite  as  healthful  as  pure  water.  Ef- 
fervescivg  preparations  of  soda  and  tartai'ic  acid,  and  of  seidlit'z  pow- 
ders, are  decidedly  injurious  as  common  beverages,  because  they 
inti'odui  e  into  the  system  a  large  quantity  of  debilitating  nrutral  salts. 
Ginger  and  root  beers  have  had  an  extensive  employment  among  pop- 
ulai'  beverages.  The  latter  is  rendered  pungent  by  yeast  fermenta- 
tion, which  develops  from  two  to  four  per  cent,  of  alcohol ;  this,  of 
course,  is  against  its  healthfulness ;  but  as  such  preparations  will  not 
keep  but  a  very  few  days  without  becoming  sour,  the  manufacturer 
often  linds  it  profitable  to  add  an  additional  quantity  of  alcohol.  These 
drinks  are  trash  at  best,  and  worse  than  useless  in  their  tendency  to 
keep  up  artificial  appetences,  requiring  strong,  pungent,  or  gross  bev- 
erages to  satisfj'. 

In  relation  to  the  nilder  kinds  of  malt  liquors,  small  beer,  or  table 
heer,  as  it  is  called,  j^orter,  pale  ale,  and  brown  stout,  Pereira  talks  pre- 
cisely like  an  "  old-fashioned  English  gentleman."  I  quote  Pereim 
mostly,  because  he  is  the  latest  and  most  approved  author  on  dietetics 
as  well  as  materia  medica  in  the  allopathic  school.  He  says:  "The 
practice  of  taking  a  moderate  quantity  of  mild  malt  liquor,  of  sound 
quality,  at  dinner,  is  in  general  net  only  unobjectionable,  but  benefi- 
cicd.  Considered  dietetically,  beer  possesses  a  tln*ee-fold  property* :  it 
quenches  thirst;  it  stimulates,  cheers,  and,  if  taken  in  sufliicieut  quan- 
tity, intoxicates;  and,  lastly,  it  noui'isbes  or  sti'engthens."  Surely  his 
admiration  of  the  virtues  of  grog  was  not  excelled  by  that  of  the  toper, 
who  found  it  amply  suflficient  for  food,  drink,  and  lodging.     Who  can 


DRINK.  315 

wonder  that  druLkenness  is  the  distinctive  v:ce  of  Christendom,  when 
the  professors  of  the  healing  art  teach  such  ridiculously  false  doc- 
trines ?  But  let  us  quote  also  Pereira's  reasoning :  "  Its  power  of 
appeasing  thirst  depends  on  the  aqueous  ingredient  (water)  which  it 
contains,  assisted  somewhat  by  its  acidulous  constituent.  Its  stimulat- 
ing, cheering,  ov  intoxicating  power  is  derived  either  wholly  or  prin- 
cipally from  the  alcohol  which  it  contains.  Lastly,  its  nutritive  or 
strengthening  quality  is  derived  from  the  sugar,  dexti-ine,  and  other 
substances  contained  in  the  extract.  Moreover,  the  bitter  principle  of 
hops  confers  on  beer  tonic  properties."  If  the  reader  can  discover  in 
such  reasoning  any  thing  but  the  veriest  nonsense,  I  confess  he  has 
the  advantage  of  me. 

Different  Kinds  of  Natural  Waters. — The  natural  waters  of 
the  globe  have  been  classed  into  common  waters,  comprising  rain,  spring, 
river,  well  or  pump,  lake,  and  marsh  waters ;  sea  ivaters,  including 
the  ocean  and  the  salt  lakes  or  inland  seas ;  and  mineral  waters,  to 
which  class  belong  all  the  springs,  sti'eams,  or  pools  usually  regarded 
as  medicinal. 

Rain  water  is  the  purest  of  all  natural  waters.  When  collected  in 
cities,  it  is  more  or  less  impure  at  the  commencement  of  the  shower, 
from  admixture  with  foreign  matters  suspended  in  the  atmosphere, 
and  is  often  loaded  with  the  particles  washed  from  the  roofs  of  the 
buildings.  After  several  hours  of  continuous  rain  in  cities,  and  a  much 
shorter  time  in  country  places,  it  -jomes  down  almost  perfectly  pure. 
Air  is  a  constant  constituent  of  or  admixture  with  rain  water,  and  it 
contains  a  slight  trace  of  carbonate  of  ammonia,  which  is  probably  a 
product  of  animal  decomposition,  and  the  cause  of  rain  water  so  read- 
ily running  into  the  putrefactive  process.  Snow  water  does  not  differ 
materially  from  rain  water,  except  in  not  containing  air.  That  it  is 
injurious  to  health  has  long  been  a  vulgar  error;  eating  snow,  how- 
ever, does  not  quench  thirst ;  but  melted  snow  is  as  efficacious  for  this 
pm'pose  as  rain  water. 

Spring  ivater  only  differs  from  rain  water  in  having  percolated 
through  the  earth,  and  ha.ving,  during  its  passage,  either  imparted 
some  of  the  particles  it  held  in  solution  to  the  soil,  or  taken  up  soluble 
matters  from  the  soil,  or  both.  Its  properties  will  therefore  depend 
entirely  upon  the  nature  of  the  soil.  A  majority  of  the  springs  in  the 
United  States  are  hard,  owing  to  earthy  and  saline  matters,  the  most 
common  of  which  are  sulphate  and  carbonate  of  lime.  There  are, 
however,  many  sojl  water  springs ;  enough,  in  fact,  to  answer  all  the 
drinking  purposes  of  as  dense  a  population  as  the  country  can  sustain, 


Sl«  HYGIENE. 


if  it  were  conveyed  to  and  distributed  among  the  dwellings.  The 
people  in  the  country  are  generally  singularly  inattentive  to  the  im- 
portant njatter  of  providing  themselves  with  pure  soft  w^ater.  They 
are  very  apt  to  get  their  supply  from  the  most  convenient  spring,  in- 
stead of  the  best.  If  they  fully  appreciated  the  importance  of  good 
water,  they  would  not  locate  the  dwelling-house  until  they  had  located 
the  spring  or  well. 

River  water  is  an  admixture  of  rain  and  spring  water ;  it  always 
holds  in  suspension  a  greater  or  less  amount  of  exti'aneous  matter,  and 
in  and  ai'ound  cities  is  strongly  contaminated  with  decomposing  animal 
and  vegetable  mattei-s.  Much  of  the  river  water  in  this  countiy,  as  it 
runs  through  the  spai-ely-populated  districts,  is  compai'atively  quite 
pure  and  healthful. 

The  \^  ^iter  of  the  Thames,  and  in  the  vicinity  of  London,  contains, 
as  impurities,  about  20  grains  of  solid  matter  to  the  gallon.  Of  this, 
carbonate  of  lime  constitutes  about  16  gi'ains,  and  sulphate  of  lime  and 
common  salt  about  3;^  grains. 

The  Croton  water  of  New  York  contains  but  a  ti-ifle  over  four 
grains  of  solid  matter  to  the  gallon,  only  a  grain  and  a  half  of  this 
being  carbonate  of  lime  ;  sulphate  of  lime,  the  chlorides  of  calcium 
and  magnesium,  and  the  carbonate  of  magnesia  constitute  a  little  over 
two  grains.  The  Cochituate  water  of  Boston  is  equally  as  pure,  and 
the  Schuylkill  of  Philadelphia  nearly  as  pure. 

Previous  to  the  inti'oduction  of  the  Croton  river,  the  Manhattan 
water  supplied  to  our  citizens  contained,  in  Chambers  and  Reade  streets 
125  grains  of  impurities  to  each  gallon ;  in  Bleecker-sti'eet  20  grains ; 
and  in  Thiiteenth-street  14  grains.  Some  of  the  weUs  in  the  lower 
part  of  the  city  contained  58  grains.  The  water  in  the  wells  of  Bos- 
ton and  Philadelphia  were  in  no  better  condition. 

The  usual  results  of  drinking  very  hard  waters,  and  those  strongly 
impregnated  with  the  exuviae  of  animal  and  vegetable  substances,  are 
sevoe  dysenteries  or  protracted  dian'heas,  and  chronic  aftections  of 
the  kidneys. 

Weil  water  is  generally  more  impregnated  with  earthy  salts,  espe- 

!  cially  bicarbonate    and   sulphate  of  lime,  than   river  water,  or  even 

t  spring  water.     Its  hardness  is  shown  by  its  curdling  and  decomposing 

':  soap,  instead  of  mixing  with  it  readily  and  forming  a  suds,  as  will  soft 

water.      Sulphate  of  lime  (gypsum,  plaster  of  Pai'is)  is  a  frequent 

cause  of  diarrhea. 

I       Horses  manifest  su:li  an  instinctive  repugnance  to  hard  water,  that 

they  will  drink  out  of  a  ti'^iid  and  muddy  pool,  provided  its  water  is 


DRINK.  81'! 

soft^  in  preference  to  partaking  of  the  clearest  and  most  transparent 
water,  if  it  be  hard. 

Lake  water  is  generally  very  impure,  being  a  collection  of  rain, 
river,  and  spring  water,  contaminated  with  puti-efying  animal  and  veg- 
etable matters. 

Marsh  water  is  similar  to  lake  water,  but  still  more  loaded  with 
offensive  and  putrescent  organic  matters.  The  stench  arising  from 
marshy  and  swampy  grounds,  which  are  occasionally  inundated  from 
the  sea,  is  owing  to  the  decomposition  of  the  sulphates  of  the  sea  wa- 
ter by  the  puti-efying  vegetable  matters,  which  process  evolves  the 
intolerable  sulphureted  hydrogen  gas. 

Sea  water  contains  on  the  average  3i  per  cent,  of  solid  matter. 
The  amount  varies  considerably  in  different  seas,  and  in  different  parts 
of  the  same  sea.  Its  composition  also  varies  in  different  localities. 
An  analysis  of  1000  grains  of  the  water  of  the  Mediterranean  gave 
the  following  result :  Water  959.26,  chloride  of  sodium  (common  salt) 
27.22,  chloride  of  potassium  0.01,  chloride  of  magnesium  6.14,  sul 
phate  of  magnesia  7.02,  sulphate  of  lime  0.15,  carbonate  of  lime  0.20. 
Iodine,  and  bromide  of  magnesium  have  been  found  in  some  sea  waters. 

Taken  into  the  stomach,  sea  water  excites  thirst,  nausea,  and,  in 
large  doses,  vomiting  and  purging. 

Mineral  waters  are  classed  according  to  the  character  of  their  pre- 
vailing impurities.  Those  whose  predominating  active  principle  is  iron 
are  called  chalybeate  or  ferruginous.  Sulphurous  or  hepatic  waters  are 
strongly  impregnated  vnXh  sulphureted  hydrogen,  which  gives  them  an 
odor  like  rotten  eggs.  Carbonated  or  acidulous  waters  contain  car- 
bonic acid,  which  renders  them  sparkling  and  pungent.  Of  the  saline 
mineral  waters  there  are  many  sub-varieties,  as  the  calcareous,  alka- 
line, silicious,  etc. 

The  medicinal  fame  of  the  "Congress  water"  at  Saratoga  is  derived 
from  the  great  amount  of  its  deleterious  ingi-edients.  One  gallon  con- 
tains the  following  impurities  :  Chloride  of  sodium  (common  salt)  385.0 
gi'ains,  hydriodate  of  soda  3.5  do.,  bi-carbonate  of  soda  8.982  do.,  bi- 
carbonate of  magnesia  95.778  do.,  carbonate  of  iron  5.075  do.,  silex 
1.5  do.,  hydro-bromate  of  potash,  a  trace  ;  in  all,  597.943  grains. 
Each  gallon  also  contains  311  cubic  inches  of  carbonic  acid  gas,  and  7 
of  atmospheric  air. 

Dr.  Steel,  of  Saratoga,  very  judiciously  advises  those  who  wish  to 
experience  the  full  benefit  of  this  water  to  drink  it  only  once  a  day — 
about  three  pints  earij  in  tiie  morning  ;  and  he  remarks  very  sensibly ; 
"It  would  be  much  better  for  those  whose  complaints  render  them  fit 
subjects  for  its  administra^ior.,  if  the  fountain  thould  be  locked  up,  and 


818  HYGIENE 


no  one  suffered  to  approach  it  after  the  hours  of  nine  and  ten  in  the 
morning."  If  it  should  be  locked  up  at  all  houi's  of  the  day  and  night, 
and  a  sti'eam  of  pure  soft  water  substituted,  the  advantage  to  the  in- 
valid portion  of  tlie  guests  would  be  still  gi'eater. 

The  Iodine  Spring,  at  that  place,  differs  from  the  former  mainly  m 
containing  3i  gi'ains  of  iodine  to  the  gallon,  with  a  httle  more  than  half 
the  quantity  of  the  other  ingi-edients.  The  Sans  Souci  Spritig,  at 
Ballston  Spa,  differs  from  the  Congress  principally  in  containing  carbon- 
ate of  lime,  instead  of  bi-carbonate  of  magnesia,  and  possessing  alto- 
gether a  little  less  than  half  the  amount  of  impurities. 

Tests  of  Ordinary  Impurities. — The  following  are  the  tests 
(copied  from  Pereira's  "  Food  and  Diet"),  by  which  the  presence  of 
the  usual  impurities  of  common  waters  may  be  ascertained : 

1.  Ehullition. — By  boiling,  au'  and  carbonic  acid  gas  are  expelled, 
while  carbonate  of  lime,  held  in  solution  by  the  carbonic  acid,  is  de- 
posited; this  deposit  is  the  fm*  or  crust  which  lines  tea-kettles  and 
boilers. 

2.  Protosulphate  of  Iron. — If  a  crystal  of  this  salt  be  introduced 
into  a  phial  filled  with  the  water  to  be  examined,  and  the  phial  be  well 
corked,  a  yellowish-brown  precipitate  (sesquioxide  of  iron)  will  be  de- 
posited in  a  few  days,  if  oxygen  gas  be  contained  in  the  water. 

3.  Litmus. — Infusion  of  litmus,  or  syrup  of  violet,  is  reddened  by  a 
free  acid. 

4.  Lime-water. — This  is  a  test  for  carbonic  acid,  with  which  it 
causes  a  white  precipitate  (carbonate  of  lime),  if  employed  before  the 
water  is  boiled. 

5.  Oiloride  of  Barium. — A  solution  of  this  salt  usually  yields,  with 
hard  Jvater,  a  white  precipitate,  insoluble  in  nitiic  acid ;  this  indicates 
the  presence  of  sulphuric  acid,  which,  in  common  water,  is  combined 
with  lime. 

6.  Oxalate  of  Ammonia. — If  this  sdt  yield  a  white  precipitate,  it 
indicates  the  presence  of  lime,  carbonate  and  sulphate. 

7.  Nitrate  of  Silver. — If  this  occasion  a  precipitate  insoluble  in  nitric 
acid,  the  presence  of  chlorine  is  inferred. 

8.  Phosphate  of  Soda. — If  the  lime  contained  in  common  water  be 
removed  by  ebullition  and  oxalic  acid,  and  to  the  sti'ained  and  ti'ans- 
parent  water  ammonia  and  phos})hate  of  soda  be  added,  any  magnesia 
present  will,  in  the  course  of  a  few  hours,  be  precipitated  in  the  form 
of  the  white  ammoniacal  phosphate  of  magnesia. 

9.  Tincture  of  Galls. — This  is  used  as  a  test  for  iron,  with  solutions 
of  which  it  forms  an  inky  liquof    ^tannate  and  gallate  of  iron).     If  the 


DRINK.  '  31» 

test  produce  this  effect  on  the  water  before,  but  not  after  boiling,  the 
iron  is  in  the  state  of  carbonate ;  if  after  as  well  as  before,  in  that  of 
sulphate.  Tea  may  be  substituted  for  galls,  to  which  its  effects  and 
indications  are  similar.  Ferrocyanidc  of  potassium  yields,  with  solu- 
tions of  the  sesquisalts  of  iron,  a  blue  precipitate,  and,  with  the  proto- 
saltSf  a  white  precipitate,  which  becomes  blue  by  exposure  to  the  air. 

10.  Hydrosulphuric  Acid  (sulphureted  hydrogen). — This  yields  a 
dark  (brown  or  black)  precipitate  (a  m.etnllic  sulphuret),  with  water 
containing  iron  or  lead  in  solution. 

11.  Evaporation  and  Ignition. — If  the  water  be  evaporated  to  dry- 
ness, and  ignited  in  a  glass  tube,  the  presence  of  organic  matter  may 
be  inferred  by  the  odor  and  smoke  evolved,  as  well  as  by  the  chaiTJng. 
Another  mode  of  detecting  organic  matter  is  by  adding  nitrate  or  ace- 
tate of  lead  to  the  suspected  water,  and  collecting  and  igniting  the 
precipitate,  when  globules  of  melted  lead  are  obtained,  if  organic  mat- 
ter be  present.  The  putrefaction  of  water  is  another  proof  of  the 
presence  of  organic  matter.  Nitrate  of  silver  is  also  a  test,  as  before 
mentioned. 

Purification  of  Common  Waters. — Filtration  removes  all  in- 
sects, living  beings,  and  all  suspended  impurities,  but  it  does  not  deprive 
water  of  the  substances  it  holds  in  solution.  Boiling  destroys  the 
vitality  of  any  animals  or  vegetables  it  may  contain,  expels  air  or  car- 
bonic acid,  and  causes  the  precipitation  of  carbonate  of  lime.  Some- 
times it  may  be  advantageous  to  boil  water  first,  and  filter  it  afterward. 
Distillation  purifies  water  from  every  thing  except  traces  of  organic 
matter;  it  is,  however,  a  process  too  ti'oublesome  and  expensive  for 
general  employment.  Chemical  agents  are  sometimes  made  use  of  to 
free  water  from  particular  ingredients.  Alum,  two  or  three  gi'ains  to 
a  quart,  will  cleanse  muddy  water ;  the  alum  decomposes  the  carbon- 
ate of  lime  ;  sulphate  of  lime  is  found  in  solution,  and  the  alumina  is 
precipitated  in  flocks,  carrying  with  it  mechanical  impurities.  Though 
this  process  renders  the  water  clear,  it  adds  nothing  to  its  healthfulness, 
but  renders  it  even  harder,  by  converting  the  carbonate  into  sulphate 
of  lime.  Alkaline  carbonates  soften  water  by  decomposing  all  the 
earthy  salts,  and  precipitating  the  earthy  matters ;  the  carbonates  of 
soda  and  potash  are  much  used  in  washing  on  this  account ;  they  do 
not  render  the  water  any  purer,  nor  fit  for  drinking  or  culinary  pur- 
poses 

Adulterations  or  Common  "Water. — The  purest  water  is  liable 
to  become    impregnated  with  poisonous   properties  when   conveyed 


320  HYGIENE. 

through  some  kinds  of  metallic  pipes,  particularly  leaden  ones.  The 
air  contained  in  very  pure  water  rapidly  corrodes  lead ;  distilled  water, 
from  which  the  air  is  excluded,  has  no  action  on  it  until  air  is  again  ad- 
mitted, when  a  thin  white  crust  of  carbonate  and  hydi'ate  of  the  oxide 
of  lead  is  speedily  formed.  Rain  water  is  often  impregnated  from  the 
lead  of  roofs,  guttei-s,  cisterns,  anc  pipes.  ('  ombinations  of  lead,  iron, 
and  zinc,  and  other  mixed  metals,  as  in  cases  where  iron  bars  are  used 
to  support  leaden  cisterns,  the  introdu  ion  of  iron  pumps  into  leaden 
cisterns,  etc.,  often  produce  a  galvanic  action  which  dissolves  a  portion 
of  the  lead.  The  leaden  covere  of  leaden  cisterns  are  also  a  source  of 
contamination ;  the  water  evaporates  from  the  cistern  in  the  form  of 
pure  or  distilled  water,  and  condenses  upon  the  lid,  w^hich  it  corrodes, 
and  then  falls  back  into  the  cistern  impregnated  with  the  metal.  Su.^h 
cisterns  should  have  wooden  covers. 

Various  saline  matters  impair  the  corrosive  action  of  water  and  air, 
and  exercise  a  protecting  influence.  The  carbonates  and  sulphates 
afford  the  best  security  against  lead  poisoninir,  because  they  fonn  a 
protecting  cnist  upon  the  surface  of  the  metal.  Dr.  Lee  declai-es 
that  "Palsy  is  often  met  with  in  the  city  of  New  York  among  grocei*3 
and  porter-house  keepers,  and  is  doubtless  occasioned  by  their  drink- 
ing beer  in  the  morning  which  has  stood  in  the  lead  pipes  over  night." 

Chemists  do  not  agree  respecting  the  action  of  our  Croton  water  on 
its  leaden  conduits ;  but  experience  settles  the  question  affirmatively. 
It  becomes  our  citizens,  therefore,  to  exercise  a  constant  watchfulness 
in  its  employment,  wliich  is,  to  let  as  much  water  run  as  the  leaden 
pipes  contain  to  their  junction  with  the  iron  pipes  in  the  sti'eets,  be- 
fore drinking  it-  With  this  precaution,  and  the  fi'equent  emptying  of 
the  leaden  pipes  through  the  day,  it  is  not  probable  that  any  appreci- 
able injur}'^  will  be  experienced  from  the  lead.  But  these  facts  prove 
that  the  principle  of  conveying  water  thi'ough  our  dwellings  by  leaden 
pipes  is  wrong,  and  a  substitute  should  engage  the  attention  of  inge- 
nious men  and  philantlnopists. 


CHAPTER  IV, 

OF  FOOD. 


Chemical  Elements  of  Food. — In  the  present  state  of  chemical 
•cience  all  known  bodies,  mineral  and  organized,  are  regarded  as  con- 
stituted of  fifty-five  simple  substai  ces,  wl     ]..  a^'c-  called  chemical  ele 


FOOD.  321 

ments.  Of  these  fifty-five  elements  nineteen  have  been  found  in 
organized  bodies,  animal  and  vegetable.  Of  these  nineteen  elements 
thirteen  are  regarded  as  essential  constituents  of  the  human  body,  viz., 
carbon,  hydrogen,  oxygen,  nitrogen,  p}ios])lwrous,  sulphur,  iron,  chlo- 
rine, sodium,  calcium,  potassium,  magnesium,  and  Jluorine. 

Pereira  lays  down  the  following  postulate :  "  A  living  body  has  no 
power  of  forming  elements,  or  of  converting  one  elementary  sub- 
stance into  another ;  and  it  therefore  follows  that  the  elements  of 
which  an  animal  is  composed  must  be  the  elements  of  its  food." 

If  this  position  is  correct,  any  alimentary  substance  capable  of  sus- 
taining the  structures  of  the  human  body,  must  possess  all  of  the 
chemical  elements  above-named  among  its  constituents.  We  do  not, 
however,  find  such  to  be  the  fact.  Milk  affords  complete  nutrition  to 
the  young  mammal,  and  occasionally  to  the  adult;  wheat  and  apples 
are  capable  of  perfectly  nourishing  the  body ;  yet  neither  of  these 
articles,  nor  all  together,  yield  to  chemical  analysis  all  of  the  elements 
above-named. 

It  is,  moreover,  probable,  and  I  think  demonstrable,  that,  to  a  cer- 
tain extent,  the  vital  functions  of  a  living  organism  have  the  power  of 
transmuting  substances  supposed  to  be  elementary.  This  is  proved 
by  the  fact,  that  the  lime  found  in  the  bones  of  the  chick  when  it  quits 
its  shell  did  not  pre-exist  in  the  recent  egg.  It  could  not  be  derived 
from  the  shell,  because  the  membrane  which  lines  its  interior  is  not 
vascular;  hence  its  only  source  is  the  transmutation  of  some  other 
substance.  The  accuracy  of  Pereira's  proposition  may  be  admitted, 
or,  rather,  it  cannot  be  controverted,  with  a  qualification  he  has  after- 
ward expressed,  viz.,  that  many  substances  now  regarded  as  element- 
ary may  be  in  reality  compounds,  which  the  body,  though  not  able  to 
create,  may  compose  and  decompose. 

Liebig,  and  most  of  the  recent  writers  on  physiology  and  organic 
chemistry,  have  distinguished  foods  into  nitrogenized  and  non-nitrogen- 
ized — a  distinction  based  on  the  presence  or  absence  of  nitrogen  when 
the  articles  are  subjected  to  chejnical  analyses.  It  is  assumed  that  the 
former  only  are  capable  of  transformation  into  blood,  and  of  form- 
ing the  substance  of  the  tissues ;  hence  Liebig  has  called  them  the 
plastic  elements  of  nutrition.  The  non-nitrogenized  foods  he  denomi- 
nates elements  of  respiration ;  their  use  in  the  animal  economy  being, 
according  to  his  notion,  to  keep  up  the  ani'mal  heat,  by  yielding  carbon 
and  hydrogen  to  be  oxidated  in  the  lungs.  The  following  '^;:'  ilar  ar- 
rangement, copied  from  Pereira,  sliDws  *.lie  absurdities  '  >  which 
mnn  of  the  most  extensive  learcing  becom»-  nvolved,  in  the  <jttempta 
to  s.j-iare  nli  the  phenomena  of  life  by  the     amparatively '     "gnificant 


822 


HYGIENE. 


chemical  processes  and  experiraente  they  can  perform  in  a  chemical 
laboratory : 


NITROGENIZED    FOODS, 

or  Plastic  Elements  of  JVutritioti 
Vegetable  Fibrine. 

"  Albumen. 

"  Caseine. 

Animal       Flesh. 

"  Blood. 


NON-KITROGENIZED  FOODS, 

or  Elements  of  Respiration. 


Fat. 
Starch. 
Gum. 

Cane  Sugar. 
Grape  Sugai-. 
Sugar  of  Milk. 


Pectine. 
Bassorine. 
Wine! 
Beer ! ! 
Spirits!!! 


Whenever  any  man  of  science  names  any  form  of  intoxicating  drink 
among  the  foods  of  the  human  body,  I  want  no  further  evidence  that 
he  is  calculating  the  problems  of  life  on  principles  fundamentally  eiTO- 
neous.  Again,  if  uitrogenized  foods  are  capable  of  nourishing  the 
tissues  because  of  theu*  nitrogen,  it  would  follow  that  those  aliments 
which  contain  the  largest  proportion  of  nitrogen  would  be  most  nutri- 
tious. But  this  does  not  hold  time  in  practice,  for  flesh-meat  contains 
fifteen  per  cent,  of  nitrogen,  while  wheat,  rye,  oats,  barley,  corn,  rice, 
peas,  beans,  and  lentils  contain  only  from  two  to  five  per  cent. ;  yet 
each  of  these  articles  is  more  nutritious  than  flesh.  Rice,  which  con- 
tains less  than  two,  and  wheat,  which  contains  but  a  fraction  over  two 
per  cent,  of  niti'ogen,  are  three  times  as  nutritive  as  flesh-meat,  not- 
withstanding this  contains  nearly  seven  times  as  much  nitrogen. 

The  truth  seems  to  be  that  an  alimentary  substance  is  more  or  less 
nutritious,  not  according  to  the  presence  or  absence  of  niti'ogen,  or  any 
other  single  constituent,  but  according  to  the  constitutional  relation  of 
the  whole  substance,  as  compounded  by  the  arrangement  of  all  its 
constituent  elements.  The  most  wholesome  aliment  and  the  most 
deadly  poison  may  be  composed  of  the  same  chemical  elements,  the 
only  difference  being  in  the  proportions  in  which  their  constituents  are 
combined. 

It  is  true,  furthermore,  that  neai'ly  and  probably  all  of  the  aliment- 
ary substances  which  are  capable  of  sustaining  the  prolonged  nutrition 
of  animals,  contain  greater  or  less  proportions  of  niti-ogen,  oxygen, 
carbon,  and  hydrogen,  with  more  or  less  of  a  number  of  other  sub- 
stances, which  are  called  elements.  And  it  is  quite  clear  to  my  mind 
tliat  no  substance  entirel}^  destitute  of  either  nitrogen,  oxj^gen,  carbon, 
or  hydrogen,  possesses  lifncii  alimentary  value,  either  as  a  "  plastic 
element  of  nutrition/'  or  as  an  "element  of  respiration."  If  fats, 
oils,  alcohol,  etc.,  are  ■•aken  int:  the  stomach,  the}  must  be  disposed  of 


FOOD.  823 

in  some  way ;  and  as  they  are  not  convertible  into  the  tissues,  they 
are  oxidated  in  the  circulation,  and  expelled  by  the  lungs,  liver,  skin, 
kidneys,  and  bowels.  That  part  of  this  excretoi;y  process  which  is 
performed  by  the  lungs  has  been  mistaken  for  a  specia'  vital  process, 
by  which  the  body  is  warmed ;  and  the  commotion  of  the  organism  in 
ger.ting  rid  of  these  offensive  materials  has  been  mistaken  for  a  func- 
tional process,  which  makes  use  of  wine,  beer,  and  spirits  in  the  nu- 
tritive economy  of  the  system.  Such  errors,  emanating  from  such 
high  authorities  in  the  scientific  world,  have  a  disastrous  effect  on  tlie 
public  mind,  and  tend  powerfully  to  check  the  progress  of  all  the  re- 
forms of  the  age. 

The  per  centage  of  carbon  contained  in  the  aliments  in  common 
use,  rejecting  fractions,  is  as  follows :  Wheat,  dried  in  vacuo  at  23^ 
Fahr.  46,  oats,  do.  50,  rye,  do.  46,  potatoon  12,  do.  dried  44,  turnips  3, 
do.  dried  42,  artichoke,  dried  43,  peas  35,  do.  dried  46,  lentils  37, 
beans  38,  fresh  bread  30,  black  bread,  dried  45,  ox  blood  10,  do.  dried 
51,  fresh  lean  meat  13,  dry  lean  beef  51,  roasted  veal  52,  sugar-candy 
42,  butter  65,  mutton  fat  78,  hog's  lard  79,  olive  oil  77.  Alcohol,  an 
aliment  according  to  Liebig  and  Pereu-a,  contains  52. 

Oxygen  and  hydrogen  exist  in  acetic  acid,  starch,  gum,  and  sugar, 
in  the  proportions  which  form  water ;  in  oil,  alcohol,  malic  acid,  gela- 
tin, gluten,  animal  and  vegetable  fibrin,  albumen,  and  casein,  the  hydro- 
gen is  in  excess ;  in  pectin,  citric  acid,  and  tartaric  acid  the  oxygen  is 
in  excess. 

Phosphorus  is  found  in  the  muscular  and  nervous  tissues  of  the 
body,  in  the  bones,  in  the  spermatic  fluid,  and  in  the  ovary.  In  some 
diseases  the  breath  of  patients  emits  a  strong  phosphoric  odor.  Phos- 
phorus is  also  a  constituent  of  nearly  all  vegetable  substahces,  existing 
in  combination  with  lime  or  magnesia. 

Sulphur  is  also  found  in  the  fibrinous  and  albuminous  tissues,  and  in 
hair,  bone,  casein,  and  the  saliva.  Metallic  matter  held  in  the  mouth 
is  ofren  discolored  by  tlie  action  of  sulphur ;  and  gold  plates  used  to 
suppoil  artificial  teeth,  and  the  amalgam  of  silver,  sometimes  employed 
to  fill  decayed  teeth,  often  become  incrusted  with  metallic  sulphuret. 
Sulphur  is  a  constituent  in  nearly  all  the  vegetable  substances  employed 
as  food.  Culinary  vegetables  generally  contain  it;  the  crucifercE  in 
abundance.  Asafoetida,  which  contains  a  large  proportion,  is  some- 
times used  as  a  seasoning  or  condiment ;  and  although  it  would  not  be 
inviting  to  a  majority  of  American  olfiictories  or  palates,  some  Oriental 
nations  consider  it  as  "food  for  the  gods."  Sulphur  is  readily  de 
tected  in  mustard,  white  caU)ag3,  potatoes,  almonds,  peas,  and  ether 
vegetables. 


324  H  Y  G  I  E  M  E. 

Iron  is  found  in  the  ashes  ot  animals  and  vegetables.  The  quantity, 
however,  detected  in  organized  beings  is  exceedingly  small,  and  the 
precise  state  in  which  it  exists  in  living  beings  is  entirely  unknown. 
Chemists  find  a  very  small  quantity  in  the  blood  corp  iscles  and  hair, 
but  are  unable  to  assign  it  any  office.  Liebig's  theory,  that  the  color 
of  the  blood  depends  on  iron,  has  been  positively  disproved.  A  slight 
trace  of  iron  is  found  in  most  vegetable  articles  used  as  food ;  for  ex- 
amples, milk,  mustard,  cabbage,  potatoes,  pens,  and  cucumbers.  ]t  is 
by  no  means  yet  proved  that  iron  is  an  essential  constituent  of  any  liv- 
ing being.  Its  liability  to  oxidation,  its  general  employment  in  agricul- 
ture and  the  arts,  and  its  abundance  in  the  mineral  kingdom,  afford  at 
least  good  gi'ounds  for  conjecture  that  the  variable  quant'ties  found  in 
plants  and  animals  are  accidental  ingredients. 

Pereira  remarks  :  "But  the  well-known  influence  of  chalybeates  in 
the  disease  called  ancemia,  in  which  the  blood  is  found  to  contain  a 
smaller  quantity  of  iron  than  in  a  state  of  health,  favors  the  notion  that 
the  proper  color  of  the  blood  is  in  some  way  connected  with  the  amount 
of  iron  contained  in  it;  for  one  of  the  most  characteristic  symptoms 
of  this  malady  is  an  absence  of  the  natural  vermilion  tint  of  the  com- 
plexion." 

Unless  the  preparations  of  iron  in  the  hands  of  European  practi- 
tioners operate  very  differently  from  those  prescribed  by  American 
physicians,  Pereu'a  must  labor  under  a  great  mistake.  The  medical 
journals  of  this  country  have,  during  a  year  or  two  past,  reported  many 
cases  of  anremia  treated  with  chalj^beates,  nearly  eveiy  one  of  which 
terminated  fatally.  The  particulars  of  several  cases  may  be  found  in 
the  Water-Cure  Jom'nal  for  1850. 

Clilorine  is  found  in  the  blood,  in  combination  with  sodium,  forming 
common  salt ;  in  the  gastric  juice,  combined  with  hydrogen,  constitut- 
ing hydrochloric  acid.  It  is  also  found  in  saliva,  and  in  all  the  excre- 
tions. It  is  a  constituent  of  nearly  all  vegetable  aliments,  from  whence 
a  sufficient  supply  is  derived  for  the  wants  of  the  animal  organism. 
The  dietetic  use  of  salt,  therefore,  to  furnish  "lilorine  to  the  system  is 
unnecessary. 

Sodium  exists  in  most  of  the  animal  tissues  and  secretions.  A 
large  part  of  that  found  in  the  different  solids  and  fluids  is  doubtless 
derived  from  the  use  of  table  salt,  for  it  is  not  an  ordinary  constituent 
of  vegetables  unless  they  gi'ow  in  the  neighborhood  of  salt  water. 

Calcium,  in  the  form  of  a  subphosphato  of  lime,  is  found  in  all  the 
animal  solids,  in  the  blood,  and  in  inr st  of  the  secretions.  It  is  a  con- 
stituent of  niost  vegetables ;  it  is  found  in  the  cereal  grains,  onions,  gar^ 
lies,  rhubarb,  grapes,  gum,  and  unrefined  sugar. 


FOOD  826 

Magnesium,  in  small  qjiantities,  is  found  in  the  blood,  teeth,  bones, 
nerves,  glands,  and  other  parts  of  the  body.  It  is  also  a  constituent  of 
grains,  potatoes,  and  other  vegetables. 

Potassium  is  found  in  minute  traces  in  the  blood,  solids,  and  several 
of  the  secretions.  It  is  a  constituent  of  most  kinds  of  vegetables,  espe- 
cially inland  plants ;  it  is  readily  detected  in  gi'apes  and  potatoes. 

Fluorine  has  been  detected  by  Berzelius  in  minute  quantities  in  the 
bones  and  teeth  of  animals,  in  the  form  of  fluoride  of  calcium.  It  is 
never  found  in  plants,  and  it  is  probably,  when  found  in  animals,  an 
accidental  ingredient  rather  than  a  normal  constituent. 

Proximate  Elements  of  Food. — Water,  gum,  sugar,  staich, 
lignin,  jelly,  fat,  fibrin,  albumen,  casein,  gluten,  gelatin,  acids,  salts, 
and  alcohol,  are  called  alimentary  principles  by  Pereira  and  other  au- 
thors. They  are  all  compounded  of  two  or  more  chemical  elements, 
and  all  of  them,  except  alcohol,  are  produced  in  the  process  of  organic 
gi'owth  and  development  in  the  vegetable  kingdom.  Alcohol,  as  al- 
ready stated,  results  from  the  death  and  putrefaction  of  organic  mat- 
ter. Foods  proper  are  compounds  of  these  proximate  elements  in 
various  proportions,  as  these  are  compounds  of  the  ultimate  elements. 
Physiologists,  in  directing  so  much  of  their  attention  to  the  investiga- 
tion of  the  chemical  qualities  of  alimentary  principles,  and  so  little  to 
the  physiological  effects  of  aliments  themselves,  have  taught  more  er- 
rors than  ti'uths  in  relation  to  food  and  diet. 

None  of  the  proximate  elements  of  food  are  capable  of  the  pro- 
longed nutrition  of  animals,  though  gluten,  which  is  in  reality  a  very 
compounded  substance,  may  alone  sustain  life  for  a  considerable  time. 
Nor  is  the  power  of  an  alimentary  principle,  or  an  aliment  proper,  to 
sustain  the  animal  organism,  at  all  proportioned  to  what  is  chemically 
regarded  as  its  nutritive  property.  Dogs  fed  on  sugar,  or  butter,  or 
fine  flour,  become  plump  and  adipose,  but  die  of  starvation  in  a  few 
weeks.  Horses  and  cattle  confined  to  the  most  nutritious  grains  soon 
glow  sickly  and  die ;  and  the  human  being,  restricted  to  a  diet  of 
starch,  fibrin,  or  superfine  flour,  soon  becomes  unhealthy.  But  a 
suitable  admixture  of  bones,  grass,  straw,  woody  fibre,  bran,  etc.,  usu- 
ally considered  as  innutritions,  allows  the  animal  organism  to  select  and 
assimilate  such  nutritive  materials  as  are  needed  to  maintain' the  integ- 
rity of  its  structures  and  functions,  and  reject  the  rest. 

Water,  constituting  about  three  fourths  of  the  entire  weight  of  the 
body,  and  being  essential  to  the  performance  of  all  the  vital  processes, 
may  be  regarded  as  liquid  alhnent,  all  the  other  aliments  or  foods  being 
23 


326  HYGIENE. 


solid,  or  solids  dissolved  in  water.     Its  properties  have  been  consid- 
ered in  the  preceding  chapter. 

Gum  is  the  mucilaginous  alimentary  principle  of  authors.  It  exists 
almost  universally  in  plants.  The  gi  nis  called  Arabic,  Senegal,  East 
Indian,  Barhary,  Cape,  tragacanth,  cherry,  plum,  and  bassora,  exude 
spontaneously,  and  concrete  on  the  stems  of  ti'ees  or  plants.  The 
following  articles  contain,  in  one  hundred  parts  of  gum  or  mucilage, 
rejecting  unimportant  fractions :  Barley-meal  4,  oatmeal  2,  wheat-flour 
2  to  5,  wheat-bread  18,  rye-meal  11,  corn  2,  rice  0-1  to  0-71,  peas  6, 
garden  bean  4,  kidney  bean  19,  potatoes  3  to  4,  cabbage  3,  sweet  al- 
monds 3,  ripe  green  gage  5,  ripe  fresh  pears  3,  gooseben-ies  0'78,- 
cherries  3,  ripe  apricot  5,  ripe  peach  5,  linseed  5,  marshmallow  root  35. 

Sugar  is  very  genergdly  distributed  thj'oughout  the  vegetable  king- 
dom. Barley-raeal  contains  about  5  per  cent.,  oatmeal  (including  bitter 
matter)  8,  wheat-flour  4  to  8,  wheat-bread  3  to  4,  rye-meal  3,  corn  1-45, 
rice  0-05  to  0-30,  peas  2,  sweet  almonds  6,  figs  62,  ripe  green  gage  11, 
tamarinds  12,  ripe  fresh  pears  6,  ripe  peai-s  kept  some  time  11,  ripe 
goosebeiTies  6,  ripe  cherries  18,  ripe  apricot  11,  ripe  peach  16,  melon 
1*5,  expressed  can*ot  juice  evaporated  to  dryness  94,  beet-root  5  to  9, 
cow's  milk  4*77,  ass's  milk  6-08,  woman's  milk  6*50,  goat's  milk  5-28, 
ewe's  milk  5. 

Sugar,  though  taken  freely  into  the  stomach,  and  sometimes  repro- 
duced in  the  secretions,  as  in  the  urine  of  diabetic  patients,  is  never 
found  in  healthy  blood.  It  must  therefore  undergo  decomposition  be- 
fore it  is  admitted  into  the  circulation. 

Most  of  the  raw  sugars  of  commerce  contain  various  impurities, 
find  the  purified  or  refined  sugars  have  a  constipating  eff*ect  on  the 
bowels.  The  best  article  for  dietetical  purposes  is  that  of  a  pale  yel- 
low color,  with  large,  clear,  brilliant  crj'stals.  Syrup  is  made  by  dis- 
solving two  pounds  and  a  half  of  sugar  in  a  pint  of  water.  Molasses 
is  the  viscid  fluid  which  drains  from  raw  sugar.  Treacle  is  a  dark- 
brown  uncrj'stallizable  syrup,  which  drains  from  the  molds  in  which 
refined  sugar  concretes. 

Sugai*  is  the  basis  of  an  immense  quantity  and  variety  of  hard  con- 
fectionary— lozenges,  hrilliants,  pipe,  rock,  comfits,  nonpareils.  They 
are  mixed  more  or  less  with  flour,  starcii-  gum,  and  often  other  less 
wholesome  articles,  flavored  with  a  variety  of  pungents  and  perftimes, 
and  not  unfrequently  medicated  with  calomel,  tartarized  antimony, 
morphine,  and  many  other  poisons.  The  whole  of  it  is  abominable 
ti-ash  at  best ;  and  although  the  children  of  our  cities  have  their  hands 
full  of  it  a  good  proportion  of  the  time,  every  mother  ought,  and  all 
inicUigeni  mothers  will   expel  it  frf  m  their  houses. 


POOD.  827 

Starch  is  found  in  the  seeds,  fruits,  roots,  steins,  tubercles,  and 
mosses  of  a  large  portion 'of  the  vegetable  kingdom.  It  constitutes  the 
amylaceous  alimentary  principle  of  authors,  and  is  known  under  the 
various  names  of  amylum,  starch,  fecula,  and  farinaceous  matter. 
Wheat-flour  yields  in  one  hundred  parts  56  to  72  parts,  wheat-bread 
53,  barley-meal  67,  oatmeal  59,  rye-meal  61,  maize  or  corn  81,  rice 
82  to  85,  peas  32,  garden  bean  34,  kidney  bean  36,  arrow-root  plant  12 
to  26,  yam  12  to  22,  bread-fruit  3.,  tapioca  plant  13,  Iceland  moss  45, 
batatas  9  to  13,  kidney  potato  9,  red  potato  15. 

The  much  larger  quantitj^  of  starch  contained  in  corn  than  in  the 
potato,  has  suggested  the  preparation  of  it  from  the  former  article. 
Recently  several  manufactories  of  corn  starch  have  been  established 
in  this  country,  and  starch  made  from  this  gi-ain  is  now  in  common 
use  as  a  dietetic  article  as  well  as  for  the  toilet.  Its  value  as  a  food  is 
far  inferior  to  that  of  the  whole  grain.     In  fact,  it  is  employed  more  as 

desert  or  superfluity  than  as  a  nutriment. 

Dr.  Prout  thinks  starch  "  differs  from  sugar  in  being  a  necessary 
article  of  food,  without  which  animals  could  not  exist,  while  sugar  is 
not."  But  as  stai'ch  is  not  found  in  animal  food,  and  as  there  are  many 
animals  of  the  carnivorous  kind  which  eat  no  other,  this  position  can 
only  be  correct  in  its  application  to  herbivorous  animals. 

The  different  kinds  of  amylaceous  matters  in  common  use  are  sago^ 
tapioca,  arrow-root,  rice  starch,  jjotafo  starch,  corn  starch,  and  lichenin, 
or  feculoid,  obtained  from  Iceland  moss.  Sago  is  the  medulla  or  pith 
of  the  stems  of  various  species  of  palms ;  it  is  manufactured  princi- 
pally in  the  Moluccas,  and  comes  to  us  in  the  form  of  sago-meal,  piearl 
sago,  and  conunon  sago.  The  first  is  princi[)ally  used  in  making  sago- 
sugar  ;  the  second  is  generally  employed  for  domestic  purposes. 
Tapioca  is  obtained  fi-om  the  roots  of  a  plant,  said  to  be  poisonous,  in 
the  Brazils.  Its  irregular,  lumpy  form  is  owing  to  its  having  been 
dried  on  hot  plates.  Cassava  bread,  used  in  Brazil,  Guiana,  Jamaica, 
and  other  places,  is  made  of  the  whole  roots  of  the  plant,  which  are 
grated  and  then  pressed  in  a  hair  bag.  Arrow-root  is  obtained  from 
the  roots  of  the  plant,  w^hose  botanical  name  is  maranta  arundinacea. 
There  are  several  varieties  in  market,  as  West  Indian,  Tahiti,  East 
Indian,  Portland,  etc. 

In  a  dietetical  or  medicinal  sense  there  is  very  little  to  choose  in 
these  different  forms  of  starch.  They  are  highly  commended  by 
physicians  to  children  and  i-nvalids,  but  as  food  they  are  incomparable 
inferior  to  the  whole  gi-ains,  vegetables,  and  fruits  from  which  they 
are  derived. 

Lignin  is  the  woody  fi'jre  which  constitutes  the  basis  of  al.  vege 


828  HYGIENE. 


table  structiires.  It  also  forms  the  skin  of  potatoes,  the  husk  of  gi-apes 
gooseberries,  etc.,  the  peel  and  core  of  apples  and  pears,  the  skin  and 
stone  of  plums,  peaches,  etc.,  the  seed-coats  of  the  kernels  of  nuts, 
the  membranous  covering  of  beans  and  peas,  the  pod  of  melons,  cu- 
cumbers, etc.,  and  the  bran  of  gi'ains.  The  per  centage  contained  m 
vm-ious  aliments  is :  Rice  4-8,  barley  18-75  (husk),  oats  34  (bran),  ryo 
24  (husk),  ripe  apricots  1-86,  ripe  gi-een  gages  1-11,  ripe  peaches  1-21, 
ripe  gooseberries  8'01,  ripe  cherries  1*12,  ripe  pears  2'19,  sweet 
almonds  9  (and  seed-coats),  peas  21-08  (amylaceous  fibre),  garden 
bean  25-94  (amylaceous  fibre  and  membrane),  kidney  bean  18-57  (do.), 
potatoes  4-03  to  10-05  (amylaceous  fibre),  cocoanut  kernel  14-95. 

Lignin,  or  wood,  when  divested  of  all  its  soluble  mattere,  rejjeat- 
edly  subjected  to  the  heat  of  an  oven,  and  finally  ground  to  a  fino 
powder,  yields  a  flour,  on  being  boiled  with  water,  resembling  corn- 
flour, and  capable  of  being  made  into  a  jelly  or  loaf-bread,  which  is 
both  agreeable  and  nutritious.  The  nutritive  importance  of  ligJiin  in 
the  animal  economy  is  equal  to  that  of  starch,  or  of  any  other  proxi 
mate  element,  for  none  of  the  others,  nor  all  together,  can  perfectly 
sustain  the  integritj^  of  the  organism  without  some  admixture  of  the 
woody  element,  which  authors  usually  put  down  as  innutritions  and 
indigestible.  Pereira  thinks  it  serves  as  a  mechanical  stimulus  to  pro- 
mote the  action  of  the  bowels — a  queer  phrase  for  him  to  apply  to 
what  he  calls  an  alimentary  principle.  Dr.-Prout  remarks:  "Of  the 
numerous  shapes  assumed  by  lignin,  the  best  adapted  for  excrementa' 
purposes  is  undoubtedly  the  external  covering  of  the  seeds  of  the  ce? 
ealia,  and  particularly  of  wheat.  Bread,  therefore,  made  with  un- 
dressed flour,  or  even  with  an  extra  quantity  of  bran,  is  the  best  form 
in  which  ftirinaceous  and  excremental  matters  can  be  usually  taken ; 
not  only  in  diabetis,  but  in  most  of  the  other  varieties  of  dyspepsia 
accompanied  by  obstinate  constipation.  This  is  a  remedy,  the  efficacy 
of  which  has  long  been  known  and  admitted  -,  yet,  strange  to  say,  the 
generality  of  mankind  choose  to  consult  their  taste  rather  than  theii 
reason,  and  by  officiously  separating  what  nature  has  beneficently  com- 
bined, entail  upon  themselves  much  discomfort  and  misery." 

Jelly  is  found  in  both  animals  and  vegetables.  Vegetable  jelly  con- 
stitutes the  pectinaceous  alimentary  principle,  so  called  because  it  has 
for  its  base  stai'ch  and  pectin,  or  pectic  acid.  Pectin  and  pectic  acid 
are  regarded  by  some  chemists  as  identical.  One  or  both  are  found  in 
most  pulpy  fruits,  currants,  apples,  pears,  quinces,  apricots,  plums,  and 
in  melons,  goosebei-ries,  blackberries,  raspberries,  sti-awberries,  bilber- 
ries, mulberries,  cherries,  tomatoes,  oranges,  lemons,  and  tamarinds. 
The  artichoke,  onion,  carrot,  turnip,  celery,  bee^.";  and   many  other 


FOOD.  SS» 

roots,  yield  a  portion  of  it.     Sugar  promotes  the  solidification  and  ge- 
latination  of  pectin   and   pectic   acid,  and   is,  therefore,  conveniently 
employed  in  the  preparation  of  fruit  jellies.     Jains  ai-e  mixtures  q^ 
vegetable  pulps  with  sugar.     Carrigeen,  jjearl,  or  Irish  moss,  are  veg 
eto-gelatinous  substances  resembling  pectin. 

Considered  dietetically,  fruit  jellies  are  among  the  slight  deviations 
from  the  healthful  preparations  of  food.  They  are  far  less  valuable 
than  the  crude  fruits,  or  the  fruits  dried,  stewed  and  sweetened,  or 
preserved  in  their  own  inspissated  juices. 

The  organic  acids  constitute  the  acidulous  alimentary  principle  of 
authors.  They  are  the  acetic,  citric,  tartaric,  malic,  oxalic,  and  lactic. 
Those  chemists  who  regard  tea  as  nutritious  add  to  this  list  tannic  acid. 
It  is  not  certain  that  acetic  acid  is  entitled  to  a  place  among  organic 
elements.  It  is  found  in  pyroligneous  acid,  vinegar,  sour  beer,  and 
sour  wine ;  but  these  materials  are  not  the  products  of  formation, 
but  of  retrogradation.  Vinegar,  which  is  generally  considered  as  al- 
most identical  with  acetic  acid,  is  very  far  from  being  alimentary. 
Like  alcohol,  it  is  a  product  of  fermentation ;  and  although  it  is  re- 
garded as  "agreeable,"  "cooling,"  "refreshing,"  "  antiseptic,"  etc.,  by 
the  medical  profession,  it  is  certainly  very  debilitating  to  Vhe  human 
stomach.  Its  tendency  to  produce  leanness  has  long  been  known. 
Young  girls  who  have  employed  it  freely  to  diminish  an  unfash- 
ionable plumpness  of  body,  have  soon  found  themselves  fatally  con- 
sumptive. If  any  argument  can  be  drawn  from  antiquity  in  favor  of 
the  propriety  of  its  dietetical  employment,  the  same  argument  may 
be  made  to  sanction  every  evil  thing  under  the  sun. 

Citric  acid  is  found  in  the  lemon,  orange,  citron,  lime,  shaddock, 
cranberry,  and,  mixed  with  an  equal  quantity  of  malic  acid,  in  the  red 
currant,  straw^berry,  raspberry,  cherry,  and  bilbeny.  In  the  pulp  of 
the  tamarind  it  exists,  mixed  with  malic  and  tartai'ic  acids. 

Tartaric  acid  is  found  in  the  free  state  in  tamarinds,  grapes,  and 
pine-apples.  In  the  form  of  cream  of  tartar  it  exists  in  tamarinds, 
grapes,  and  mulberries.  This  acid  is  much  employed  in  effervescing 
compounds.  ' 

Malic  acid  is  extensively  distributed ;  it  is  found  in  apples,  pears, 
quinces,  plums,  apricots,  peaches,  cherries,  gooseberries,  currants, 
raspberries,  strawberries,  blackberries,  pine-apples,  barberries,  elder- 
berries, grapes,  tomatoes,  tamarinds,  and  other  fruits. 

Oxalic  acid  is  found  in  garden  rhubarb,  common  sorrel,  wood  sorrel, 
and  some  other  vegetables.  It  may  be  produced  by  the  action  of 
nitric  acid  on  sugar,  starch  gum,  wr^ol,  hail  silk,  and  many  vegetable 
acids. 


BSO  HYGIENE. 


Lactic  achi  exists  in  sour  milk ;  it  is  also  generated  in  the  souring 
process  of  various  vegetables ;  for  example,  when  oatmeal  sours  in  a 
large  quantity  of  water.  Liebig  states  that  no  lactic  acid  is  fbund  in 
a  healthy  stomach,  but  that  in  some  dyspeptic  individuals  sugar  yields 
lactic  acid,  attended  with  flatulence  and  preternatural  acidity  of  the 
stomach.  These  facts  prove  conclusively  to  my  mind  that  this  acid  is, 
like  vinegar,  a  product  of  destructive  decomposition,  instead  of  organic 
formation,  and  hence  is  in  no  sense  an  aliment. 

The  precise  chemical  offices  which  the  vegetable  acids  perform  ia 
the  animal  economy  is  not  obvious,  nor  is  it  of  the  least  consequence 
for  us  to  know.  It  is  sufficient  that  thej  exist  in  those  fruits  and  veg- 
etables which  nature  has  provided  for  our  nourishment.  And  if  nature 
has  assigned  them  any  nuti'itive  duty,  it  is  at  least  probable  that  she 
has  provided  them  in  about  the  proper  quantities  and  proportions,  just 
as  she  has  the  sugar,  salt,  starch,  gum,  and  all  the  other  nutritive  ele- 
ments, so  that  we  may  use  them  as  we  find  them,  %vithout  troubling 
ourselves  to  manufacture  an  exti'a  supply  by  way  of  "  necessary'''  sea- 
sonings. 

Fixed  oils  constitute  the  oleaginous  aliments^  and  the  oily  aliment- 
ary principle  of  authors.  Under  this  head  some  authoi-s  include  also 
tl'e  volatile  oils  of  those  vegetables  which  are  used  as  condiments — ■ 
mint,  marjoram,  savory,  sage,  thyme,  carraway,  anise,  fennel,  parsley, 
mustai'd,  horseradish,  garlic,  onions,  eschalots,  leeks,  cinnamon,  nut- 
meg, mace,  cloves,  pepper,  allspice,  ginger,  bitter  almonds,  peach  leaves, 
cheny,  laurel,  etc.  Some  of  these  vegetables  do  indeed  possess  aliment- 
ary properties,  but  the  volatile  oil  residing  in  them  is  as  destitute  of 
nutritive  vu'tue  as  vinegar  or  alcohol. 

The  fixed  oils  are  :  Fat^  suet,  tallow,  lard,  or  axunge,  marrow, 
grease,  butter,  and  blubber,  derived  "from  the  animal  kingdom,  and 
olive  oil,  almond  oil,  walnut  and  other  nut  oils,  derived  fi-om  vegetables. 

The  quantity  of  oil  or  fat  in  100  pai'ts  of  the  following  substances  is: 
Filberts  60,  olives  32,  olive  seeds  54,  walnuts  50,  earth-nut  47,  cocoa- 
nut  (fleshy  part)  47,  almonds  46,  plums  33,  white  mustard  36,  black 
mustard  18,  gi'ape  stones  11  to  18,  m&'ze  9,  dates  0-2;  yolk  of  eggs 
28,  ordinary  flesh-meat  14,  ox  liver  4,  cow's  milk  3-13,  human  do.  3-55, 
ass's  do.  0-11,  goat's  do.  3-32,  ewe's  do.  4*20,  bones  of  sheep's  feet 
5'55,  bones  of  ox  head  11-54 

Fats  ai'e  peculiarly  liable  lo  become  rancid  on  exposure  to  the  air;  a 
high  degree  of  heat  also  produces  chemical  changes  which  render 
them  exceedingly  acrid  and  irritating  to  the  digestive  organs ;  hence 
frying  is  a  very  objectionable  metliDd  of  cooking. 

Peieira  says*  "Fixed  oils,  or  fa    is  more  difficult  of  digestion,  and 


FOOD.  881 

more  obnoxious  to  the  stomach  than  any  other  alimentary  principle. 
Indeed,  in  some  more  or  less  obvious  or  concealed  form,  I  believe  it 
will  be  found  the  offending  ingredient  in  nine  tenths  of  the  dishes 
which  disturb  weak  stomachs.  Many  dyspeptics,  who  have  most  re- 
ligiously avoided  the  use  of  oil  or  fat  in  its  obvious  or  ordinary  state  (as 
fat  meat,  mairow,  butter,  and  oil),  unwittingly  employ  it  in  some  other 
more  concealed  form,  and,  as  I  have  frequently  witnessed,  have  suffered 
therefrom."  Liebig,  as  already  stated,  considers  fatty  matter  the 
principal  ftiel  by  which  the  animal  heat  is  sustained.  Dr.  Beaumont 
ascertained  that  the  gasti'ic  juice  had  a  very  slow  and  feeble  action  on 
fatty  matters,  either  in  or  out  of  the  stomach.  Dr.  Combe  states  that 
there  is  one  form  of  dyspepsia  in  which  the  fat  of  bacon  is  digested 
with  perfect  ease,  when  many  other  apparently  more  appropriate  arti- 
cles of  food  oppress  the  stomach  for  hours.  Prof.  Lee,  of  this  city, 
remarks :  "  We  have  treated  many  cases  of  cholera  infantum,  where 
every  thing  would  be  rejected  from  the  stomach  except  salt  pork,  or 
fat  bacon,  rare  broiled,  and  given  in  small  quantities."  I  think  an  ex- 
planation of  the  cases  mentioned  by  Drs.  Combe  and  Lee  may  be 
foimd  in  the  fact  that  such  stomachs,  and  usually  the  duodenum  also, 
are  loaded  with  foul,  acid,  acrid,  or  putrescent  secretions,  which  the 
grease  mingles  with,  and  for  a  time  obviates  their  irritation.  If  warm 
ivater  had  been  freely  given,  and  the  cutaneous  function  attended  to, 
the  pork  and  bacon  might  have  been  spared  with  advantage.  Brandy 
will  often  quiet  a  dyspeptic's  stomach,  and  at  the  same  time  be  one  of 
the  worst  quieters  he  could  employ,  and  calomel  will  often  "stay  on 
the  stomach"  when  the  patient  would  be  better  if  it  were  off.  Pi"o- 
fessor  Dunglison,  in  his  recent  work  on  Human  Health,  says,  "  Ole- 
aginous substances  are  eminently  nutritious ;"  an  assertion  pre-eminent- 
ly susceptible  of  disproof. 

I'he  most  objectionable  dishes,  on  account  of  their  fatty  character, 
al  ordinary  tables,  are  yolk  of  eggs,  livers,  brains,  sti'ong  cheese,  butter- 
cakes  and  toast,  pastiy,  m.arrow-puddings,  suet-puddings,  hashes,  stews, 
broths,  and  several  kinds  of  fishes,  as  eels,  sprats,  salmon,  and  herrings. 

The  vegetable  fixed  oils  are  less  indigestible,  and  from  their  less 
puti'escent  tendency,  more  healthfiil  than  the  animal.  Indeed,  it  is 
highly  probable  that  persons  long  accustomed  to  a  plain,  unstimulating, 
and  unconcentrated  diet,  could  employ  the  oily  fruits,  seeds,  and  nuts 
as  a  part  of  their  aliment  with  entire  physiological  satisfaction. 

Vegetable  jihrin,  albumen,  casein,  and  gluten,  and  animal  fibrin,  al- 
humen,  and  casein,  constitute  the  proteinaceous  alimentary  imncij^le  of 
Pereira,  which,  except  in  not  including  gelatin,  agrees  with  the  albu- 
minous alimentary  principle  of  Dr.  Prout.      Protein,  however,  from 


332  HYGIENE. 

which  this  gi'oup  of  proximate  elements  is  named,  has  no  real  ex- 
istence in  organized  beings  at  all ;  but  chemical  analysis  resolves 
the  fibrin,  albumen,  and  casein  of  both  animal  and  vegetable  sub- 
stances into  a  something  and  salt  sulp:ur,  phosphorus,  potash,  soda, 
and  phosphate  of  lime,  and  this  something,  which  is  formed  in  the 
process  of  analysis,  is  called  protein.  Protein,  from  whatever  sub- 
stance obtained,  exhibits  the  same  identica.  composition,  that  is,  as 
nearly  as  can  be  determined  by  chemical  analysis,  which  is  always 
imperfect,  and  never  quite  uniform  in  determining  the  atomic  constitu- 
tion of  complicated  organic  subsfltmces. 

The  fibrin,  albumen,  and  casein  of  animals  ai'e  chemically  identical 
with  the  fibrin,  albumen,  and  casein  of  vegetables.  According  to  Lie- 
big,  they  are  produced  by  vegetables  only,  although  the  animal  organ- 
ism is  capable  of  converting  one  of  them — one  modification  of  protein, 
into  another.  If  this  be  time,  and  if  the  proteinaceoiis  compounds — 
the  "plastic  elements  of  nutrition" — only  are  capable  of  forming  the 
tissues,  all  the  tmly  nutritive  materials  of  animals  not  only  exist  in,  but 
ai*e  formed  in  vegetables ;  and  this  fact  forms  a  strong  presumption  in 
favor  of  the  superiority'  of  a  purely  vegetable  diet — taking  the  aliment 
directly  fi'om  the  vegetable  kingdom  in  its  primitive  purity  and  vitality, 
before  it  is  vitiated  by  the  taint  of  animal  deterioration  and  puti-efaction. 

Vegetable  fibrin  exists  abundantly  in  wheat,  rye,  barley,  oats,  maize, 
rice,  and  the  juice  of  gi'apes.  It  is  also  found  in  buckwheat,  and  in 
many  newly  expressed  vegetable  juices,  as  of  carrots,  turnips,  and 
beet-root;  it  exists  also  in  the  raw  gluten  obtained  from  wheaten 
flour  Animal  fibrin  is  the  principal  constituent  of  lean  flesh,  and  la 
found  m  the  blood.  One  hundred  parts  of  lean  beef  contain  of  fibrin 
about  18,  veal  17,  mutton  20,  pork  17,  chicken  17,  cod,  haddock,  sole, 
each  about  13,  pancreas  of  calf  8,  blood  of  sheep  0-03,  biood  of  ox  0-37, 
blood  of  hog  0-46. 

Vegetable  albumen  is  found  in  abundance  in  oily  seeds — almonds, 
nuts,  etc.;  it  is  a  constituent  of  wheat  and  other  gi'ains,  and  a  consider- 
able quantity  is  contained  in  the  juices  of  carrots,  turnips,  asparagus, 
cauliflowers,  cabbages,  etc.  It  diflfers  from  albumen  in  not  coagulating 
when  heated,  and  from  fibrin,  in  dissolving  in  water.  Animal  albumen 
exists  in  the  solid  state  in  flesh,  glands,  and  viscera,  and  in  the  fluid 
state  in  the  egg,  and  in  the  serum  of  the  blood.  The  quantity  con- 
tained in  100  parts  of  the  following  aliments  is :  Blood  of  the  ox,  hog, 
goat,  and  sheep  18  to  19,  beef  2-2,  veal  2-6  to  3-2,  pork  2-6,  deer  2-3, 
pigeon  4-5,  cliicken  3-  carp  5-2,  trout  4-4,  sweet-bread  of  calf  14, 
caviare  (fresh)  31,  live:  of  ox  2C  yolk  of  egg  17,  white  do  3  5,  East 
India  isinglass  '''to  13 


FOOD.  383 

Vegetable  casein  has  been  called  legumin,  because  it  is  found 
chiefly  in  leguminous  seeds — peas,  beans,  lentils.  Almonds,  nuts,  and 
other  oily  seeds  contain  it  with  albumen.  Many  vegetable  juices  yield 
it  in  small  quantities.  It  is  soluble  in  water,  unlike  fibrin,  and  uncoag- 
ulable  when  its  aqueous  solution  is  heated,  unlike  albumen.  Animal 
casein  is  the  coagulable  matter  in  milk,  and  forms  its  caseum,  or  curd. 
In  the  liquid  state  it  does  not  coagulate  by  heat.  Cheese  is  the  coagu- 
lated casein  depnved  of  its  whey,  and  mixed  with  more  or  less  of 
butter.  When  rich  in  butter,  cheese  is  very  liable  to  undergo  sponta- 
neous decomposition,  and  generate  active  poisons.  The  strong,  pi- 
quant flavor  of  old  cheese  depends  on  oleic  acid,  and  an  acrid  oil,  both 
extremely  unwholesome.  The  per  centage  of  casein  in  milk  is : 
Woman's  1-52,  goat's  4-02,  ewe's  4-50,  ass's  1-82,  cow's  3  to  4-48.  In 
two  samples  of  cow's  milk,  the  animals  fed  on  potatoes  and  hay,  one 
yielded  15-1,  the  other  only  3*3. 

As  a  food,  liquid  casein,  curd,  and  fresh  cheese  are  wholesome 
articles,  but  all  old  cheese  is  an  exceedingly  obnoxious  aliment.  Dr. 
Dunglison  says :  "  Cheese  is  supposed  to  be  an  excellent  condiment, 
and  accordingly  it  is  often  systematically  taken  at  the  end  of  dinner,  as 
a  digestive^  Dr.  Dunglison  ought  to  have  added,  especially  as  he  was 
writing  the  "  Elements  of  Hygiene,"  that  the  supposition  was  a  very 
eiToneons  one,  and  the  practice  a  very  bad  one. 

Gluten  is  the  tenacious  elastic  mass  Avhich  is  left  of  wheaten  dough 
after  washipg  away  the  gum,  sugar,  starch,  and  albumen.  It  is  a  mix- 
ture of  several  organic  principles,  and  is  regarded  as  one  of  the  pro- 
teinaceous  compounds.  Liebig's  vegetable  Jibrin-  is  the  insoluble  por- 
tion of  gluten  when  it  is  boiled  in  alcohol.  Mucin  is  the  substance 
which  deposits  as  the  hot  alcoholic  solution  of  the  soluble  portion  of 
gluten  cools,  and  the  portion  remaining  in  solution  is  called  gluten. 
The  pure  gluten  of  authors  is  the  compound  of  gluten  and  mucin.  It 
is  the  gluten  of  wheaten  flour  which  renders  it  adhesive,  and  conve 
niently  manufactured  into  macaroni,  vert  licelli,  and  similar  pastes ;  to 
its  larger  proportion  of  this  ingredient,  wheat  owes  its  superiority  to 
other  grains  for  the  purposes  of  making  fermented  bread,  crackers, 
and  cakes.  In  the  ordinary  commercial  process  of  bread-making 
(bakers'  bread)  the  gluten  is  more  or  less  destroj'ed,  and  converted 
into  acetic  acid,  which  is  neutralized  by  ammonia,  or  some  other  alkali. 
If  the  panary  fermentation  is  allowed  to  proceed  beyond  the  point  of 
converting  the  sugar  of  the  flour  or  meal  into  cai'bonic  acid  gas  (which 
being  diffiised  among  the  ductile  and  tenacious  particles  of  gluten,  pnfls 
up,  or  raises  the  dough),  the  process  of  decomposition  attacks  the 
gluten  itself,  which  it  literally  rots,  and  although  such  bread  uiny  be 


884  HYaiENE. 

exceedingly  light  and  spongy,  and  expand  into  the  "  lai'gest  loaf,"  it  is 
very  unwholesome,  compared  with  good  breads  and  after  standing 
twent^'-four  hours  becomes  insipid  and  disagreeable. 

The  quantity  of  glutinous  matter  contained  in  the  cereal  grains  is 
liable  to  great  variation,  according  to  soil,  manner  of  cultivation,  species 
of  gi'ain,  etc.,  if  we  may  trust  thp  deductions  of  chemical  analyses. 
Wheat  has  been  found  to  contain,  in  100  parts,  12  to  35,  barley  5  to  6, 
oats  4  to  8,  rye  7  to  10,  rice  3  to  4,  corn  3  to  6,  common  beans  10, 
dry  peas  3},  potatoes  3  to  4,  red  beet  1-3,  common  turnips  0-01,  cab- 
bage 0-8. 

All  of  these  proteinacious  aliments — gluten,  casein,  albumen,  and 
fibrin — as  well  as  fat,  starch,  sugar,  and  gum,  have  been  fed  separately 
to  dogs  and  other  animals,  in  order  to  ascertain  their  nutritive  proper- 
ties. The  animals  all  died  of  starvation,  and  physiological  science 
profited — ^just  nothing  at  all,  unless  it  was  from  the  mortalitj^  of  the 
dogs !  If  animals  were  intended  by  nature  to  subsist  on  any  single 
element  of  nutrition,  consistency  would  seem  to  demand  that  such  ele- 
ment should  be  accessible  in  some  way  except  through  the  tedious 
process  of  culinary  preparation  or  chemical  analysis.  Such  unnatural 
dietetic  experiments  can  only  result  in  "cnielty  to  animals." 

Gelatin  is  regarded  by  Dr.  Prout  as  an  imperfect  kind  of  albuminous 
matter.  Gelatin  and  albumen  are,  however,  not  convertible  into  each 
other  by  any  known  chemical  process.  Those  tissues  of  animals  called 
gelatinous — skin,  tendons,  cartilage,  cellular  and  serous  membranes — 
by  Jbciling,  yield  a  substance  called  gelatin ;  and  this  substance,  with 
water,  forms  a  tremulous  mass,  called  animal  jelly.  The  quantity  of 
gelatin  found  in  100  parts  of  the  following  substances  is :  Muscles  of 
beef  6,  do.  veaJ  6,  do.  mutton  7  do.  pork  5,  do.  chicken  7,  do.  cod  7, 
do.  haddock  5,  sole  6,  sweet-bread  of  calf  6,  antlers  of  stag  (haitshorn) 
27,  caviare  (fresh)  0-5,  spongy  bones  39,  hard  bones  43  to  49,  isinglass 
70  to  93. 

Gelatinous  substances  ai*e  moderately  nuti'itious,  but  generally,  in 
the  form  of  stews,  hashes,  soups,  etc.,  difficult  of  digestion,  on  account 
of  the  fatty  matters  they  contain ;  gelatin  easily  becomes  rancid  and 
putrescent  when  exposed  to  a  high  degree  of  heat,  and  is  then  ex- 
tremely offensive  to  the  stomach.  Calf's  foot  jelly  is  a  favorite  with 
physicians  and  invalids,  but  flu*  inferior,  dietetically  or  medicinally,  to 
Indian  or  wheat-meal  gi'uel. 

A  few  yeai's  ago  a  Gelatin  Commission  was  appointed  in  Paris, 
for  the  purpose  of  asceitaiuing  the  nutritive  v/rtues  of  bones  and  other 
refuse  animal  matter,  with  the  view  of  providing  a  cheap  diet  for  the 
poor !     After  a  series  of  experiments,  which  caused  a  large  number 


FOOD  335 

of  dogs  to  "  bite  the  dust,"  it  was  finally  concluded  that  gelatin  alone 
would  not  sustain  animal  life — a  conclusion  that  correct  physiological 
principles  would  have  settled  without  the  experiments.  As  a  specimen 
of  the  exti'emely  absurd  manner  in  which  those  experiments  have  usu- 
ally been  conducted,  I  quote  the  following  from  Pereu'a's  "  Food  and 
Diet:"  "M.  Donne  tiied  the  effects  of  gelatin  on  himself.  He  took 
daily  from  20  to  50  gi'ammes  (308^  to  77 li  gi'S.  ti*oy)  of  dry  gelatin, 
in  the  form  of  a  sugared  and  anomatized  jelly,  with  either  lemon  or 
some  sjnrit ;  and  from  85  to  100  gi'ammes  (1312  to  1543^  grs.  troy)  of 
bread.  At  the  expiration  of  six  days  he  had  lost,  two  pounds  in  weight, 
and  during  the  whole  time  was  tormented  with  hunger,  and  suffered 
with  extreme  faintness,  which  was  only  alleviated  after  dining  in  his 
usual  way." 

Such  "experiments"  are  not  worth  criticising:,  except  to  exhibit  the 
foolish  and  frivolous  manner  in  which  those  who  assume  to  teach  us 
physiology  derive  the  facts  which  they  parade  with  such  flourishes  in 
their  "scientific"  books.  Any  man  accustomed  to  a  "good  dinner" 
every  day,  as  the  phrase  is  usually  understood,  and  spirituous  liquor 
with  it,  would  suffer  hunger,  or,  rather,  craving  and  faintness,  on  first 
changing  his  dietetic  habits  to  greater  abstemiousness  and  simplicity, 
whether  the  change  was  to  better  or  worse. 

The  gelatinous  substances  commonly  employed  in  the  preparation 
of  jellies,  solutions,  etc.,  are  isinglass  and  hartshorn.  The  former  is 
procured  from  the  air-bag  or  sivimming-hladder,  sometimes  cfdled 
the  sound,  of  various  fishes.  The  Russian  and  Siberian  sturgeons 
yield  the  finest  kinds  for  domestic  purposes.  Blanc-mange  is  a  jelly 
prepared  of  Russian  isinglass  dissolved  in  milk,  and  flavored  with  su- 
gar, lemon,  etc.  Cod  sounds,  procured  from  the  common  cod-fish,  are 
used  as  a  substitute  for  isinglass ;  the  glue  obtained  by  boiling  cod 
sounds  dries  into  a  hard  substance,  and  is  used  in  the  shops  for  gluing 
pieces  of  wood  together.  Glue  is  also  prepared  from  the  skins  and 
hides  of  beasts  and  the  bones  of  animals,  for  both  dietetical  and  com- 
mercial purposes.  The  shavings  of  the  antlers  of  the  stag  are  em- 
ployed in  the  preparation  of  the  decoction  of  hartshorn ;  hartshorn 
jelly  is  made  by  boiling  down  half  a  pound  of  the  shavings  in  three 
quarts  of  water  to  one  quart,  and  flavoring  with  lemon,  wine,  etc. 
Jellies  made  from  calves'  feet,  calves'  heads,  cows'  heels,  sheep's  trotterSt 
and  petit-toes  (sucking  pigs'  feet),  are  in  gi-eat  repute  as  delicate  ali- 
ments for  epicures  and  invalids.  I  regard  them  all  as  miserable  trash 
at  best. 

TTie  salts  which  are  found  to  exist  in  very  small  quantities  in  vege- 
tables and  fi'uits  constitute  the  saline  alb  \entary  j^rincij^le  of  authors. 


S36  HYGIENE. 


Chloride  of  sodium  (common  salt)  and  the  earthy  p}ic$phates  are  the 
most  frequently  found  in  vegetable  aliments ;  and  some  chemists  re- 
gard salts  of  potash  and  compounds  of  iron  as  indispensable  constitu- 
ents of  our  food,  because  they  are  generally  found  in  the  human  body, 
and  frequently  in  vegetable  productions. 

Perhaps  there  was  never  a  greater  and  more  general  delusion 
abroad  than  that  in  relation  to  the  nature,  properties,  and  uses  of  com- 
mon salt.  It  can  be  shown,  with  almost  the  certainty  of  a  mathemati- 
cal demonsti'ation,  that  it  possesses  no  nutrient  properties,  and  is  in  no 
sense  a  dietetical  article,  nor  in  any  sense  of  any  possible  use  for  any 
purpose  of  the  animal  economy;  and  yet  medical  writers  ai'e  continu- 
ally echoing  the  stale  phi'ase,  "  that  animals  cannot  exist  without  the 
free  use  of  salt ;"  and  this  directly  in  face  of  the  facts,  that  hundreds 
of  species  of  animals  never  taste  of  salt,  and  that  millions  of  the  human 
race  have  lived  healthfull}^  and  died  of  a  good  old  age,  without  em- 
ploying it  at  all ;  and  that,  furthermore,  hundreds  of  thousands  of  hu- 
man beings  now  live  in  the  enjoyment  of  excellent  health,  who  have 
never  used  salt  either  as  a  food  or  a  condiment.  The  stereotyped 
statements  so  frequently  copied  in  medical  books  and  journals  are 
really  amusing  for  their  very  absurdit}^  Pereira  says  :  "It  is  a  neces- 
sary article  of  food,  being  essential  for  the  preservation  of  life  and  the 
maintenance  of  health."  Duuglison  says  :  "  Salt  is  a  natural  and  agi'ee- 
able  stimulant  to  the  digestive  function ;  a  diet  of  uusalt^d  aliment 
generating  disease,  chiefly  of  a  cachectic  character.  Children  who 
are  not  allowed  a  sufficient  quantity'  of  this  useful  condiment^  are  ex- 
tremely liable  to  worms."  Liebig  says  :  "  Salt  is  essential  to  the  for- 
mation of  bile  in  the  herbivora,  and  to  that  of  gasti'ic  juice."  These 
expressions,  and  a  hundred  similar  ones  which  could  be  quoted  from 
as  many  authors,  are  purely  fictitious,  as  is  proved  by  the  whole  liis- 
tory  of  the  animal  kingdom,  and  the  experience  of  a  large  portion  of 
the  human  iamily.  But  let  us  look  at  the  theory  or  philosophy  of  the 
matter. 

Dr.  Dunglison  admits  that  salted  meats  are  more  indigestible  than 
fresh,  and  he  says  also:  "When  highly  dried  they  become  more  or 
less  coriaceous,  and  of  a  texture  very  unfit  for  the  due  action  of  the 
gastric  secretions."  Dr.  Paris  thinks:  "Salt  ccti bines  with  the  ani- 
mal fibre  of  salted  meats,  by  which  the  texture  is  so  changed  as  to 
render  them  less  nuti-itive  as  well  as  less  digestible."  "  Certain  fish," 
says  Dunglison,  "  when  salted,  as  the  anchovy,  cod,  haddock,  herring, 
etc.,  ai'e  used  as  relishes  in  the  way  of  condiments.  They  are  stimu- 
lating;  but  the  combination  of  Jiesh  and  salt  is  very  indigestible,  and 
unfit  for  the  dyspeptic."     Pereira  says:  "The  antiseptic  power  of  salt 


F  0  U  1>.  337 

is  by  no  means  well  understood."  Liebig  says :  "  Fresh  flesh,  over 
which  salt  has  been  strewed,  is  found,  after  twenty-four  hcurs,  swim- 
ming in  brine,  although  not  a  drop  of  water  has  been  added.  The 
water  has  been  yielded  by  muscular  fibre  itself,  and  having  dissolved 
the  salt  in  immediate  contact  with  it,  and  thereby  lost  the  power  of 
penetrating  animal  substances,  it  has  on  this  account  separated  from 
the  flesh.  The  water  still  retained  by  the  flesh  contains  a  proportion- 
ally small  quantity  of  salt,  having  that  degree  of  dilution  at  which  a 
saline  fluid  is  capable  of  penetrating  animal  substances.  This  property 
of  animal  tissues  is  taken  advantage  of  in  domestic  economy  for  the 
purpose  of  removing  so  much  water  from  meat  that  a  suflicient  quantity 
is  not  left  to  enable  it  to  enter  into  puti'efaction." 

If  Liebig's  explanation  be  true — and  I  believe  it  is  tixie,  and  it  is 
corroborated  by  the  experiments  and  opinions  of  other  distinguished 
chemists — that  the  antiseptic  property  of  salt  is  owing  to  its  abstract- 
ing from  the  animal  fibre  its  aqueous  particles,  thus  rendering  it  less 
capable  of  solution  and  decomposition,  it  proves  also  that  salt  is  anti- 
dietetic  in  the  exact  ratio  that  it  is  antiseptic,  for  digestion  implies  the 
decomposition  and  ti'ansformation  of  the  elements  of  the  alimentary 
substance.  But  some  authors,  among  whom  are  Paris  and  M.  Eller, 
have  expressed  the  opinion,  and  proved  it  by  experiments,  that  salt 
actually  combines  chemically  with  the  animal  tissues,  thus  effecting  to 
some  extent  their  destruction ;  hence  a  large  quantity  of  it,  or  what  is 
usually  called  the  "  free  use  of  salt,"  cannot  be  otherwise  than  seriously 
injurious. 

The  following  awfully  convincing  argument  in  favor  of  salted  food  is 
frequently  quoted  by  "  old  schoor'  writers  on  hygiene  :  "  Lord  Somer- 
vilie,  in  an  address  to  the  English  Board  of  Agriculture,  refers  to  a 
punishment  that  formerly  existed  in  Holland.  The  ancient  laws  of 
the  country  ordained  men  to  be  kept  on  bread  alone,  unmixed  with 
salt,  as  the  severest  punishment  that  could  be  inflicted  upon  them  in 
their  moist  climate.  The  eft'ect  was  horrible  ;  these  wi'etched  crim- 
inals are  said  to  have  been  devoured  by  worms  engendered  in  their 
own  stomachs."  Whether  this  story  is  fact  or  fiction,  the  principle 
applicable  to  its  explanation  is  obvious  enough.  It  is  true  that  salt  will 
kill  many  kinds  of  worms ;  and  if  the  bread  fed  to  the  Hollander  con- 
victs was  really  a  bad,  rotten,  wormy  article,  there  can  be  no  doubt 
that  the  addition  of  salt  enough  to  destroy  the  vermin  was  a  decided 
advantage. 

The  fondness  of  domesticated  animals  for  salt  is  often  referred  to  as 
evidence  that  the  desire  for  salt  is  a  necessary  and  natural  instinct  in 
all  animals ;  and  the  fact  that  the  deer  of  our  forests  seek  the  licks  of 
1—29 


888  hyg:e>e. 


salt  water,  is  adduced  in  evidence  of  the  same  nat;>ral  instinct.  But 
it  should  be  remembered  that  domesticated  animals  have  domesticated 
tastes,  and  that  civilized  horses,  sheep,  cattle,  and  hogs,  are  just  as 
liable  to  acquire  depraved  appetites  as  civilized  men.  I  have  known 
co\AS  to  break  into  the  "sap-bush"  in  maple-sugar  districts,  and  drink 
themselves  almost  to  death  on  syi-up,  yet  no  one  would  pretend  that 
sugar,  molasses,  or  ti'eucle,  was  a  natural  food  for  cattle,  except  as  it 
exists  in  the  juices  of  vegetables.  It  should  be  obseiTed,  too,  that  the 
wild  animals  who  frequent  the  salt  water  pools,  only  do  so  habitually  in 
the  warm  season,  when  insects  and  worms  are  troublesome. 

The  scurvy,  which  is  owing  principally  to  a  diet  consisting  of  a  large 
proportion  of  salted  provisions,  is  a  disease  whose  symptoms  indicate 
an  exceedingly  impoverished  state  of  the  blood,  and  a  putrescent  con- 
dition of  all  the  fluids  and  solids  of  the  body.  The  antiseptic  property 
of  salt  does  not  therefore  render  it  wholesome.  The  ti'uth  is,  the 
term  antiseptic  has  no  applicability'  to  a  living  body  or  its  aliment.  It 
is  a  property  which  preserves  dead  organic  matter  in  a  fixed,  un- 
changeable state ;  and  so  far  as  it  affects  any  living  tissue,  it  must 
deaden  its  vitality. 

The  dietetical  rule  for  the  employment  of  salt  is  veiy  simple — tht 
less  the  better.  I  do  not  suppose  a  vei-y  moderate  quantity  is  harmful 
to  any  appreciable  extent,  i  very  little  may  be  so  diluted  by  the  fluids 
of  the  stomach,  and  so  readny  washed  out  of  the  system  as  to  occasion 
no  important  inconvenience.  But  if  used  habitually  to  the  extent  of 
provoking  unnatural  appetite  and  exciting  thirst,  it  cannot  be  other- 
wise than  prejudicial  to  the  whole  organic  domain,  occasioning  glandu- 
lar obstructions,  rlaidity  of  the  muscles,  producing  genei-al  irritation  of 
the  mucous  membrane  of  the  alimentaiy  canal,  and  loading  the  circu- 
iting fluids  with  a  foreign  ingredient,  which  the  excretory  organs  must 
labor  inordinately  to  get  rid  of. 

So  far  as  common  salt  and  its  elements  (sodium  and  hydrochloric 
acid)  exist  in  esculent  fruits  and  vegetables,  so  far  I  admit  they  are 
alimentary.  But  it  seems  ^o  me  quite  clear  that  nature  has  put  the 
saline  as  well  as  the  acid  aud  alkaline  elements  of  our  food  together  in 
exactly  the  right  proportions,  so  that  the  wants  of  the  organic  economy 
do  not  require  us  to  make  any  extraneous  additions. 

Probably  those  who  have  never  tried  the  experiment  would  be  sur 
prised  to  learn  how  easily  the  appetite  for  very  salt  food  is  overcome. 
Many  persons,  on  restricting  themselves  to  less  than  one  fourth  the 
usual  quantity  for  one  month,  have  found  the  palate  as  well  satisfied  as 
it  was  previously  on  four  times  the  quantity.  The  diminution  of  quan- 
tity can  then  be  carried  still  further  without  sacrificing  much  gustatory 


FOOD.  339 

pleasure,  for,  as  the  unnatural  irritant  is  withdrawn,  the  sense  of  taste 
becomes  proportionally  keen,  so  that  food,  before  unpalatable  without 
high  seasoning,  is  relished  with  little  or  none. 

The  remarks  in  relation  to  common  salt  are  equally  applicable  to  the 
dietetical  nature  of  all  other  saline  ingredients  found  in  alimentary  sub- 
stances, although  none  of  them  are  in  use  as  condiments.  The  plios- 
jyhate  of  lime,  which  is  tlie  basis  of  the  bony  structure,  is  found  more 
generally  in  vegetables  than  any  other  salt.  The  earthy  phosphates  are 
found  in  one  hundred  parts  of  wheat  0'36  to  0-9,  rye  0*06  to  4*18, 
barley  0*1  to  0-6,  oats  0*16  to  0*6,  rice  0*4,  garlic  I'l,  casein  6*0,  milk 
0-1975,  blood  0-03,  bones  45  to  56,  muscular  ilesh  of  ox  a  trace,  do.  of 
calf  0-1,  do.  of  pig  a  trace,  do.  of  roe  0-4,  do.  of  chicken  0-6,  do.  of 
trout  2*2,  corn,  potatoes,  milk,  and  many  other  foods  contain  the  earthy 
phosphates. 

Minute  quantities  of  the  salts  of  potash  are  found  in  most  vegetable 
foods,  and  in  the  blood,  solids,  and  secretions  of  animals.  The  state  in 
which  the  compounds  of  irx)n  ex^st  in  the  system,  and  the  manner  in 
which  they  are  introduced,  ai'e  entirely  unknown ;  and  it  is  question- 
able whether  they  are  in  any  degree  natural  constituents  of  alimentary 
substances. 

A.LIMENTS,  OR  FooDS  Proper. — Having  treated  of  the  ultimate  or 
chemical  elements  of  food,  and  the  proximate  elements  compounded 
of  the  ultimate,  we  come  now  to  the  consideration  of  aliments,  or  foods 
proper,  which  are  compounds  of  the  proximate  elements.  Pereira 
terms  the  proper  foods  "  comjyound  alijnentSj,"  a  name  predicated  on 
the  mistaken  notion  that  the  alimentary  principles  were  really  simjjle 
aliments.  He  might  as  well  call  the  oxygen  and  the  hydrogen  of  the 
water  we  drink  aqueous  principles,  and  their  combination  in  the  form 
of  water  compound  drink! 

Whatever  may  be  the  natural  dietetic  character  of  man — a  question 
to  be  discussed  in  the  succeeding  division  of  this  work — both  the  ani- 
mal and  vegetable  kingdoms  are  n.«de  subservient  to  his  nutrition. 
Hence  the  obvious  propriety  of  treating  this  branch  of  our  subject 
under  the  general  divisions  of  animal  and  vegetable  food. 

§.  Animal  Food. — Animal  substances  yield  the  Alimentary  princi- 
ples called  proleinaceous,  gelatinous,  and  oleaginous,  to  which  may  be 
added  the  sugar  of  milk.  They  are  derived  from  flesh,  blood,  bones, 
cai'tilages,  ligaments,  cellular  tissue,  viscera,  milk,  and  eggs.  All 
the  species  of  animals  which  human  power  and  ingenuity  have  been 
able  to  grasp — beasts,  birds,  fishes,  reptiles,  and  insei^te,  and  every 
viscus  or  structure  of  each  animal — brain,  lung,  heart    stomach;   in 


840  HYGIENE. 


testine,  kidneys,  skin,  etc.,  has  been  more  or  less  employed  as  human 
aliment. 

In  the  more  civilized  counti'ies  the  mammals — neat  cattle,  sheep,  and 
hogs,  aflbrd  the  principal  supply  of  food ;  the  deer,  ra'buit,  hare,  elk, 
moose,  buffalo,  and  bear,  belong  to  this  class,  and  are  used  to  some  ex- 
tent in  many  counti'ies.  Even  the  horse,  dog,,  cat,  rat,  and  mouse,  are 
common  food  among  the  Kalmuck  Tartars  and  some  other  tribes  of 
the  human  family.  Of  birds  those  principally  eaten  are  the  common 
fowl,  turkey,  goose,  duck,  parti'idge,  woodcock,  and  pigeon,  though  a 
gi-eat  variety  of  other  game  birds  are  common  at  the  refectories.  The 
only  reptiles  which  are  much  sought  after  in  the  United  States  are  the 
various  kinds  of  turtles,  the  most  common  of  which  are  the  salt  ivater 
terrapin,  painted  tortoise,  broad  terrapin,  red-bellied  terrapin,  geo- 
graphic tortoise,  snapping  turtle,  soft-shelled  turtle,  and  the  green  tur- 
tle. The  common  water-frog  and  the  bull-frog  are  occasionally  eaten, 
and  the  ■fle-'^h  of  vipers  was  once  in  repute  as  an  analeptic  or  restorative 
diet  for  invalids.  O^ fishes  oui*  brooks,  rivei-s,  lakes,  and  oceans  furnish 
an  endless  variety,  from  the  ichale  of  a  hundi'ed  tons  to  the  shrimp  of 
a  tenth  part  of  an  ounce.  The  shell-fish  employed  as  food  are  the 
lobster,  crawfish,  crab,  prawn,  shrimp,  etc. — the  crustaceousj  and  the 
oyster,  mussel,  cockle,  whelk,  scallop,  limpit,  p)^nwinkle,  etc. — the 
raollusks. 

The  best  animal  food  is,  beyond  all  peradventure,  that  derived  from 
the  herbivora — beef,  mutton,  etc-  Those  animals  which  derive  their 
nourishment  directly  fi-om  the  vegetable  kingdom  will  certainly  afford 
a  purer  and  more  wholesome  aliment  tlian  animals  who  subsist  on 
other  animfils — the  carnivora.  Omnivorous  animals,  that  eat  indiscrim- 
inately vegetables  or  other  animals,  are  far  inferior  to  the  purely  herb- 
ivorous as  food  for  human  beings.  Of  the  hog,  whose  filthy  carcass 
is  converted  into  a  mass  of  disease  by  the  ordinary  fattening  process,  I 
need  only  express  my  abhorrence.  Although  swine  flesh  and  gi'ease, 
under  the  names  of  pork  and  lard,  are  staple  and  favorite  articles  of 
food  throughout  Christendom,  common  observation  has  long  since  traced 
the  prevalence  of  scrofula,  erysipelas,  and  a  variety  of  glandular  and 
ei-uptive  diseases  resulting  from  impure  blood,  to  their  general  em- 
ployment. If  there  are  any  animals  which  should  be  exterminated 
from  earth,  mad  dogs  and  fattened  hogs  are  among  vhem.  If,  as  Dr. 
Adam  Clarke  suggested  at  a  dinner  where  a  smoking  roaster  of  a  pig 
graced  the  table,  the  animal  was  "  cursed  under  the  law,"  how  can  it 
be  blessed  under  the  gospel  ?  The  flesh  of  animals  that  subsist  ex- 
clusively on  vegetable  food  contains  a  greater  portion  of  nutritive  mat- 
ter, according  to  chemical  analysis,  than  the  flesh  of  any  other  animals. 


FOOD  841 

But  thd  quality  of  the  food  derived  from  herbivorous  animals  may 
be  gi'eatly  varied  by  circumstances.  Very  young  or  very  old  animals 
are  less  healthf il  than  young,  nearly  full-grown,  or  middle-aged.  Ani- 
mals which  have  been  excessively  fattened,  ov  stall-fed,  and  those 
which  have  been  hard  worked,  are  deteriorated  as  food ;  and  animals 
tiiat  have  been  "  slopped"  with  liquid  preparations,  the  refuse  matters 
of  the  kitchen,  c^r  the  filthy  excrements  of  distilleries,  are  very  un- 
clean and  unhealihful. 

There  is  also  a  choice  in  the  different  parts  or  structures  of  all  ani- 
mals when  we  come  to  the  matter  of  converting  them  into  the  actual 
substance  of  the  organs  and  structures  of  our  own  bodies.  The  veiy 
best  part  of  any  animal  for  any  human  being  to  eat  is  the  lean  flesh  or 
muscular  fibre ;  and  that  flesh  is  unquestionably  the  most  wholesome 
which  is  found  in  animals  neither  fattened  nor  emaciated.  But  some 
allowance  must  be  made  for  the  masticatory  ability  of  human  teeth, 
"as  society  is  now  constituted."  Flesh-meat  requires  thorough  mas- 
tication. Human  beings  have  not  the  tearing  teeth  of  the  tiger  and 
the  wolf,  nor  the  cutting  motion  of  the  jaw  which  belongs  to  the  car- 
nivora.  Moreover,  the  teeth,  jaws,  and  gums  of  most  people  who  live 
in  the  ordinary  way  are  preternaturally  sensitive  and  tender ;  and  in 
addition  to  all  this,  a  large  portion  of  people,  even  young  people,  ii 
civilized  society,  wear  artificial  teeth.  They  cannot,  therefore,  well 
masticate  tough  meat,  as  is  often  demonstrated  in  the  cases  of  choking 
in  the  attempt  to  swallow  half-chewed  flesh.  For  this  reason  the  ani- 
mal had  better  be  in  good  condition,  and  only  the  most  tender  fibres 
selected  as  food.  Epicures  generally  have  their  flesh  kept  until  it 
becomes  tender  from  age  ;  but  such  tenderness  is  the  condition  of  in 
cipient  putrefaction,  and  although  the  article  may  be  very  easily  dis- 
posed of  by  the  teeth,  and  very  quickly  dissolved  in  the  stomach,  it 
can  never  be  well  digested,  nor  can  it  ever  be  converted  into  pure 
blood  and  sound  tissues.  It  is  advantageous  to  break  up  the  fibres  of 
tough  meat  by  thoroughly  pounding  before  cooking. 

Tiie  process  of  decomposition  commences  in  a  dead  animal  the  mo- 
ment that  life  is  extinct,  although  it  may  not  be  offensively  apparent  to 
our  senses  for  some  hours  or  days  after  death  And  as  living  animals  can 
derive  no  nittriment  fi-om  any  solid  food  exuept  it  be  in  its  organized 
state,  it  follows  that  the  flesh  of  animals  as  food  deteriorates  continually 
after  the  animal  is  killed  ;  and  hence  the  sooner  butcher's  meat  is  em- 
ployed after  being_  killed,  the  more  wholesome.  It  may,  however,  be 
immediately  frozen,  and  kept  a  long  time  without  injury.  The  manner 
of  slaughtering  the  animals  also  affects  the  quality  of  their  flesh.  They 
should  ahvays  be  JcilU  i  aUojMtki call]/— begging  pardon  of  my  "old- 


,^2  HYGIENE. 


school  friends,"  if  I  have  any — that  is,  hied  in  such  a  manner  as  to 
empty  the  vessels  as  cleanly  as  possihleviand  never  executed  by  stunning, 
pounding,  Av^inging  the  neck,  etc.  The  blood  not  only  contains  the 
nutrient  elements  of  the  food,  but  the  waste  matters  to  be  expelled 
from  the  body,  and  also  such  accidental  impurities  as  may  have  obtained 
admission  into  the  body;  and  the  more  bloody  any  kind  of  animal  food 
is,  the  more  unclean,  uutresccut,  and  unwholesome.  Dr.  Dunglison 
Utters  the  following  flat  conti'adictions  on  the  same  page  o|  his  late  work 
on  Human  Health.  In  speaking  of  the  Roman  custom  of  killing  ani- 
mals by  running  a  red-hot  spit  through  the  body,  he  says:  "This  mode 
of  slaughtering  was  replete  with  objections,  if  regarded  in  an  aliment- 
aiy  point  of  view.  The  flesh  of  animals  thus  killed  is  dark  colored, 
owing  to  the  retention  of  blood  in  the  vessels,  and  hence  it  becomes 
speedily  putrid. ^^  Per  contra,  says  Dr.  Dunglison  :  "When  an  animal 
is  killed  accidentally,  without  bleeding,  its  flesh  is  not  unwholesome,  al- 
though it  may  not  be  palatable,  in  consequence  of  the  blood  remaining 
in  the  vessels.'^  And  yet  again  says  Dr.  Dunglison,  as  if  to  render 
confusion  as  confounded  as  possible :  "  The  blood  i«  the  most  putresci- 
ble  of  all  fluids,  and  consequently  animals,  under  such  circumstances, 
do  not  keep  sound  so  long  as  when  they  are  bled  to  death."  And  yet 
once  more  says  Dr.  Dunglison:  "Caution  should  always  be  observed 
in  eating  animals  that  have  died  from,  or  been  killed  dm'ing  disease. 
Although  the  meat  may  often  be  innoxious,  at  other  times  it  would 
seem  to  be  capable  of  producing  disease,  and  even  death."  The  body 
of  an  animal  dying  from  disease  7nay  he  healthful  food,  says  Dr.  Dungli- 
son. Of  such  thoughtless  and  senseless  gabble  is  the  gi'eat  mass  of 
medical  and  dietetical  books  afloat  made  up.  The  bloody  drippings 
from  broiled  flesh  which  are  so  eagerly  "spooned  out"  by  many  per- 
sons to  season  their  potatoes,  or  "sop"  their  bread  with,  are  always 
more  or  less  charged  with  animal  excrement,  and  never  fit  to  be  taken 
into  the  stomach,  albeit  some  medical  books  prate  about  that  stufi"  being 
the  "juice"  and  "strength"  of  the  meat! 

The  Mosaic  law,  which  forbade  the  Jews  to  eat  the  blood  of  any 
beast  or  bird,  or  to  partake  of  their  flesh,  unless  the  throat  had  been 
cut,  in  order  to  drain  ofi*  the  blood,  was  founded  on  coiTect  physiolog- 
ical principles.  As  a  further  precaution  against  eating  blood,  they 
were  required,  previously  to  boiling  meat,  to  let  it  soak  half  an  hour  in 
water,  and  then  lie  an  hour  in  salt ;  the  object  of  tWs  proceeding  was 
to  draw  out  any  remaining  portion  of  blood  the  flesh  might  contain 
In  regard  to  the  philosophy  of  dietetics,  Moses  was  far  in  advance  of 
the  majority  of  tiie  Christian  teachers  of  the  present  day. 

The  sausages  sold  in  the  shops  under  the  nanie  of  black  pudding 


FOOD.  343 

are  made  of  pig's  blood  mixed  with  fat,  seasoned  with  aromatics,  end 
inclosed  in  the  prepared  intestines. 

Brande  and  Schlossberger  give  the  following  proximate  composition 
of  muscular  flesh: 

Albumen,  Nutritive 

100  Parts.  Water.  or  Fibrin.  Gelatin.  Matter, 

Beef,  74  20  6  26 

Veal,  75  19  6  25 

Mutton,  71  22  7  29 

Pork,  76  19  5  24 

Chicken,  73  20  7  27 

Cod,  73  14  7  21 

Haddock,  82  13  5  18 

Sole,  79  15  6  21 

The  comparative  healthfulness  of  other  parts  of  animals  can  be  read- 
ily determine'';  nj  a  reference  to  the  physiological  principles  already 
adverted  to.  The  fatty  matters,  next  to  the  blood,  are  the  worst  ali- 
mentary substances ;  and,  notwithstanding  artificially  depraved  appe- 
tites generally  crave  unnatural  aliment  with  an  intensity  proportioned 
to  its  impurity,  such  fact  does  not  alter  the  truth,  nor  sliould  qualify 
our  manner  of  expressing  it.  The  kidney,  whose  function  is  to  elim- 
inate from  the  body  a  large  proportion  of  its  most  puti-escent  materials, 
though  often  considered  a  "dainty  dish"  by  epicures,  is  certainly  unfit 
to  eat.  A  cooked  kidney  always  exhales  a  urinous  odor.  The  liver 
stands  in  the  same  relation  to  the  human  stomach.  Next  in  the  order 
of  their  unfitness  are  the  brains,  lungs,  stomach,  and  intestines,  skin, 
cartilages,  tendons,  etc.  All  these  viscera  and  structures  are  made 
into  a  variety  of  fashionable  dishes,  and  all  have  their  admirers ;  but 
just  as  far  as  we  depart  from  lean  flesh  i-n  selecting  aliments  from  the 
animal  kingdom,  just  so  far  does  their  value  depreciate. 

The  dietetic  character  of  animal  food  is  also  aflected  by  the  manner 
of  cooking.  It  is  to  be  prefeiTed  lightly  or  but  moderately  cooked, 
providing  a  due  degree  of  tenderness  of  fibre  is  secured.  In  broiled 
steaks  this  may  be  accomplished  by  pounding;  but  large,  thick,  roasting 
pieces  are  apt  to  be  tough  if  not  w^ell  cooked.  Broiling,  on  all  accounts, 
is  the  best  method  of  cooking  all  flesh-meat.  Boiling,  taking  care  to 
skim  oft"  any  floa*c3!g  particles  of  oil,  is  better  than  roasting;  and  this 
again  is  better  \h?in  frying,  which  is  a  method  never  to  be  recommended. 

Another  argument  may  here  be  stated  in  favor  of  the  position  that 
muscular  flesh  is  the  best  form  of  animal  food,  which  is,  the  §t)solute 
identity  of  the  chemical  elements  of  pure  flesh  and  pure  blood.  Th© 
analyses  of  Playfair  and  Boeckmann  give  the  following  results : 


544 

HYG 

lENE. 

Roasted 

Elements. 

Ox  Blood. 

Dry  Beef 

Roasted  Tieef. 

pLoasted  Veal. 

Deer. 

Carbon, 

51-95 

51-83 

52-590 

52-52 

52-60 

Hydrogen, 

7-17 

7-57 

7-886 

7-87 

7-45 

Nitrogen, 

15-07 

15-01 

15-214 

14-70 

15-23 

Oxygen, 
Ashes, 

21-39 
4-42 

21-37  f 
4-23  S 

24-310 

24-91 

24-72 

100-00  100-00  iOO-000  100-00  100-00 

The  milk  of  the  mammals,  though  an  animal  secretion,  can  hardly 
be  called  {mimul  food,  in  sti'ict  language.  It  contains,  on  the  average 
nearly  ninety  per  cent,  of  water,  and  about  ten  per  cent,  of  solid  mat- 
ter, consisting  of  butter,  casein,  sugar,  and  various  salts.  The  cream 
of  cow's  milk,  according  to  Berzelius,  consists  of  butter  4-5,  casein, 
or  curd  3-5,  whey  92-0=100-0.  By  agitation,  as  in  churniyig,  tlie 
gjobules  of  fatty  matter  unite,  and  form  butter;  the  residue  is  callecl 
huttcrmilk ;  it  consists  of  casein,  serum,  or  whey,  and  a  very  smal^ 
quantity  of  butter.  SJcimmed  mill:  very  soon  becomes  acid  and  curdy. 
The  admixture  of  an  acid  or  rennet  (which  is  the  infusion  of  tho 
fourth,  or  true  stomach  of  the  calf),  immediately  coagulates  it,  separ- 
ating the  casein,  or  curd,  from  the  whey.  The*  addition  of  acetic 
acid  will  cause  a  still  further  sepai-ation  of  coagula,  which  has  been 
called  zieger,  hracotte,  etc.  After  the  separation  of  casein  and  zieger, 
the  whey  left  yields  lactic  acid^  salts.,  and  some  nitrogenous  sub- 
stances, one  of  which  is  supposed  to  be  osmazome.  Osmazome,  how- 
ever, does  not  appear  to  be  a  tangible  reality,  but  a  flavor  or  effluvia 
developed  by  the  chemical  changes  which  take  place  in  several  animal 
substances  during  the  process  of  cooking — heating,  roasting,  boiling,  etc. 

Good  milk  is  a  homogeneous  but  not  viscid  liquid,  not  coagulable  by 
heat.     When  examined  by  the  microscope  it  appears  to  consist  only 
of  transparent  spherical  globules.     The  cream  j'ielded  varies  from  five 
to  twenty  per  cent.,  as  tested  by  the  lactometer,  which,  by  the  way 
seems  to  be  a  very  unsatisfactory  instrument  for  the  purpose. 

No  secretion  is  so  readily  aflected  by  the  ingesta,  or  the  general 
health  of  the  animal  producing  it,  as  the  milk.  The  taste,  color,  and 
odor  of  cow's  milk  are  readily  modified  by  the  food.  Children  are 
easily  salivated,  narcotised,  catharticised,  and  poieoned  and  disordered 
in  many  ways,  through  the  mother's  milk.  The  organic  instincts,  true 
to  the  first  principle  of  self-preservation,  determine  the  accidental  im- 
purities of  the  body  to  this  channel  as  the  most  ready  way  of  expelling 
them  from  the  body  Nursing  mothers  have  little  idea  how  much 
disease   nain,  and  nii«er  "  they  inflict  on  their  little  ones,  nor  how  fre- 


F  0  3  D.  346 

quentl)^  they  commit  infanticide^  by  taking  irritating  aliments  and 
drinks,  and  injm'ious  drags  into  their  own  stomachs.  If  I  could  pre- 
sent this  subject  to  them  in  all  its  force,  and  in  all  its  bearings  on  their 
happiness,  and'  on  the  well-being  of  the  hun^n  race,  as  I  hope  to  at- 
tempt in  a  future  publication,  I  am  certain  there  would  be  a  sudden 
and  very  radical  revolution  in  the  way  of  dieting  mothers  and  doctoring 
children. 

The  milk  produced  by  cows  fed  on  distillery  slops,  which,  to  the 
disgrace  of  municipal  authorities,  rich  men  are  permitted  to  sell  to  the 
poor  in  nearly  all  our  large  cities,  is  not  only  very  iunutritious,  but  abso- 
lutely poisonous.  In  New  York,  Brooklyn,  and  Williamsburgh,  several 
thousand  cows  are  kept  in  close  and  horribly  filthy  stables,  fed  on 
warm  slops,  and  other  refuse  matters  of  the  distilleries,  which  rot 
their  teeth,  weaken  their  limbs,  and  render  their  whole  bodies  masses 
of  disease ;  and  their  milk  is  furnished  to  our  citizens  as  a  principal 
article  of  diet  for  their  children  ! 

Although  milk  cannot  be  considered  a  necessary  or  strictly  natural 
food  for  mammals,  except  during  the  period  of  infancy,  when  the  teeth 
are  undeveloped — and  no  animals  of  the  class  mammalia,  save  man,  em- 
ploy it  otherwise — it  is  nevertheless,  when  pure,  the  best  form  of  ali- 
ment out  of  the  strict  order  of  natural  foods.  It  contains  all  the  elements 
requisite  for  prolonged  nuti-ition,  and  except  in  certain  abnormal  states 
of  the  digestive  organs,  its  moderate  employment  is  attended  with  no 
inconvenience.  Some  invalids  cannot  enjoy,  and  some  dyspeptics  can- 
not tolerate  it ;  but  exception^  cases  from  morbid  conditions  are  not 
rules  for  healthy  persons. 

Butter^  as  prepared  for  the  table,  js  a  different  article  dietetically 
from  its  fatty  particles  as  they  exist  in  milk.  The  former  must  rank 
with  all  animal  oils,  in  being  difficult  of  digestion,  but  slightly  nuti'itive, 
and  liable  to  generate  rancid  acids  in  the  stomach.  There  is,  however, 
a  great  difference  between  fresh-made  and  slightly  salted  butter,  and 
that  which  is  old  and  highly  salted.  Compared  with  the  latter  the 
former  is  almost  innocuous.  Me'..ed  and  cooked  butter  is,  wherever 
found,  a  very  deleterious  aliment.  Siveet  cream,  from  its  solubility  in 
water,  and  greater  miscibility  with  the  saliva,  is  far  preferable  to  but- 
ter. Indeed,  I  am  not  aware  that  experience  assigns  to  it  any  injurious 
or  even  unpleasant  effects  as  an  aliment.  ^ 

The  fresh  curd  of  milk  is  perfectly  wholesome,  and  pot-cheese, 
when  made  of  i?iilk  as  soon  as  it  becomes  sour,  and  before  it  gets  bit- 
ter, is  also  a  harmless  article.  Green  cheese  is  not  very  objectionable, 
but  old,  strong  cheese  is  one  of  the  most  injurious  and  indigestible 
tliiiigrs  in  existence.     It  is  also  one  of  the  most  constipating  articles  to 


ft4fl  HZGIENE. 


the  bowels  thnt  can  be  found .  It  is  a  common  fancy  among  med- 
ical men,  and  a  common  whim  among  the  people,  that  old,  sti'ong,  rank 
cheese,  though  itself  very  indigestible,  stimulatt^s  the  stomach  to  digest 
other  things ;  hence  almost  all  the  medico-dietetical  works  quote  the 
old  adage : 

"  Cheese  is  a  mity  elf, 
Ingesting  all  things  but  itself." 

There  is  more  poetry  than  truth  in  the  doggerel  distich.  Old  cheese 
occasionnlJy  undergoes  spontaneous  dejj-omposition,  during  which  pro- 
cess acrid  and  poisonous  elements  are  developed,  as  is  frequently  the 
case  with  bacon  and  sausages. 

Next  to  the  flesh  of  the  herbivora,  or  rather  the  graminivorous  ani- 
mals, the  jiesli  of  birds  affords  the  most  wholesome  form  of  animal 
food.  All  of  the  species  of  the  feathered  tribes  in  conmion  use,  how- 
ever, are  not  equally  wholesome.  Their  alimentary  value  depends  in 
a  great  degree  on  their  food  and  manner  of  life.  Pereira  says:  "Ra- 
pacious birds,  as  tlie  hawk  and  owU  are  not  eaten,  partly,  perhaps,  from 
prejudice,  and  partly  because  those  which  touch  carrion  acquire  a 
cadaverous  smell."  I  should  think  the  stench  alluded  to  was  a  suffi 
ciently  strong  reason  for  refusing  to  eat  them,  without  imputing  any 
thing  to  the  score  of  prejudice. 

The  white-jleshed  bu'ds — chicken,  turkey,  partridge,  quail,  etc. — ai'e 
very  nearly  as  nutritious  and  digestible  as  beef.  Chicken  flesh  is  called 
the  "  least  stimulating  of  animal  foods"  by  medical  writers,  but  I  think 
the  assertion  is  wholly  gi-atuitous.  The  dark-fleshed  birds,  as  game 
birds,  grouse,  robin,  woodcock,  snij^e,  etc.,  are  less  nuti-itive  and  less 
digestible,  but  more  greasy  and  savory  to  epicures.  Pereira  says  of 
the  flesh  of  these  birds:  "It  is  richer  in  ozmazome,  and  when  suffi- 
ciently kept  it  acquires  a  peculiar  odor,  called  funiet,  and  an  aromatic^ 
bitter  taste,  most  sensible  in  the  back.  In  this  condition  it  is  said  to  be 
npe,  or  high,  and  is  much  esteemed  as  a  luxuiy."  This  "fumet,"  so 
highly  prized,  is  the  stench  of  putreftiction,  as  is  the  "  cadaverous 
smell"  of  carnivorous  birds.  Prof  Dunglison  eulogizes  this  fumet  still 
more  exti-avagantly :  "The  solubility  of  game,  grouse,  etc.,  is  amazingly 
increased,  as  weii  as  the  luxury  of  the  repast,  by  keeping  it  until  it  has 
attained  the  requisite /wmc<;  which  indicates  that  incipient  putrefaction 
is  diminishing  its  cohesion."  The  luxury  of  putrefying  animal  flesh 
sounds  sti-angely  to  those  who  do  not  go  to  epicures  and  "riotous 
livers"  to  learn  their  dietetic  rudiments.  It  is  unfortunate  for  the 
cause  of  human  health  and  longevity,  that  phys  ologists  do  not  consult 
nature  and  common-sense  more,  and  cooks  a  .d  refectOKes  less,  in 
seeking  for  the  facts  and  principle >  of  hygiene. 


FOOD.  347 

The  aquatic  birds,  geese  and  ducks,  sre  strong,  rancid,  and  oily,  and 
extremely  unwholesome.  The  canvas-sack  is  considered  one  of  the 
gi-eatest  of  luxuries ;  but  here,  as  in  a  majority  of  cases,  the  luxury 
consists  in  the  pampering  of  an  exceedingly  depraved  appetite. 

The  manner  in  which  fowls  are  fattened  for  the  markets  of  many 
large  towns,  though  it  commends  them  to  the  tastes  of  epicures,  detracts 
very  much  from  their  purity  as  food.  They  are  confined  in  dark 
places,  sometimes  their  eyes  are  put  out  or  stitched  up,  and  crammed 
with  a  paste  made  of  barley -meal,  mutton  suet,  molasses,  and  milk ; 
this  ripens  them  in  a  fortnight,  when  if  they  are  not  innnediately 
killed,  a  fever  or  general  inflammation  comes  on,  which  frequently 
desti'oys  them. 

Particular  parts  of  certain  birds  have  long  been  celebrated  as  "deli- 
cate morsels"  by  epicures ;  as  the  brains  oi  the  ostrich  and  peacock, 
the  tongues  of  the  nightingale  and  flamingo,  the  trail,  or  intestine  of 
the  woodcock,  the  enlarged  liver  of  the  goose,  etc.  This  last  article 
is  a  diseased  condition  of  the  liver,  called  by  physiologists  fatty  degen- 
eration, and  is  produced  by  confining  the  goose  in  a  dark,  warm  place, 
and  stuffing  it  with  food  and  chaixoal.  Sometimes  in  this  way  the 
liver  swells  enormously,  weighing  two  pounds.  The  body  of  the  goose 
also  becomes  very  fat,  and  in  the  language  of  Pereira,  "excellent  for 
the  table."  Pereira  says  of  this  morbid  liver:  "It  is  obvious,  therefore, 
that  these  diseased  livers  must  be  difficult  of  digestion,  and  unfit  for 
persons  with  delicate  stomachs."  Why  should  any  persons,  be  their 
stomachs  delicate  or  indelicate,  eat  "diseased"  livers? 

The  eggs  of  oviparous  animals,  when  fresh  and  rare-boUed,  are 
moderately  nutritious  and  easy  of  digestion.  They  are  not  particularly 
objectionable  as  a  part  of  a  dietary  selection,  yet  their  virtue  is  rather 
negative  than  positive.  Poached  eggs  are  extremely  pernicious ;  and 
eggs  are  very  indigestible  when  hard-boiled  or  fried.  One  w^riter, 
Mr.  Pearson,  states  that  there  are  "instances  of  laboring  ])eople,  and 
persons  who  use  violent  exercise,  with  whom  eggs,  hardened  by  boiling 
or  frying,  agree  better  than  in  the  soft  or  liquid  state."  It  is  not  un- 
common for  laboring  men  to  suppose  that  hiu-d  water  agrees  better 
with  their  stomachs  than  soft  water ;  but  no  intelligent  physiologist 
will  think  so. 

The  flesh  of  turtles  is  prepared  at  the  refectories  in  the  forms  of 
steak  and  soup.  It  is  unwholesome  aliment  in  all  ways,  though  Sir 
Hans  Sloane,  who  appeai-s  to  be  as  high  authority  among  flesh-eaters 
as  Hoyle  is  among  chess-players,  says,  "the  livers  are  counted  delica- 
cies." Sii*  Hans  also  tells  us  that  the  callepce,  or  under  part 
of  the  breast  or  belly,  baked   -s  veckoned  the  best  piece.     Moreover, 


«48  II  Y  G  I E  N  E. 


Sir  Hans  remarks :  "  Persons  who  feed  much  on  turtles  sweat  out  a 
yellow  serum,  especially  under  the  armpits."  And  again  says  our 
author:  "The  lard,  ur  fat  of  the  green  turtle,  when  melted  out,  is  of  a 
warm  yellow  color,  and  communicates  a  yellow  tinge  to  those  who  feed 
on  it;  whence  theii-  shirts  are  yellow,  and  their  skin  and  face  of  the 
same  color;"  from  all  of  which  testimony  we  conclude  that  these  rep- 
tiles are  not  fit  for  human  beings  to  eat.  The  eggs  of  these  animals 
are  sometimes  eaten. 

In  a  general  sense,  fish  aliment  is  far  inferior  to  flesl  The  pis- 
civorous ti'ibes  of  the  human  family  are  universally  in  a  state  of  exti'eme 
mental  and  bodily  abjection.  The  explanation  of  this  fact  is  found  in 
the  food  upon  which  the  animals  which  they  errf:  subsist — smaller  fishes, 
worms,  and  insects,  and  the  impurities  of  the  element  in  which  they 
reside — so  far  as  salt-water  fishes  are  concerned,  which  penetrate  their 
structures,  and  mingle  in  all  their  fluids  and  secretions.  Fish  is  not  as 
nutritious  as  flesh,  and  is  usually  considered  as  less  stimulating.  The 
feverishness  so  generally  noticed  after  a  meal  of  fish  may  be  imputed 
to  the  impurity  of  the  aliment,  though  some  regard  it  as  evidence  of 
stimulation.  As  a  general  rule  the  least  oily  fishes  are  the  most 
wholesome,  as  the  cod^  halibut,  trout,  u'hitefish,  bass,  blackjish,  had- 
dock, whiting,  sole,  turbot,  etc.  Salmon,  eels,  herrings,  pilchards, 
sprats,  viackerel,  shad,  etc.,  are  among  the  oily  varieties.  Dr.  Dekay, 
in  a  late  work,  enumerates  440  species  of  fishes  belonging  to  the  State 
of  New  York,  hence  the  varieties  distributed  over  the  aqueous  portions 
of  the  globe  must  be  innumerable. 

The  objectionable  nature  of  fish  aliment  is  generally  made  still  more 
objectionable  by  the  usual  method  of  cooking — frying,  and  the  indi- 
gestible additions  of  melted  butter,  lobster-sauce,  egg-sauce,  etc. 

The  idea  has  been  extensively  entertained  that  fish  diet  gr*eatly  in- 
tensifies the  procreative  powers,  and  Tourtelle  refers  to  the  numerous 
children  found  in  seaports  as  proof.  But  there  is  no  evidence  that 
ichthyophagous  people  propagate  faster  than  others.  Were  the  opin- 
ion currecf,  it  woulu  afford  another  argument  against  the  sanatory  na- 
ture of  the  food  ;  for  it  appears  to  be  a  law  of  the  animal  kingdom  that 
tl^e  rapidity  of  propagation  increfises  with  the  increase  of  the  cause? 
which  destroy  the  animal. 

The  Egyptian  priests  were  forbidden  to  eat  fish,  and  among  the 
aquatic  animals  which  Moses  prohibited  to  the  Hebrews  were,  "Wlrat- 
soevcr  hath  no  fins  nor  scales."  A  law  similar  to  that  of  Moses  was 
made  by  Numa  Pompilius  for  the  Romans.  In  tropical  climates  many 
Bpecies  of  fish  are  absolutely  poisonous,  especially  at  particular  seasons, 
producing,  when  eaten,  violent  itching,  colic,  burning  heat  in  the  tliroat. 


FOOD.  54& 

nausea,  giddiness,  blindness,  cold  sweats,  often  terminating  in  death. 
Dr.  Burrows  enumerates  twenty  kinds  of  poisonous  fish.  The  nature 
of  this  poison  is  wholly  unknown. 

The  fishes  found  in  the  clear  water  of  lakes,  rivers,  and  rivulets  are 
greatly  superior  to  those  which  inhabit  muddy  or  foul  waters.  Some 
kinds  of  fish  are  eaten  whole,  as  the  white  bait.  Nearly  all  the  parts 
and  viscera  of  these  animals  are  eaten  more  or  less,  not  excepting  the 
milt  or  testicle  of  the  male,  and  the  roe  or  ovary  of  the  female.  The 
former,  called  the  soft  roe,  and  the  latter,  called  the  hard  roe,  are 
"among  the  "  esteemed  luxuries"  of  sensuous  epicures.  The  caviare, 
which  Dr.  Dunglison  calls  "  an  article  of  national  food,"  is  the  pre- 
served roe  of  the  sturgeon  and  various  other  fishes,  salted,  peppered, 
and  further  flavored  with  minced  onions.  The  milt  of  the  herring 
has  been  recommended  by  several  distinguished  physicians — Ritter, 
Neumann,  Frank,  Siemerling,  and  Hufeland — as  a  remedy  for  various 
diseases ;  and,  what  is  specially  amusing,  its  effiacy  was  ascribed  to  the 
common  salt  it  contained  ! 

Of  the  crustaceans,  lobsters,  crabs,  shrimjjs,  and  praiuns,  are  those 
most  genera  y  eaten.  They  are  all  exceedingly  indigestible,  and  a 
frequent  cause  of  disordered  digestive  organs.  The  peculiar  odor  and 
taste  of  these  animals  are  due  to  a  resinous  substance  of  the  membrane 
enclosing  the  shell,  and  which  becomes  red  by  boiling.  Pereira  says : 
"  Both  the  crab  and  the  lobster  excite,  in  some  constitutions,  urticaria^ 
or  nettle-rash,  and  even  colic." 

Of  the  class  mollusca,  the  oyster  is  the  greatest  favorite  with  the 
lovers  of  sea-food.  They  are  not  very  nutritive,  containing  only  about 
12^  per  cent,  of  solid  matter.  When  eaten  raw  they  are  more  digest- 
ible and  wholesome  than  when  cooked  in  any  manner.  Oysters  have 
had  the  reputation  among  medical  men  of  being  a  specific  for  dyspep- 
sia, scrofula,  and  consumption,  but  the  more  intelligent  physicians  of 
the  present  day  specially  prohibit  them  in  those  diseases,  except  when 
they  deem  it  policy  to  compromise  with  the  appetites  or  prejudices  of 
their  patients.  Mussels,  clams,  scallops,  cockles,  and  even  snails,  are 
oaten  to  a  considerable  extent  by  people  on  the  sea-coasts.  The  for- 
mer are  frequently  poisonous.  Dr.  Lee  states  :  "  It  is  a  very  common 
thing  for  persons  to  be  poisoned  in  this  city  (New  York)  by  eating 
mussels  produced  from  our  adjacent  waters."  Eruptive  and  paralytic 
afiections  are  said  to  be  the  results  of  being  poisoned  by  these  animals. 
The  vineyard  or  great  snail,  has  been,  and  still  is,  in  England,  not 
only  a  -popular  but  a  regular  remedy  for  consumption.  Fulvius  Hir- 
pinus,  of  Roman  celebrity,  had  several  snail  parks  in  his  garden, 
where  he  kept  and  flUtened  the  "  most  famous  and  excellent"  snails, 
30 


350  HYGIENE. 


each  variety  liiiving  a  park  to  itself.  He  fed  them  upon  a  pap  mad© 
of  sweet  wine,  honey,  and  flour;  "and  under  this  diet,"  says  Dr 
Dunglison,  "  they,  becairie  so  wholesome  and  delicate,  and  were  so 
much  esteemed,  that  they  were  sold  for  eighty  quadrants  the  dishful." 
I  am  of  opinion  that  the  wholesomeness  of  an  aliment  is  not  to  be  de- 
termined by  the  tastes  of  epicures,  or  its  price  in  the  market ! 

But  few  insects  are  employed  as  food  among  civilized  people  at  the 
present  day.  The  gruh-ivorm  was  in  repute  as  a  "  delicacy"  in  the 
day.-  of  Pliny.  Locusts,  grasshoppers,  and  some  species  of  spiders, 
have  been  eaten.  In  South  America  centipedes  ai-e  eaten.  The  Bra- 
zilian Indians  are  fond  of  the  ichite  ant;  and  the  West  Indian  negroes 
relish  a  species  of  caterpillar.  On  the  dietetic  value  of  these  insects 
I  need  not  dwell. 

§.  Vegetable  Foods. — The  vegetable  kingdom  affords  the  purest 
aliments,  as  well  as  the  greatest  variety  of  alimentaiy  principles. 
Vegetable  foods  are  found  in  the  form  of  the  seeds,  fruits,  roots,  huds, 
and  young  shoots,  leaves,  flowers,  and  stems,  of  flowering  plants,  and 
lichens,  ferns,  sea-weeds,  and  mushrooms,  of  flowerless  plants. 

The  seeds  and  fruits  are  the  most  important  and  most  usefiil  of  hu- 
man aliments  ;  yet  it  would  be  difficult  to  decide  which  of  these  is 
most  necessary,  for  the  perfection  of  nuti-ition  requires  both. 

The  seeds  commonly  employed  are  the  cereal  grains — wheat,  oats, 
barley,  rye,  rice,  maize  or  Indian  corn,  and  millet;  the  leguminous 
seeds — peas,  beans,  and  lentils  ;  the  cupuliferous  seeds — chestnuts, 
etc. ;  and  the  oily  seeds  or  nuts — almonds,  walnuts,  hazel-nuts,  butter- 
^Mts,  filberts,  cashew-nuts,  cocoa-nuts,  etc. 

The  most  common  alimentary  fruits  are  the  diiipaceous  or  stone 
fruits — peaches,  nectarines,  apricots,  cherries,  etc. ;  the  pomaceous  fruits 
— ajyples,  pears,  quinces,  etc. ;  the  baccate  or  bemed  fruity — currants, 
gooseberries,  whortleberries,  cranberries,  grapes,  elderberries,  etc.;  the 
aurantiaceous  fruits — oranges,  lemons,  limes,  citrons,  shaddocks,  etc. ; 
the  curcubitaceous  fniits,  pepones,  or  gourds  —  cucumbers,  melons, 
squashes,  i^umpldns,  etc. ;  leguminous  fruits,  legumes,  or  pods — of 
the  tatJiarind,  bean,  etc. ;  the  synochus  fruits — figs,  tomatoes,  etc. ;  the 
Borosis  fniits — mulberries, pine-apples,  etc. ;  the  etgeno  fruits — strawber- 
ries, raspberries,  blackberries,  etc. 

In  the  order  of  roots,  tubers,  and  subterranean  stems,  we  have  the 
potato,  turnip,  carrot,  beet,  parsnip,  artichoke,  etc. 

Among  buds  and  young  shoots  we  find  onions,  leeks,  garlics,  shaU 
yQts,  asparagus,  etc. 

Leaves  anc*  'eaf-stalks  furnish  us  cabbage,  spinach,  cauliflower,  broc 
coli,  con^slips,  milkweed,  turrv^v  tops,  potato  tops,  dandelion  tops,  let-' 


FOOD.  351 

tuce,  mustard  tops,  endive,  water-cress,  common  cress,  celery,  rhubarb, 
sorrel,  plantain,  etc. 

Of  the  receptacles  and  bracts,  the  flower-heads  of  the  garden  arti- 
choke are  the  best  known. 

The  stems  of  several  palms  yield  a  fiirinaceous  food,  as  sago.  The 
pulpous  stems  of  3.  fern-tree  in  New  Zealand  are  eaten,  and  esteemed 
an  excellent  vegetable. 

The  tuberous  rhizomes  of  ferns,  in  Polynesia  and  other  parts  of  the 
world,  yield  a  fai'inaceous  matter,  which  is  occasionally  employed  as 
food. 

Many  lichens,  of  which  Iceland  moss  is  the  most  familiar  example, 
are  used  dietetically  and  medicinally. 

Several  species  of  algae  or  sea-weeds — Irish  moss,  Ceylon  or  Jafna 
moss,  etc.,  are  also  employed  both  as  food  and  medicine. 

Several  species  of  the  fungi  or  mushrooms  are  considered  edible. 
The  best  known  among  them  are  the  Jield  mushroom,  boletus,  morel, 
truffle,  pepper  dulse,  and  tangle. 

Of  the  cereal  grains  wheat  and  rice  ai'e  the  most  extensively  culti- 
vated. Although  they  possess  about  an  equal  amount  of  alimentary 
properties,  the  wheat  is  far  superior  as  a  single  article  of  diet.  Those 
who  employ  a  diet  mostly  of  rice  require  a  larger  proportion  of  succu- 
lent fi'uits,  or  watery  vegetables,  or  ligneous  matter,  as  leaves,  roots, 
etc.,  than  those  who  subsist  principally  on  the  whole  gi-aki  of  wheat, 
for  the  reason  that  the  latter  contains  in  the  bran  a  much  larger  pro- 
portion of  lignin.  But  even  wheat  is  too  nutritious  and  concentrated 
of  itself,  and  requires  the  admixture  of  a  due  proportion  of  fruits,  or 
other  succulent  and,  comparatively,  innuti'itious  vegetables. 

It  appears  to  be  a  confirmed  habit  among  dietetical  writers  and  med- 
ical practitioners  to  ^\Tite  and  speak  of  animal  food,  as  compared  with 
bread  and  other  preparations  of  the  grains,  as  being  more  "  nourish- 
ing," more  "substantial,"  etc.,  in  the  face  of  all  human  experience 
and  all  chemical  investigation,  which  prove  the  latter  to  contain  at  least 
three  times  as  much  nutriment  in  a  pound  as  can  be  obtained  from  the 
best  flesh-meat.  Those  tribes  of  men,  laborers,  hunters,  etc.,  who 
subsist  almost  wholly  on  flesh,  fish,  or  fowl,  devour  on  the  avei'age 
about  seven  pounds  per  day ;  while  those  persons  in  similar  ch'cum- 
stances  and  occupations  who  subsist  almost  exclusively  on  farinaceous 
vegetable  food,  eat  but  little  more  than  one  pound.  In  fact,  the  quan- 
tities of  animal  food  consumed  by  some  human  beings,  who  are  car- 
nivorous in  practice,  seem  almost  incredible.  Captain  Parry  relates 
the  case  of  an  Esquimaux  lad,  who,  at  a  meal  which  lasted  tueniy 
hours,  consumed  4  lbs.  raw  sea-hoirse  flesh,  4  lbs.  broiled  ditto,  I4  pint 


862  HYGIENE. 


gravy,  besides  1|  lbs.4)read,  3  wine  glasses  raw  spirits,  1  tumbler  stiong 
gi"og,  and  9  pints  of  water.  Captain  Cochrane  states,  in  a  "  Narrative 
of  Travels  through  Siberian  Tartary,"  that  he  has  re'peatedly  seen  a 
Yakut  or  Largouse  eat  forty  pounds  of  meat  in  a  day !  It  is  stated 
that  the  men  in  the  service  of  the  Hudson's  Bay  Company  ai'e  al- 
lowed the  daily  rations  of  seven  or  eight  pounds  of  ordinaiy  flesh- 
meat. 

The  world  is  full  of  examples  of  laboring  individuals,  even  in  cold 
climates,  subsisting  on  coarse  bread,  not  exceeding  the  average  amount 
of  one  pound  of  wheat,  rye,  or  corn  daily ;  and  the  millions  of  China 
and  India  subsist  on  much  less  than  that  quantity  of  rice,  with  only 
animal  or  other  food  enough  to  amount  to  a  condiment  or  seasoning. 

For  the  purpose  of  making  raised  or  fermented  bread,  wheat  is  su- 
perior to  all  other  grains,  on  account  of  its  large  proportion  of  gluten. 
The  wlieat  of  hot  climates,  as  a  general  rule,  contains  more  gluten 
than  tliat  of  cool  climates.  The  Southern  or  red  wheat  of  this  countiy  is 
more  glutinous  than  the  Western  or  white  wheat ;  hence  the  Southern 
flour  is  called  stronger  by  the  bakers,  and  is  capable  of  being  puffed  up 
into  the  largest,  and,  for  the  manufacturers,  the  most  profitable  loaf. 
Wheat  also  proves  more  palatable  to  a  majority  of  people  in  its  various 
forms  of  preparation  than  any  other  grain.  Boussingault  gives  the 
following  analysis  of  wheat,  rye,  and  oats,  which  makes  them  almost 
identical  in  chemical  constituents.  The  other  gi'ains  cannot  diifer 
essentially  from  these : 


Ultimate  Elements. 

\Mieat. 

Rye. 

Oat3. 

Carbon, 

46-1 

"  46-2 

50-7 

Hydrogen, 

5-8 

5-6 

6-4 

Oxygen, 

43-4 

44-2 

36-7 

Niti-ogen, 

2-3 

1-7 

2-2 

Ashes, 

2-4 

2-3 

4-0 

Total,  100-0  100-0  100-0 

The  proximate  constituents  of  the  grains  are :  Starch,  albumen, 
Jihrin,  gluten,  mucin,  sugar,  gum,  cil,  lignin,  earthy  phosphates,  and 
tcater. 

The  methods  by  which  wheat  is  prepared  for  the  table  are  very 
numerous.  The  very  best  is  unquestionably  the  unleavened  wheat- 
meal  bread.  The  yeast  brown  bread  ranks  next  in  wholesomeness. 
Fine  bread,  made  of  flour,  with  the  addition  of  a  quantity  of  rye-meal, 
or  coarse-gi'ound  Indian  meal,  or  both,  is  an  excellent  article.  The 
common  superfine  bread,  especially  as  preu^'ed  for  the  market  by  th» 


F  C  0  D  863 

bakers,  is  the  lowest  order  of  bread-kind  in  the  scale  of  healthfulness. 
All  the  bakers'  bread  with  which  I  am  acquainted — and  I  have  ex- 
amined it  very  extensively — is  over-fermented,  by  wliich  much  of  the 
starch  as  well  as  the  sugar  is  destroyed,  and  more  or  less  of  the  gluten 
decomposed,  and  converted  into  acetic  acid,  which  acid  is  neutralized 
by  ammonia,  or  otliov  alkaline  matters.  Thi«i  is  the  reason  that  stale 
}jakei"s'  bread  is  so  l.  ipalatable  after  it  is  fairly  cold,  while  good  domes- 
tic bread  preserves  its  sweetness  and  flavor  for  a  week  or  two.  Uni- 
versal experience  as  well  as  physiological  science  pronounced  all  fresh 
fermented  bread  unwholesome.  Fermented  bread  is  never  fit  for  the 
stomach  until  it  has  been  twelve  liDurs  from  the  oven,  and  is  not  in  its 
best  condition  under  twenty-four  hours.  There  are  two  reasons  why 
new  bread,  when  fermented,  is  prejudicial  to  the  digestive  organs. 
Its  texture  being  soft,  spongy,  and  adhesive,  it  is  not  well  masticated 
and  insalivated;  and  again,  the  process  of  fermentation  not  only  devel- 
ops the  carbonic  acid  gas  which  raises  the  dough,  but  also  converts  a 
small  portion  of  the  elements  of  the  saccharine  matter  into  alcohol ; 
this  alcohol  is  probably  not  perfectly  dissipated  by  the  heat  of  the  oven, 
nor  until  the  bread  has  *been  many  hours  from  it.  To  make  the  best 
bread  it  is  essential  to  have  a  good  article  of  flour — if  fresh-ground  the 
better — fine,  fresh,  sweet  yeast ;  the  dough  must  be  well  kneaded,  so 
as  to  diffuse  the  yeast  equally  through  the  mass ;  the  loaf  must  be 
placed  in  the  oven  the  precise  moment  when  it  k  sufficiently  light, 
or  it  will  be  heavy  from  deficient,  or  sour  from  excessive  fermentation, 
and  baked  in  a  brick  oven  from  an  hour  to  an  hour  and  a  half,  accord- 
ing to  the  size  of  the  loaf.  Very  good  yeast  bread  may  be  baked  in  a 
stove  or  kitchen-range  by  observing  carefully  all  the  above  conditions. 

Wheaten  grits  (cracked  wheat),  an  article  rapidly  getting  into  popular 
favor  through  hydropathic  auspices,  simply  boiled,  make  an  excellent 
dish,  seasoned  w^ith  a  little  sugar  or  milk.  For  children  there  is  nothing 
in  the  world  superior,  from  the  very  moment  they  are  able  to  take  any 
food  except  the  mother's  milk.  I  know  it  will  almost  horrify  some 
good  mothers  and  kind  nurses  to  be  told  that  cracked  wheat,  "  bran 
and  all,"  is  proper  aliment  for  the  delicate,  susceptible  stomachs  of  little 
infants;  while  many  a  college-bred  M.D.  is  ready  to  declare  that  such 
coarse,  rough,  scratchy  food  is  enough  to  tear  its  tender  bowels  all  to 
pieces ;  and  I  know,  too,  tliat  the  great  "  standard  authors"  of  the 
medical  professirn,  and  all  their  little  echoes  throughout  the  country, 
proclaim  the  br^in  part  a  "mechanical  irritant;"  and  yet  I  know  the 
assertion  I  make  to  be  true.  Let  those  who  oppose  this  kind  of  diet 
for  children,  if  the;/  can,  give  some  rational  reason  why  thiity  children 
l)er  wee'f  in  the  city  of  New  York  die  of  the  disease  called  convulsions^ 


364:  HYGIENE. 


a  disease  whose  almost  exi  lusive  cause  is  obstruction,  or  constipation, 
and  this  condition  being  almost  universally  produced  in  them  by  the 
vai'ious  preparations  of  fine  flour.  Farina,  formerly  called  pearl  wheat, 
contains  more  of  the  ligneous,  or  branny  property,  and  is  hence  far 
preferable  to  fine  flour  for  mush  or  pudding.  Semolina,  soujee,  and 
mam^acroup,  ai'e  also  granular  preparations  of  wheat  similar  to  farina, 
considerably  emploj^ed  in  England.  Maccaroni,  vermicelli,  and  caglivari 
paste,  are  pasty  prepai-ations  of  wheaton  flour.  Hot  rolls  are  rendered 
tender  and  brittle  by  excessive  fermentation,  but  are,  for  the  same 
reason,  very  indigestible  and  unhealthful.  Rusks,  tops,  bottoms,  buns, 
etc.,  are  fermented,  and  for  the  same  reason  unhealthful  when  fresh ; 
they  are  also  less  digestible  from  the  additions  of  butter,  sugar,  and 
milk.  Gingerbread  is  made  exti'emely  hght  by  means  of  carbonic 
acid  gas,  but  the  combination  of  flour,  treacle,  butter,  alum,  and  potash 
is  a  serious  objection  to  its  wholesomeness.  The  common  sea-biscuit^ 
or  ship-bread,  is  made  of  either  wheat-meal,  or  flour  containing  a  con- 
siderable proportion  of  bran,  simply  mixed  with  water,  and  baked.  It 
is  hard  and  compact,  and  very  wholesome.  Wlieat-meal  crackers 
(Graham  crackers)  when  made  without  shortening,  and  not  over-fer- 
mented, are  a  good  article  for  exercising  the  teeth,  and  promoting  the 
salivarj^  secretion. 

Cakes,  in  almost  endless  variety,  are  made  of  superfine  floisr,  butter, 
lard,  sugar,  eggs,  with  spices,  essences,  fi-uits,  or  alcoholic  liquors,  for 
seasonings.  Of  course  they  are  pernicious,  as  a  general  i^ile,  according 
to  their  complexity.  Plum-cake  is  a  fair  specimen  of  the  average 
character  of  the  cakes  of  cook-books  and  popular  recipes.  All  dietetic 
writers  of  any  respectability  agi*ee  as  to  its  unfitness,  while  the  common 
fruit-cake  and  wedding-cake  are  as  univei'sally  regarded  as  exceedingly 
indigestible  ti'ash.  Pancakes,  or  fritters,  are  fried  in  hog's  lard. 
Griddle-cakes,  made  of  wheat-meal,  or  of  flour  and  Indian  meal,  or 
of  rice  or  buckwheat,  are  a  tolerable  article,  provided  they  are  cooked 
on  soapstone  gi'iddles  without  grease.  A  very  palatable  and  compara- 
tively wholesome  cake  may  be  made  of  wheat-meal,  sugar,  and  sweet- 
cream,  or  good  rich  milk  in  place  of  the  cream.  Those  who  become 
accustomed  to  unbolted  farinaceous  food,  will  generally  prefer  this  kind 
of  cake  to  that  made  of  fine  flour,  even  as  a  matter  of  taste. 

Puddings  are  sometimes  made  of  wheaten  flour;  but  no  form  of 
boiled  flour  can  be  very  digestible  or  wholesome.  Bread  puddings 
are  the  best  of  these  preparations;  hasty  and  batter  puddings  next  in 
the  descending  scale.  The  ^;Zj/??i  or  suet  p^udding  is  one  of  the  most 
pernicious  compounds  ever  invented ;  it  is  generally  made  of  bread 
crumbs^,  currants,  raisins   beef  suot,  salt,  citi'on,  eggs,  sugar,  mace,  and 


FOOD.  355 

nutmeg,  and  eaten  with  butter,  sugar,  and  wine  for  sauce.  Dumplings 
are  another  form  of  boiled  flour  and  fruit ;  they  can  be  made  so  as  to 
be  tolerably  light  and  digestible,  but  as  usually  served  up  at  refectories 
they  tax  the  digestive  powers  very  severely. 

Considerable  attention  has  of  late  years  been  given  by  bread -makers 
to  various  methods  of  manufacturing  raised  bread  without  yeast ;  em- 
ploying m  its  stead  acids  and  alkalies,  usually  hydrochloric  acid  and 
sesqui-carbonate  of  soda.  If  the  proportions  of  these  articles  are  exactly 
balanced,  and  their  admixture  with  the  dough  carefully  managed,  the 
acid,  uniting  with  the  alkali,  forms  common  salt,  while  carbonic  acid 
gas,  without  leaving  any  free  acid  or  alkali,  is  set  free  to  raise  the 
dough.  A  variety  of  other  experiments  have  been  tried  in  this  country 
and  in  England,  but  I  believe  they  have  never  succeeded  in  realizing 
quite  as  good  an  article  as  can  be  made  with  the  best  of  yeast,  skill- 
fully managed.  Two  years  ago  one  of  our  city  bakers  commenced 
tlie  manufacture  of  bread  raised  with  an  acid  and  alkali.  The  baker 
conscientiously  supposed  his  article  to  be  more  wholesome  than  the 
ordinary  fermented  bread,  but  wishing  to  be  well  assured  of  the  fact, 
ho  submitted  specimen  loaves  to  the  medical  gentlemen  of  the  New 
York  Academy  of  Medicine,  requesting  a  professional  o.pinion  concern- 
ing its  hygienic  chai'acter.  The  Academy  referred  the  matter  to  a 
special  committee,  but  there  it  rested ;  and  notwithstanding  the  urgent 
importunities  of  the  manufacturer,  the  Academy  has  not  even  yet  seen 
fit  to  express  any  opinion. 

Oats  have  been  extensively  used  as  food  by  the  people  of  Scotland 
and  the  northern  parts  of  England,  and  to  some  extent  in  this  and  other 
countries.  The  entire  seeds  of  oats  contain,  in  100  parts,  about  66  of 
meal  to  34  of  husk.  100  parts  of  dried  oatmeal  yielded,  according  to  Dr. 
Christison's  analysis :  Starch  72-8,  sugar  and  mucilage  5-8,  albumen 
3-2,  oily-resinous  matter  0-3,  lignin,  or  bran  11-3,  and  water  6-6.  Oat- 
meal is  prepared  by  grinding  the  kiln-dried  seeds,  deprived  of  their 
husk  and  outer  skin.  Groats  are  the  grains  deprived  of  their  integu- 
ments. 

Oatmeal  is  usually  employed  in  the  form  of  mush,  porridge,  or  stir- 
ahout,  prepared  by  simply  boiling  in  water,  and  oat-bread,  or  oat-cakes, 
made  by  rolling  the  dough  into  very  thin  cakes,  and  baking  it  before 
the  fire,  or  in  a  stove  or  oven.  These  preparations  are  more  whole- 
some than  those  of  fine  whoaten  flour,  because  they  contain  a  larger 
proportion  of  lignin,  or  bran,  and  are  hence  more  laxative,  or  rather 
less  constipating.  Persons  unaccustomed  to  oatmeal  sometimes  com- 
plain of  acidity  after  eating  it;  but  such  a  result  may  occur  on  first 
eating  any  kind  of  grain  to  which  the  stomach  has  not  been  habituated* 


866  HYGIENE. 


it  is,  however,  more  frequently  noticed  with  respect  to  rye  and  corn 
than  the  other  gi-ains. 

Barley  is  but  little  used  as  human  food  in  modern  days,  the  breweries 
converting  neai'ly  the  whole  crop  of  the  world  into  the  poisons  callec^ 
malt  liquors.  It  is,  however,  far  from  being  the  most  inferior  of  gi-ains, 
either  in  chemical  constituents  or  physiological  properties.  The  seeds 
of  barley  contain,  in  100  parts:  Meal  70-05,  husk  18-75,  water  11*20. 
100  parts  of  harley-meal  yield:  Starch  67-18,  fibrous  matter  7-29, 
ginn  4-6'2,  sugar  5-21,  gluten  3-52,  albumen  1*15,  phosphate  of  lime 
with  albujnen  0-24,  water  9-37. 

Various  preparations  of  barley  are  in  repute  for  the  sick-room. 
Pereira  considers  barley-water  as  a  ^^  light,  mila,  emollient,  demulcent 
liquid,  slightly  nutritive,  and  very  easy  of  digestion  ;^^  a  rai'e  combina- 
tion of  medicinal  virtues,  ti'uly,  for  steeped  seeds  of  grain  to  possess ! 
Less  learning  would  be  displayed,  but  more  intelligence  communicated, 
by  calling  the  water  in  which  a  little  barley-meal  had  been  boiled 
diluent  and  nutritive,  the  former  being  the  property  of  the  water,  and 
the  latter  the  property  of  the  gi-ain.  Scotch,  hulled,  or  j^ot  barley,  is 
the  seeds  deprived  of  their  husks ;  and  when  these  seeds  are  rounded 
and  polished  they  constitute  pearZ  barley.  Patent  barley  is  the  farina 
obtained  by  grinding  the  pearl  barley  to  powder.  Barley  contains  too 
small  a  quantity  of  gluten  to  make  good  bread  by  panary  fermentation. 

Rye  is  considerably  employed  as  food  among  the  inhabitants  of 
northern  Europe,  and  in  New  England,  In  Germany  and  Sweden  it 
is  the  principal  ingi-edient  in  bread.  The  enth'e  seeds  of  i*ye  yield,  in 
100  parts  :  Meal  65-6,  husJc  24-2,  wnter  10-2.  Rye-meal  contains,  in 
100  parts  :  Starch  61-07,  gum  11-09,  gluten' ^-AS,  albumen  3-28,  sac- 
charine matter  3-28,  husk  6-38.  Rye-meal  mush  is  somewhat  more 
laxative  to  persons  unaccustomed  to  it  than  wheat-meal  mush,  and  is  a 
valuable  food  in  constipation  and  torpid  bowels. 

Buckwheat  is  sometimes  employed  in  bread-making.  In  Germany 
and  France  it  is  in  common  use  for  pottage  and  puddings ;  and  in  the 
United  States  it  is  extensively  cultivated,  and  eaten  in  the  form  of 
griddle- cakes.  It  is  not  in  itself  objectionable ;  but  the  melted  butter 
and  sugar  with  which  buckwheat  cakes  are  seasoned,  and  the  burned 
grease  used  in  cooking  them  render  them  exceedingly  noxious.  The 
itching  and  skin  diseases  generally  atti'ibuted  to  buckwheat,  are  really 
chargeable  to  its  accompaniments — pork  gi'av^-,  sausages,  butter^  sugar, 
etc. 

Rice  is  the  principal  grain  of  India,  Cliina,  and  most  Eastern  coun- 
h'ies.  It  is  also  extensively  cultivated  in  the  West  Indies,  Central 
America,  the  southern  countries  of  Europe,  and  the  southern  paits  ot 


FOOD.  367 

the  United  States.  The  coir  position  of  Carolina  rice  is,  according  to 
Braconnot,  in  100  parts  :  Starch  85-07,  woody  fibre  4*80,  glutinous  mat- 
ter 3-60,  oily  matter  0"13,  sugar  0*29,  gum  0*71,  phosphate  of  lime  0*40, 
water  5*00,  with  traces  of  acetic  c. id,  phosphate  of  i^otash,  chloride  of 
potassium,  and  vegetable  salts  of  potash  and  lime. 

In  nutritive  properties  rice  does  not  differ  materially  from  wheat, 
although  it  is  much  lefes  adapted  to  prolonged  nutrition  as  an  exclusive 
article  of  diet,  because  of  its  small  proportion  of  lignin  or  bran.  From 
the  fact  that  the  cholera  first  appeared  in  a  rice-gTowing  country,  and 
has  prevailed  extensively  in  counti'ies  where  this  grain  is  the  principal 
food  of  the  inhabitants,  a  suspicion  has  arisen  that  a  rice  diet  was 
among  the  causes  of  cholera.  Although  a  rice  diet  alone  would  be 
incapable  of  producing  such  a  disease,  there  can,  I  think,  be  hardly  a 
question  that  a  diet  almost  exclusively  of  rice  would  produce  a  predis- 
position, enabling  other  sources  of  impurity  and  debility  readily  to  de- 
velop the  disease.  In  fact,  this  principle  is  fully  illustrated  by  the 
phenomena  of  cholera  and  bowel  complaints  as  they  appear  in  this 
country.  The  ordinary  employment  of  concenti'ated  farinaceous  foods 
with  us  (food  containing  too  small  a  proportion  of  what  is  called  in- 
nutritious  matter,  to  keep  the  excretories  free  and  unobstructed)  abso- 
lutely produces  a  general  predisposition  to  bowel  complaints,  only 
requiring  some  disturbing  agent  of  the  nature  of  an  exciting  cause,  to 
induce  diarrhea,  dysentery,  cholera  morbus,  cholera  infantum,  inflam- 
mation of  the  bowels,  or  Asiatic  cholera,  according  to  the  combination 
of  all  the  predisposing  and  exciting  influences.  Obstruction,  constipa- 
tion, irritation,  and  inflammation  always  result,  unless  due  relations 
betAveen  bulk  and  nutrin  ent  are  maintained  in  our  aliments;  and 
hence  the  more  concentrated  or  nutritive  the  gi'ain  or  flour  we  em- 
ploy, the  greater  should  be  the  proporti  n  of  the  less  nutritious  vege- 
tables and  succulent  fruits.  An  immense  amount  of  disease^  suffering, 
decrepitude,  and  premature  death  result  from  a  misunderstanding  of, 
or  inattention  to,  this  simple  and  obvious  principle ;  and  the  advice 
emanating  from  medical  men,  boards  of  health,  medical  ccrmcils,  etc., 
in  cholera  seasons,  recommending  the  people  to  abstain  from  fi'uits  and 
vegetables,  and  eat  principally  rice,  superfine  flour,  dried  beef,  smoked 
herring,  etc.,  has  destroyed  many  lives  and  saved  none. 

The  best  preparation  of  rice  is  that  of  simple  boiling ;  it  should  nofc 
be  stirred  sufficiently  when  cooking  to  break  up  or  mash  the  seeds. 
Mice,  milk,  and  sugar  make  one  of  the  best  plain  puddings.  Rice 
griddle-cakes,  which  contain  eggs  and  sugar,  are  somewhat  offensive 
to  nil  stomachs,  and  especially  so  to  dyspeptics. 

The  various  remarks  which  medico-dietetical  wiiters  have  perpeti'ated 


»68  HYGIENE. 


concerning  the  nature  of  rice  as  an  aliment,  afford  some  amusing  ex- 
amples of  the  loose  and  thoughtless  manner  in  which  men  m.ay  reason 
when  they  have  no  settled  principles  to  reason  from  or  upon.  Thus 
says  Dr.  Dunglison,  in  allusion  to  the  constipating  effects  of  rice  upon 
the  bowels :  "  Perhaps  the  cause  of  its  having  astringent  properties 
assigned  to  it  is  its  long  retention  in  the  stomach  when  that  organ  is 
debilitated.  This  is  probably  owing  to  its  possessing  but  little  stimu- 
lating jjoz^'cr."  Was  ever  greater  nonsense  uttered !  Again,  says 
Dr.  Dunglison  :  "  Formerly  the  idea  prevailed  that  rice,  ivhen  habitu- 
ally eaten,  is  possessed  of  poisonous  properties" — as  though  its  nature 
depended  on  whether  we  eat  it  constantly  or  occasionally !  Bontius 
thought  that  the  use  of  rice  tended  to  the  production  of  blindness. 
Probably  he  was  not  aware  that  disordered  vision,  giddiness,  etc.,  is  a 
very  common  effect  of  too  concentrated  food  and  of  excessive  aliment- 
ation in  all  countries. 

Maize  or  Indian  corn  is  extensively  employed  as  food  in  America, 
Asia,  and  some  parts  of  Europe.  Its  proximate  composition  in  100 
parts,  as  analj-zed  by  Dr.  Gorham,  is :  Starch  77-0,  ze'in  (a  substance 
somewhat  resembling  gluten)  3-0,  albumen  2-5,  gum  1*75,  sugai 
1*45,  extractive  matter  0*8,  cuticle  and  ligneous  fibre  3*0,  phosphate, 
carbonate,  and  sulphate  of  lime,  nearly  1*5,  water  9-0.  In  nuti-i- 
tive  power  and  wholesomeness  maize  is  but  little  inferior  to  wheat. 
It  has  not  enough  of  the  glutinous  property  to  make  light  loaf  bread 
alone,  but  ma^es  an  excellent  bread  with  the  addition  of  a  portion  of 
wheat-meal  or  wheaten-flour.  The  coarse-ground  meal  is  incomparably 
superior  to  the  fine-ground  for  all  cooking  purposes.  Samp  is  made 
by  boiling  the  broken  grains  until  soft ;  hominy  is  a  preparation  of  the 
gi-ain  between  samp  and  meal;  and  Indian  mush  is  the  boiled  meal. 
These  are  all  excellent  dishes  as  a  part  of  a  dietetic  course.  Corn, 
Indian,  or  Johnny  cakes  are  made  by  wetting  the  meal  with  water,  or 
milk,  or  both,  and  baking  in  a  stove,  oven,  or  before  the  fire.  The  In- 
dian method  of  baking  under  hot  ashes  is,  for  healthfulness,  still  better. 
Sometimes  these  cakes  are  sweetened  and  raised  with  sour  milk  and 
hi-carbonate  of  soda.  This  preparation  is  not  as  wholesome  as  the 
former,  but  far  superior  to  most  of  the  sweet-cakes  made  of  fine 
wheaten  flour.  Saleratus  is  very  generally  employed  in  this  countiy 
in  nearly  all  kinds  of  Indian  or  wheaten  cakes,  but  it  is  a  most  perni- 
cious article.  Yor  plain  puddings  the  coarse  Indian  meal,  or  hontiny, 
is  the  best  article,  excepting,  perhaps,  wheaten  grits  and  rice.  Milk 
and  sugar  are  aV  the  seasonings  wanted  to  make  as  rich  a  pudding  as 
human  appetites  ought  to  desire. 

Our  New  England   mothers  and  grandmothers  had  a  raetliod  of 


FC  DD  869 

making  a  most  delicious  and  salutary  bread,  without  raising  or  fer- 
mentation, in  which  Indian  meal  was  the  chief  ingredient.  Due  por- 
tions of  the  meals  of  corn,  rye,  and  wheat  were  kneaded  into  a  rather 
soft  dough  with  water  or  milk,  and  baked  all  night  in  an  iron  bake- 
kettle,  which  was  well  covered  with  coals  and  hot  ashes.  In  the 
morning  an  article  "  fit  for  a  king"  and  all  other  "  lords  of  creation," 
was  brought  forth  from  the  baker.  Such  mothers  would  be  godsends 
to  the  puny  children  of  this  degenerate  age. 

Dr.  Lee  says :  "A  pound  of  corn,  when  cooked,  makes  from  two 
and  a  half  to  tlii'ee  and  a  half  pounds  of  food,  and  this  will  suffice  for 
the  daily  support  of  a  laboring  man.  If  an  individual  could  be  sup- 
ported on  this  alone,  his  annual  expense  for  food  would  be  but  $3  65, 
or  say  $15  to  a  family  of  five.  The  average  cost  of  potatoes  may  be  put 
at  about  half  a  cent  a  pound,  and  allowing  five  pbunds  per  day  to  an 
adult  individual,  the  expense  wiE  be  about  $9  a  year.  "When  we 
consider  that  it  is  not  unusual  for  land  to  yield  one  hundred  bushels  of 
corn  to  the  acre,  or  thirty  tons  of  potatoes,  we  may  form  some  esti- 
mate of  the  population  which  this  country  is  capable  of  supporting  from 
the  produce  of  the  soil." 

We  may  see  the  munificence  of  the  Creator,  in  making  provision 
for  all  our  natural  v^ants,  in  a  sti'onger  light  by  vaiying  the  calcula- 
tion. Let  us  suppose  an  acre  of  land  planted  with  corn,  half  an  acre 
with  potatoes,  and  good  apple-trees  surrounding  the  whole — all  to  be 
in  the  best  state  of  cultivation.  We  would  then  have  a  combination 
of  foods  capable  of  fully  sustaining  the  organism  in  its  highest  integ- 
rity ;  and  nutrition  enough  from  an  acre  and  a  half  to  sustain  at  least 
thirty  human  beings. 

Millet  or  kirse  is  less  employed  than  any  other  cereal  grain.     It  is 
cultivated  in  some  places  as  a  garden  plant,  and  used  in  cooking  pud 
dings,  seasoning  porridge,  etc. 

Peas,  beans,  and  lentils  possess  nearly  the  same  proportions  of  ulti- 
mate chemical  constituents  as  the  cereal  grains.  In  proximate  com- 
position they  are  more  oily  and  amylaceous.  They  are  most  digestible 
when  green  and  fresh.  When  dried  and  old  they  produce  more  or 
less  flatulence,  and  sometimes  colic  in  persons  accustomed  to  a  concen- 
trated or  stimulating  diet.  This  objection,  hov/ever,  is  generally  soon 
overcome  in  those  who  adopt  a  plain  and  correct  dietary  system.  Not 
a  little  of  the  indigestibility  charged  upon  the  lugirainous  seeds  is  justly 
due  to  the  gi-ease,  butter,  and  seasonings  with  which  they  are  usually 
cooked  and  served. 

The  nuts  or  kernels  are  generally  oily,  and,  tv-  most  stomachs,  indi- 
8;estible.     The  chestnut,  however,  contains  no  oi.  and  when  cooked  is 


S60  HYGIENE 


pleasant  and  considerably  nutritive ;  it  is  employed  as  a  staple  article 
of  food  in  some  counti'ies.  It  is  at  least  probable  that  all,  or  nearly  all, 
of  the  nuts  are  in  themselves  natural  and  wholesome  food;  their  indi- 
gestibility  resulting  from  the  abnormal  state  of  the  digestive  organs  we 
have  produced  by  our  artificial  and  enervating  habits  of  life.  Bitter 
almonds^  though  extensively  used  by  cooks  and  confectioners,  contain 
poisonous  properties ;  the  volatile  oil  obtained  from  them  is  a  more 
potent  poison  than  Prussic  acid. 

At  the  head  of  the  fruit  kingdom  stand  the  apple-ti'ee  and  the 
grape-vine.  Many  other  fruits  are  as  w^Lolesome  in  their  season,  and 
some  are  more  nutritive,  but  none  are  so  hardy  and  enduring,  nor 
capable  of  such  extensive  cultivation.  The  varieties  of  the  apple  that 
can  be  produced  are  almost  innumerable.  The  sweet,  subacid,  and 
mealy  kinds  are  the  most  nutritious.  If  well  grown  and  fully  ripe 
they  may  be  eaten  in  the  raw  state,  roasted,  or  baked,  with  nearly 
equal  advantage  as  a  part  of  the  meal,  or  they  may  be  stewed  and 
sweetened.  They  can  also  be  preserved  by  drying,  or  in  their  own 
inspissated  juices,  the  year  round. 

Unfortunately,  grapes  are  cultivated  much  more  for  the  pui'pose  of 
manufacturing  intoxicating  wine,  than  for  human  sustenance.  An  ar- 
gument in  favor  of  this  use,  or  rather  abuse,  of  the  fruit  of  the  vine, 
has  been  predicated  on  the  opinion  somewhat  prevalent,  that  wine- 
gi-owing  countries  were  the  most  temperate  ones.  But  Dr.  Bell,  31. 
Villerme,  M.  Perier,  Mr.  Buhver,  and  other  standard  writei^s,  have 
shown  this  opinion  to  be  an  error.  In  France  nearly  one  thousand 
millions  of  gallons  of  alcoholic  drinks  were  consumed  in  1830,  of  which 
wine  constituted  more  than  half.  Several  Americans  who  have  resided 
in  Paris  testify  that  "  drunkenness  is  the  prevailing  curse  of  the  labor* 
iug  classes  of  France." 

Of  the  different  varieties  of  grapes  the  Isabella  and  catawha  are 
oore  generally  cultivated  in  this  country  ;  the  former  of  these  is  most 
common  in  our  markets,  and  most  highly  esteemed.  Dried  gi*apes  ai'e 
called  raisins.  The  muscatels  and  blooms  are  sun-dried.  Sometimes 
the  grapes  are  dipped  in  a  mixture  of  water,  ashes,  and  oil,  and  after- 
ward sun-dried,  by  which  treatment  the  juice  exudes  and  candies  on 
the  fniit.  The  small  or  Corinthian  raisin  is  the  hlack  currant  sold  at 
our  groceries. 

There  is  an  old  adage  which  says,  "  Fruit  is  gold  in  the  morning, 
silver  at  noon,  and  lead  at  night."  The  proverb  is  founded  more  in 
our  artificial  habits  than  in  nature.  Those  who  are  accustomed  to  a 
plain  vegetable  diet  can  take  fruit  with  equal  pleasure  and  profit  at 
either  meal.     B\i    stomachs  weakened  by  enervating  drinks  or  con- 


FOOD  B61 

centrated  aliments  can  tolerate  fruits  much  better  in  the  fore  part  of 
the  day. 

The  opinion  is  common  that  the  fruits  produced  in  different  climates 
or  localities  are  most  suitable  for  the  inhabitants  residing  there.  Un- 
questionably this  is  true  so  far  as  quality  and  maturity  are  concerned ; 
for  most  kinds  of  fruit  being  exceedingly  perishable,  are  of  neces- 
sity gathered  before  fully  ripe,  when  they  are  to  be  transported  on 
long  voyages.  For  this  reason  many  of  the  peaches  and  strs-W- 
berries  brought  to  the  New  York  market  are  far  inferior,  both  in 
flavor  and  dietetical  vhtues,  to  those  picked  and  eaten  where  they  are 
raised. 

Almost  all  persons  can  use  nearly  all  sorts  of  fniits  in  our  markets, 
excepting,  perhaps,  the  very  acid  kinds,  with  freedom  and  advantage, 
providing  they  are  well  grown,  perfectly  ripe,  and  are  eaten  only  at 
meals.  Those  persons  with  whom  they  seem  to  disagi-ee  should  grad- 
ually accustom  themselves  to  their  employment — eat  a  very  little  at 
first,  and  increase  the  quantity  as  the  stomach  will  bear.  We  have 
many  varieties  of  pumpkins  and  squashes,  which  are  not  only  excel- 
lent for  pies,  but  make  a  delicious  sauce.  The  only  cooking  they  re- 
quire is  to  be  well  boiled.  As  a  general  rule,  those  of  the  firmest, 
heaviest  texture  are  the  best  flavored  and  most  nutritious. 

Of  the  edible  roots  the  potato  holds  the  first  rank.  It  is  nearly  or 
quite  as  nutritious  as  the  best  flesh-meat,  and  in  ultimate  chemical 
composition  is  almost  identical  with  the  cereal  grains,  containing,  iu 
100  parts  :  Carbon  44-0,  lujdrogen  5-8,  oxygen  44-7,  nitrogen  1'5, 
ashes  4-0.  Its  proportion  of  solid  matter  is  24-1  to  74-9  of  water. 
The  potato  alone  is  capable  of  sustaining  the  prolonged  nutrition  ol 
human  beings,  as  has  been  verified  by  repeated  experiments.  Potato 
starch  is  extensively  sold  under  the  names  of  2^otato  flour,  English  ar- 
roio-root,  corn  starch,  etc.  A  mixture  of  potato  starch  and  chocolate 
has  been  sold  in  England  under  the  name  of  BrighVs  universal  sana- 
tive breakfast  beverage. 

Two  or  three  years  ago  Professor  Mulder  entered  into  a  profound 
philosophical  contemplation  of  the  nature  and  properties  of  the  potato, 
and  came  to  the  conclusion  that  its  use,  "  as  an  article  of  food,  was  the 
principal  cause  of  the  physical  and  mental  degeneracy  of  the  people 
of  those  nations  who  employed  it."  The  learned  professor  had  un- 
doubtedly mistaken  the  effects  of  intoxicating  liquors,  tobacco,  and  many 
other  noxious  agents,  for  those  of  the  innocent  potato. 

The  Carolina  or  siveet  potaio  contains  considerable  saccharine  mat- 
ter, and  is  equally  digestible  and  wholesome  as  the  common  or  Irish 
potato,  making  due  allowance  for  habit.  When  boiied  until  sofl.  but 
T— 3] 


562  HYGIENE 

without  destroying  their  shape,  potatoes  are  probably  more  nutritive 
and  wholesome  than  when  prepared  in  any  other  manner. 

Potatoes  have  long  been  celebrated  as  a  preservative  against  the 
scurvy ;  and  it  has  puzzled  physicians  exceedingly  to  determine  m 
what  particular  part  or  element  this  antiscorbutic  property  resided. 
Some  have  ascribed  it  to  citiic  acid.  I  am  of  opinion  that  this  virtue 
resides  equally  in  every  part  of  the  tuber,  and  that  its  preventive  power 
in  this  disease  is  due  to  its  healthfulness  as  an  article  of  food,  and  not 
to  any  particular  medical  property.  In  fact,  all  good  fresh  fruits  and 
vegetables  are  antiscorbutic. 

With  regard  to  the  other  esculent  roots,  turnips,  parsnips,  heels, 
carrots,  etc.,  they  are  of  but  little  value  in  an  alimentary  point  of  view, 
yet  useful  in  preserving  the  due  relations  of  bulk  and  nutriment  with 
those  who  partake  of  a  large  proportion  of  fjirinaceous  food.  To 
most  stomachs  they  prove  more  or  less  flatulent,  but  th>s  depends  very- 
much  on  the  vigor  of  the  digestive  powers,  and  the  other  dietetical 
habits.  A  perfectly  healthy  stomach  can  manage  them  without  any 
difficulty. 

Of  the  cruder  vegetable  products  the  cabbage  is  the  most  nutritive. 
It  contains  considerable  nitrogen  as  well  as  sulphur.  An  Edinburgh 
physiologist — Dr.  Johnson,  I  believe — has  lately  "  discovered"  that  it 
possesses  more  muscle-making  property'  than  wheat ;  but  his  inference 
is  drawn  from  the  mistaken  opinion  that  foods  are  nuti'itive  to  muscular 
tissue  in  proportion  to  the  nitrogen  they  contain.  As  cabbage  contains 
more  than  ninet}^  per  cent,  of  water,  its  nutritive  power  must  l^e  less 
than  ten  per  cent.,  while  we  know  wheat  possesses  from  eighty  to 
ninety  per  cent,  of  nutriment. 

Pot-kerbs,  including  cabbage,  spinach,  asparagus,  and  a  variety  of 
leaves,  leafstalks,  stems,  young  roots  and  shoots,  receptacles,  bracts, 
flowers,  etc.,  are  generally  grateful  and  wholesome ;  always  so  to 
healthy  stomachs.  If  they  ever  prove  injurious,  it  is  from  the  melted 
butter,  oil,  vinegar,  etc.,  with  which  they  are  too  often  cooked  and 
eaten.  These  aliments,  too,  prove  flatulent  to  many  stomachs;  and  the 
rule  already  mentioned  is  applicable  to  these  and  all  other  crude  and 
watery  vegetables.  Delicate  stomachs  must  get  gi-adually  accustomed 
to  their  use,  if  they  would  avoid  unpleasant  effects.  Salads  are  usually 
eaten  with  mustard,  vinegar,  pepper,  salt,  and  oil,  and  are  objectionable 
mainly  on  account  of  the  seasonings.  Lettuce  contains  the  narcotic 
principle  of  opium,  and  is  injurious  on  that  account. 

Most  of  the  fruits  herein  mertioned,  and  some  of  the  vegetables, 
are  employed  in  making  pies  and  pastry.  As  usually  prepared  by  the 
baker,  tliev  are  of  course  exceedingly  pernicious,  for  however  delicious 


TEMPERATURE  363 


and  wholesome  the  fniit  of  itself  may  be,  the  crust  is  far  otherwise. 
But  excellent,  and  delicious,  and  even  healthful  pies  can  be  made  of 
the  mild-flavored  or  sweet  fruits,  simply  sweetened,  with  a  crust  of 
wheat-meal  or  fine  flour,  shortened  with  potatoes,  and  seasoned  Avith 
new  milk  or  sweet  cream. 

Condiments^  or  seasonings^  though  not  in  any  sense  alimentary  sub- 
stances, are  so  commonly  employed  with  almost  all  articles  of  food, 
that  they  deserve  a  moment's  notice  in  this  connection.  Those  in 
general  use,  in  addition  to  salt  and  vinegar,  already  discussed,  are  mus- 
tard, cayenne,  black  pe-pper,  allspice,  cinnamon,  cloves,  mace,  Jiutmeg, 
horse-radishes,  ginger,  etc. ;  various  other  pungent  and  spicy  substances 
are  frequently  employed.  They  all  tend  to  blunt  the  organic  sensibili- 
ties, and  the  more  acrid  are  extremely  irritating  to  the  whole  mucous 
surface.  Though  the  majority  of  dietetical  writers  commend  them, 
and  nearly  all  medical  writei-s  declare  them  to  be  indispensable,  I  know 
of  but  one  physiological  rule  in  relation  to  them — the  less  the  better. 
It  is  ti-ue  that  an  appetite  partially  palsied  by  their  use,  cannot  appre- 
ciate the  flavor  of  aliments  without  them;  and  stomachs  accustomed  to 
digest  under  their  irritation,  will  not  at  first  work  as  satisfactorily  in  theii 
absence,  but  the  same  rule  obtains  with  regard  to  liquor,  tobacco,  or 
any  other  artificial  habit.  Hunger  is  the  only  natural  sauce ;  and  those 
persons  who  can  summon  moral  and  animal  courage  sufficient  to  abstain 
from  acrid  seasonings  of  all  kinds,  will  find,  in  a  short  time,  that  the  God 
of  nature  has  made  all  the  foods  He  has  intended  we  should  eat  extreme- 
ly palatable,  without  endowing  them  with  any  properties  to  provoke  our 
appetites  to  the  injury  of  the  vital  domain.  He  made  the  food 
savory  enough  for  us  to  "eat  to  live;"  if  we  over-season  it,  we  may 
Boon  find  ourselves  too  closely  allied  with  those  who  "  live  to  eat,"  to 
have  pure  appetites  or  sound  health. 


CHAPTER  V. 

OF  TEMPERATURE. 


Vicissitudes  of  Weather. — The  wonderful  power  of  the  living 
organism  to  develop,  maintain,  and  regulate  its  own  heat,  enables  hu- 
man beings  to  exist  in  great  extremes  of  climate,  and  exposed  to  nu- 
merous and  sadden  vicissitudes  of  weather.  Franklin,  Parry,  Ross, 
Back,  and  other  northern  navigators,  have  been  exposed  for  mont*»a 


£504  HYGIENE. 

together  to  a  temperature  varying  from  50°  to  70°  below  zero,  while  ie 
the  oasis  of  Mourzouk,  and  many  parts  of  the  tropical  zone,  the  ther- 
mometer often  ascends  to  130°.  The  maximum  of  heat  noticed  by 
travelei-s  in  various  places  is  :  Equator  101°,  Cape  of  Good  Hope  111°, 
Bassora  114°,  Cairo  104°,  Madras  104°,  Pendicherry  112°,  Saris  3  01°, 
Guadaloupe  101°,  Surinam  90°,  Martinique  95°,  Vera  Cniz  96°,  Vienna 
f^6°,  Warsaw  93°,  Copenhagen  92°,  Petersburgh  87°,  Iceland  69°.  In 
Sew  York  city  the  thermometer  has  a  range  of  about  100°,  rarely, 
however,  rising  to  100°,  and  seldom  sinking  below  0.  The  changes  of 
temperature  in  this  climate  frequently  amount  to  40°  or  50°  in  twenty- 
four  hours. 

Generation  of  Animal  Heat. — The  more  energetically  the  or- 
ganic functions  are  performed,  the  more  rapid  is  the  generation  of  ani- 
mal heat ;  hence  the  animals  of  cold  climates,  whose  actions  are  vigor- 
ous, manifest  a  higher  bodily  temperature  than  those  of  hot  climates, 
whose  motions  are  more  sluggish.  The  quadrupeds  of  the  frigid  '/oue 
are  said  to  have  a  higher  temperature  than  those  of  any  other  region 
of  the  globe ;  an  arctic  fox,  killed  in  an  atmosphere  of  14°,  was  found 
by  Capt.  Lyon  to  have  a  temperature  of  106|. 

Capacity  to  Endure  External  Heat. — The  human  body  is 
capable  of  enduring  for  a  considerable  time  a  highly-heated  atmosphere, 
when  the  air  is  dry.  Mechanics  whose  occupations  require  it,  often 
endure,  without  perceptible  inconvenience,  an  elevation  of  SSO''  to  280  ". 
Some  workmen  have  entered  the  furnaces  of  iron-foundries  while  the 
floor  was  red-hot,  and  the  thermometer  stood  at  350°.  Chabert,  the 
"Fire-king,"  was  in  the  habit  of  entering  an  oven  heated  from  400" 
to  600°. 

Artificial  Heat. — As  the  human  body  is  a  self-regulating  machine, 
within  certain  limits,  as  respects  its  tempei-ature,  it  follows  that  all  arti- 
ficial means  of  supplying  heat  to  the  body  can  only  be  regarded  as 
necessary  evils.  Fire  relaxes  and  debilitates  the  skin  and  the  whole 
-system ;  yet  in  cold  climates  and  seasons  we  have  no  better  way  of 
maintaining  the  requisite  temperature  of  our  rooms.  These  should 
always  be  warmed  equally  throughout  every  part,  and  the  temperature 
kept  as  low  as  possible,  consistently  with  comfort.  The  comfortable 
point  of  out-door  air  depends  very  much  on  the  temperature  we  have 
previously  been  accustomed  to ;  it  also  varies  in  different  climates  and 
seasons.  In  this  country  it  ranges  from  65°  to  75°;  but  when  the 
thermometer  has  been  for  some  days  between  90''  and  100°,  a  depres- 


TEMPEEATURE.  365 


eion  of  fifteen  or  twenty  degrees  imparts  an  uncomfortable  sensation 
of  cold;  and  in  spring  a  sudden  elevation  from  30°  or  40°  to  75"  imparts 
an  oppressive  sensation  of  heat.  A  room  permanently  heated  above 
55°  to  60°  can  hardly  be  consistent  v/ith  health,  and  a  few  degi'ees  less 
is  still  better  for  most  persons.  Those  who  occupy  rooms  warmed  by 
grates  should  never  sit  directly  before  the  fire.  Many  persons  have 
a  habit  of  sitting  with  then-  faces  close  to  a  hot  fire,  but  such  habits 
are  not  only  very  weakening  to  the  whole  skin,  but  particularly  inju- 
rious to  the  brain  and  nervous  systevn. 

Healthfulness  of  Climate. — It  has  been  proved  by  ample  experi- 
ment that  the  aeration  of  the  blood  is  more  rapid  in  cool  or  cold  than  in 
warm  or  hot  air,  owing  to  the  circumstance  that  rarefied  air  contains  less 
oxygen  in  the  same  bulk  than  cold  air.  But  I  cannot  subscribe  to  tha 
doctrine  generally  advanced  in  medical  books  that  all  warm  climates,  or 
even  hot  climates,  are  necessarily  unhealthful.  It  is  well  known  that 
bilious  attacks,  diseases  of  the  liver,  fluxes  (as  diarrhea,  dysentery,  and 
cholera),  and  some  forms  of  fevers,  are  mor<|  prevalent  in  hot  climates, 
especially  among  those  who  go  from  a  northern  to  a  southern  latitude. 
But  I  think  a  better  explanation  can  be  found  in  another  way.  It  is  as 
well  known  that  persons  can  endure,  with  appai'ent  impunity,  in  a  cold, 
bracing  air,  riotous  living,  excessive  alimentation,  constipating  food,  and 
many  other  erroneous  habits,  which  will  inevitably  produce  disease, 
and  frequently  death,  in  a  hot,  enervating  atmosphere.  The  travelers 
who  visit  pestiferous  Africa,  the  Englishmen  who  remove  to  the 
scorching  suns  of  British  India,  and  the  Northerners  who  go  to  the 
sickly  South,  may  find  the  true  explanation  of  their  liability  to  disease 
in  their  own  dietetic  errors. 

Undoubtedly  the  more  mild  and  uniform  climates  are  most  con 
ducive  to  permanent  health  and  longevity.  Examples,  however,  are 
not  wanting  of  individuals  attaining  the  age  of  165  in  Plussia,  and  of 
200  in  Arabia.  Variable  climates,  like  England  and  the  United  States, 
are  more  favorable  to  activity  of  mind  and  body — a  rapid  development 
of  all  the  physiological  and  mental  powers ;  yet  that  excess  of  action 
must  sooner  exhaust  their  vitality.  Various  parts  of  the  United  States 
have  furnished  numerous  examples  of  centenarians,  but  I  believe  Joice 
Heath,  who  reached  the  age  of  162,  was  the  oldest  person  this  countiy 
ever  produced.  Rev.  Mr.  Harvey  delivered  a  temperance  lecture  in 
the  Broadway  Tabernacle  in  this  city,  in  1846,  at  the  age  of  114. 

Common  Colds. — "  Catching  co.d"  is  usually  attributed  to  a  sudden 
transition  from  a  warn,   to  a  cold  atmosphere ;    but   I   believe   more 


866  HYGIENE 

colds  result  from  the  contrary  change — fr  jm  a  cold  to  a  highly-heated 
atmosphere,  especially  the  sudden  change  from  a  cold,  out-door  atmos- 
phere, to  the  confined  air  of  a  hot  room.  I  need  not  say  that  the  body, 
when  excessively  cold,  should  be  warmed  very  gradually.  When  very 
hot,  however,  the  body  is  better  enabled  to  resist  extreme  cold,  and 
may  be  suddenly  exposed  to  it  with  impunity,  provided  it  has  not  been 
warmed  by  any  debilitating  process  or  agency,  as  hot,  confined  air, 
severe  and  exhausrtng  exercise,  etc.  Colds  are  more  frequently  pro- 
duced by  unequal  temperature  than  by  extremes  of  either  heat  or  cokl. 
Thus,  when  a  part  of  the  body  usually  covered  wuth  clothing  is  exposed 
to  a  sti-ong  draught  of  air,  w4ien  the  rest  of  the  body  is  protected  with 
clothing  or  bedding,  a  cold  is  very  easily  caught.  Again,  a  person  ac- 
customed to  wear  boots  in  the  winter  season,  will  often  "take  cold"  by 
weai'ing  shoes  a  few  hours,  even  though  he  remain  within  doors,  and 
his  feet  feel  perfectly  comfortable.  Young  ladies,  at  balls  and  parties, 
often  make  such  changes  in  their  clothing  as  to  expose  some  parts  of 
the  body  usually  covered,  as  the  neck,  or  cover  some  parts  usually  un- 
dressed, as  the  hands  and  head,  or  dress  some  parts  thinly  which  have 
been  accustomed  to  thicker  clothing,  the  feet  and  arms,  for  example, 
by  which  the  usual  temperature  of  the  body  is  unbalanced,  and  severe 
colds  produced. 

A  very  common  way  in  which  a  severe  cold,  or  a  gi-eat  disturbance 
of  the  body  which  is  usually  denominated  a  cold,  is  produced,  is  eating 
a  very  full  evening  meal  after  fasting  all  day,  and  then  retiring  soon 
after  to  rest,  and  sleeping  in  a  warm  room,  or  a  room  heated  by  hot  air. 
The  temperature  of  the  apartment,  aided  perhaps  by  bad  ventilation, 
relaxes  the  body,  so  that  the  stomach  cannot  relieve  itself  of  its  burden, 
and  in  the  morning  the  sufferer  awakes,  if  indeed  he  has  slept,  fever- 
ish, sore,  and  inflammatory,  and  with  all  the  manifestations  of  a  hard 
or  confined  cold. 

It  is  also  to  a  crowded  state  of  the  stomach,  as  much  perhaps  as  to 
the  relaxing  temperature  and  bad  air,  that  the  colds  so  generally  follow- 
ing balls  and  dancing  assemblies  are  to  be  attributed.  The  viands  at 
these  parties  are  all  so  prepared  as  to  tempt  the  appetite  to  excessive 
indulgence,  when  the  state  of  exhaustion  requires  exactly  the  opposite 
— fasting,  so  that  the  muscular  system  may  have  its  due  sui)ply  of 
nervous  energy  for  the  restoration  of  the  motive  powers. 

Those  who  are  exposed  to  cold,  pure,  out-door  au%  may  eat  very  in- 
temperately,  as  respects  both  quality  and  qunntit}',  and  suffer  but  very 
little,  compared  with  those  who  commit  the  same  error  in  the  enerwit- 
ing  atmosphere  of  a  crowded  assembly,  when  the  body  is  in  a  state  of 
exhaustion,  the  vsrhole  musculai  system  relaxed,  and  the  digestivo 
powers  proportionately  enfeebled. 


EXERCISE. 


367 


Mean  Temperatures. — The  following  table  of  mean  temperatures 
has  been  compiled  from  meteorological  registers : 


a;        I. 

C   -^    ttj 

Mean  Temferature  of  different 
Seasons. 

Mean  Tempera- 
ture ol' 

Places. 

Win- 
ter. 

Spring 

Sum- 
mer. 

Au 
tumK. 

Warrn- 

e.'it 
Month. 

Cold- 
est 
Month. 

New  York 

O       1 

40.40 

39  56 

38.53 

39.06 

32.47 

31.34 

29.48 

19.11 

23.10 

13.10 

10.27 

46.47 

44.54 

57.08 

4L30 

48.12 

48.50 

43.46 

41.53 

.32.37 

36.48 

51.30 

30. 

38.46 

o      / 

53.78 
53.42 
5.?..56 
53  78 
60.18 
64.76 
72.23 
77.72 
78.(8 
79  03 
81.86 
41.74 
42.44 
26.42 
51.02 
49.28 
51.08 
59.00 
60.40 
64.56 
59.98 
50.36 
69.01 
■55.86 
80.06 

15        / 

29.84 
32.18 
36.80 
32.^0 
51.09 
48.56 
59.29 
71.96 
71.24 
76.07 
80.24 
14.18 
23  44 
0.60 
33.82 
34.70 
38.66 
44.30 
45.86 
59.50 
61.52 

5L26 
51.44 
53.83 
54.14 
66.73 
65.48 
71.47 
77.90 
78.98 
79.00 
83.C6 
38.84 
38.58 
23.90 
46  87 
47.66 
49.28 
56.00 
57.74 
62.20 
65.66 

o      / 

79.16 
73.94 
75  90 
72.86 
80.89 
79.16 
82.73 
81.50 
83.31) 
81.00 
82.04 

68  00 
60.54 
48  38 
68.70 
64.94 
64.58 
74.00 
75.20 

69  33 
80-24 

o      y 
54.50 
56.48 
56.59 
54.86 
67.55 
66.02 
75.  ]  5 
78  62 
78  98 
80.00 
80.24 
46.04 
45.43 
33.44 
53.83 
50.00 
51.44 
60.70 
62.78 
67.23 
72.50 

<5        1 

80.78 
77.00 
79.13 
74.30 
82.81 
79.70 

83  94 
81.86 
S3.84 
91.00 

84  38 
73.40 
63.52 
51.80 
71.46 
66,56 
65.30 

77.00 

82  76 

O       1 

25.34 

Philadelphia 

32.72 

Washington,  D.  C 

34.66 
30.20 

Charleston,  S.C 

Natchez    Miss 

49.43 

46  94 

St.  Augustine,  Fl 

Vera  Cruz 

56.60 
71.06 

•  Hav  ana 

69.93 

Barbadoes 

65.0 

Cumana 

7<).16 

Quebec,  L.  C 

Eastport,  Me 

13.81 
20.91 

Nain,  Labrador 

11.20 

Newport,  R.  I 

Geneva 

32.14 
3416 

Paris 

36.14 

Florence  

Home 

42.26 

Madeira 

Algiers 

GO.03 

London  

New  Orleans 

St.  Louis,  Mo 

Jamaica 

CHAPTER  VI. 


OF  EXERCISE. 

Necessity  for  Exerise. — To  secure  the  full  and  pei'fect  develop- 
ment of  the  body,  nature  has  implanted  among  the  mental  propensities 
a  special  organ  of  motion.  The  phrenological  organ  of  "  mirthfulness," 
or  "  playfulness,"  seems  to  be  intended  to  secure  this  end,  by  prompt- 
ing to  frequent,  free,  active,  and  vigorous  exercise.  Young  animals, 
especially  of  the  mammiferous  class,  manifest  this  disposition  very 
early;  and  young  children  must  have  theu*  frequent  "play-spells,"  or 
be  sick — there  is  no  alternative.  I  am  disposed  to  believe  that  it  is  im- 
possible for  a  healthy  adult  to  be  otherwise  than  active  in  body  or  mind, 
or  both,  and  that  laziness  is  actually  a  disease,  dependent  on  some  ab- 
normal condition  of  the  organism. 


368  HYGIENE. 


It  is  true  that  a  variet)'  of  social  circunistaucfrs  may  operate  to  pro- 
duce an  indolent  dispositior  of  mind  and  inactive  habit  of  body,  as  ex- 
treme poverty,  excessive  wealth,  gi'inding  servitude,  tyrannical  govern- 
ment, etc. ;  but  all  these  also  produce  a  primary  condition  of  ill  health. 
So  of  personal  habits,  dissipation,  gluttony,  dietetic  errors,  or  unhealth- 
ful  voluntary  habits  in  other  respects;  they  all  conduce  to  the  production 
of  a  morbid  condition. 

Nothing  is  more  discouraging  to  the  future  prospects  of  a  young 
child  than  a  disposition  to  sit  still,  be  quiet,  keep  out  of  mischief,  etc. 
Such  children  may  give  the  n»jrse  and  schoolmaster  but  little  trouble  in 
keeping  them  "out  of  the  way;"  but  in  after  life  their  parents  may 
find  it  somewhat  ti-oublesome  and  expensive  to  provide  them  attendants 
and  doctors. 

Physiology  of  Exercise. — The  function  of  respiration,  by  which 
the  blood  is  vitalized,  and  the  nutrition  of  the  muscular  structure,  on 
which  depends  all  the  motive  power  or  strength  of  the  system,  are  in- 
timately connected  with  the  circulation  of  the  blood,  and  this  with 
active  exercise.  This  principle  is  well  illusti'ated  in  the  effects  of 
gymnastics  and  training,  by  which  the  muscles  of  any  part  of  the  body 
are  remarkably  invigorated  by  regular,  systematic  exercises.  People 
of  all  trades  and  occupations  find  those  j)arts  of  the  muscular  system 
wdiich  are  habitually  the  most  exercised  to  be  the  most  powerful 
Thus  farmers  have  the  whole  muscular  system  nearly  equally  devel- 
oped ;  blacksmiths,  joiners,  carpenters,  sailors,  etc.,  have  sti'ong  arms 
and  chests;  travelers,  dancers,  etc.,  are  disproportionately  developed 
in  the  muscles  of  the  lower  exti'emities ;  shoemakers,  tailors,  etc.,  have 
a  tolerable  development  of  the  arms  and  chest,  but  suffer  in  the  lower 
extremities  and  abdomen;  merchants,  clerks,  and  others  who  pursue 
an  easy,  in-door  occupation,  have  slender  muscles  generally;  and  pro- 
fessional men,  whose  exercise  is  more  intellectual  than  bodily,  exhibit 
large  brains,  with  slender  muscles. 

V^ARiETiES  OF  ExERCiSE. — For  hygienic  purposes  there  are  many 
exercises  equally  advantageous.  All  that  is  necessary  is  that  nil  parts 
of  the  body  be  actively  and  frequently  exercised,  within  the  bounds 
of  not  producing  fatigue  amounting  to  exhaustion ;  that  is  to  sny,  a 
degi-ee  of  fatigue  which  >s  not  readily  recovered  from  on  resting.  All 
exercises,  however,  to  secure  their  full  benefit,  should  be  coupled  with 
an  object  of  either  utility  or  a.nusement,  otherwise  the  mind  is  apt  to 
labor  adversely  to  the  body.  Occupation — some  useful  business  pursuit, 
which  I'oouires  and  h^ncf  secures  nlteution  atid  hibor  during  severn/ 


EXERCISE.  369 


hours  of  each  day — is  absolutely  essential  to  the  highest  sanatory  con- 
dition of  the  body,  for  nothing  else  will  insure  so  constant,  regular, 
and  equally  divided  exercise  for  both  body  and  mind. 

Amusements  and  plays  could  be  advantageously  alternated  to  vary  the 
monotony  of  the  exercises ;  and  indeed  social  and  family  recreations 
would  constitute  prominent  fea  ures  of  aU  physiologically  regulated 
neighborhoods.  Among  the  active  exercises  which  may  be  beneficially 
ii'sorted  to  as  pastime,  are  walking,  running,  leajnng,  dancing.  Box- 
ing and  fencing  are  physiologicnlly  adapted  to  expand  the  chest,  and, 
in  fact,  strengthen  the  whole  muscular  system,  but  they  are  too  closely 
associated  with  pugilism,  and  barbarism,  and  brutalism  to  be  recom- 
mended, especially  as  many  other  exercises  are  equally  beneficial. 
Wrestling  is  a  dangerous  method  of  developing  the  muscular  power. 
Ten-pins,  billiards,  etc.,  are  excellent  exercises  physiologically,  but  no 
better  than  sawing  wood,  planing  boards,  digging  j^otatoes,  hoeing 
corn,  raking  hay,  etc.,  etc.  Singing,  declaiming,  reading  aloud,  are 
admirable  methods  of  cultivating  the  vocal  powers,  and  increasing  the 
capacity  of  the  respiratory  apparatus.  Riding  on  horseback  is  one  of 
the  best  exercises  in  cases  of  weak  digestive  powers,  as  is  also  riding 
in  a  carriage  without  springs  over  a  rough  road,  or  street  paved  with 
cobble  stones.  Hunting  Rud  fishing  are  highly  recommended  by  some 
hygienic  writers,  but  the  ideas  of  gormandizing,  and  the  exhibitions 
of  cnielty  with  which  they  are  associated,  are  hardly  becoming  a  re- 
fined, enlightened,  and  Christian  people.  Such  amusements  are  more 
appropriate  to  savage  than  to  civilized  life. 

Of  the  passive  kinds  of  exercise,  riding  in  easy  carriages,  sailing, 
swinging,  etc.,  they  are  rather  to  he  regarded  as  mere  amusements, 
or  as  expedients  for  the  invalid.  They  are  highly  serviceable,  and,  in- 
deed, indispensable  to  such  valetudinarians  as  have  not  strength  to  get 
a  sufficiency  of  the  out-door  air  without  them. 

Exercises  of  Children. — Our  social  organization  is  very  defective 
in  its  provisions  for  the  appropriate  exercises  of  infants  and  young 
children.  The  cradle  is  a  most  unphysiological  method  of  exercising 
a  child  to  sleep;  its  primary  object  was  to  save  the  nurse  trouble,  but 
a  child  accustomed  to  be  rocked  to  sleep  will  give  the  nurse  more 
ti'ouble  in  the  end  than  one  accustomed  to  sleep  without  such  assist- 
ance. The  motion  of  the  cradle,  too,  is  "njurious  to  the  brain  and 
nervous  system.  The  modern  "baby-jumper"  is  a  better  conti-ivance. 
but  even  this  can  be  advantageously  superseded  by  giving  the  child 
*•  the  largest  liberty"  to  exercise  in  its  own  way.  Plenty  of  r«om,  a 
siuocftlc  floor,  and  a  pl&ntif  il  suppl"  of  any  kind  of  "plaything?^  '  wliicli 


870  IrYGIENE. 

are  not  da/igerous — India-rubber  balls,  baskets,  brooms,  rattle-boxes, 
etc. — afford  the  opportunities  which  a  child  will  always  improve  to  the 
best  possible  advantage.  Unfortunately,  among  the  poorer  classes  of 
our  cities  young  children  are  kept  in  stupid  inactivity,  simply  because 
they  have  no  room  to  stir;  and  this  confinement  makes  them  sickly, 
puny,  peevish,  and  finally  indolent. 

Times  for  Exercisog. — In  regard  to  the  times  for  exercising, 
the  common  instincts  of  mankind  have  generally  guided  them  cor- 
rectly. The  most  severe  and  active  exertions  should  never  be  per- 
formed on  a  full  stomach,  nor  immediately  before  or  after  a  meal. 
The  best  hygienic  regulation  for  a  laboring  or  business  man,  who  takes 
three  meals  a  day,  and  is  regular  in  his  habits  of  retiring  at  night  and 
rising  in  the  morning,  is  to  exercise  moderately  an  hour  or  so  before 
breakfast,  perform  the  severest  labor  between  breakfiist  and  dinner, 
and  work  moderately  again  between  dinner  and  supper.  Much  evening 
work  is  a  violation  of  "the  natural  order."  Persons  of  sedentary  occu- 
pations should  choose  such  exercises  as  they  can  habitually  and  regu- 
larly attend  to,  all  of  which  should  be  as  much  out-door  as  possible. 
Their  most  active  exercises  should  take  place  on  first  rising  in  the 
morning,  and  at  other  times  of  day  when  the  stomach  is  pai'tially 
empty.     Vigorous  evening  exercises  ai'e  also  suitable  for  them. 

"  Nature  lives  by  toil ; 
Beasts,  birds,  air,  fire,  the  heavens  and  rolling  worlds, 
All  live  by  action  ;  nothing  lies  at  rest 
But  death  and  ruin." 


CHAPTER  VII. 

OF  SLEEP. 


General  Observations. — Sleep  may  be  defined — the  periodical 
suspension  of  all  the  functions  of  external  relation.  The  constitutional 
relation  of  man  to  the  changes  of  the  seasons  and  the  successions  of 
days  and  nights,  implies  the  necessity  of  sleep.  All  animals  sleep,  buj 
no  animal,  save  man,  sleeps  on  his  back,  "  with  face  upturned  to 
heaven."  The  time  of  sleep  required  by  different  individuals  varies 
greatly,  according  to  temperament,  mann^"  of  life,  dietetic  habits,  etc. 
John  AVesIej',  with  an  active  nervous  lompcrainout,  and  a  rigilly-plain 
vegetable  diet,  could  perform  mental  and  bodily  labors  almost  Herculean, 


SLEEP.  371 

and  slet  p  but  four  or  five  of  the  twenty-four  hours  ;  while  Daniel 
Webster,  with  a  more  powerful,  but  less  active  organization,  and  the 
ordinary  mixed  diet,  "has  a  talent  for  sleeping"  eight  or  nine  hours. 

As  a  general  rule,  in  the  animal  kingdom,  herbivorous  animals  sleep 
less  than  carnivorous ;  and  the  universal  experience  of  the  human 
race  proves  that  vegetarians  require  much  less  sleep  than  the  human 
omnivora,  or  those  who  subsist  on  both  animal  and  vegetable  foods. 
This  fact  must  be  accounted  for  on  the  principle  of  the  greater  purity, 
blandness,  and  adaptedness  of  vegeia'">le  food,  requu'ing  less  vital  ex- 
penditure to  appropriate  it,  and  exhausting  the  organic  economy  less 
in  disposing  of  its  waste  or  innutritions  particles. 

Phenomena  of  Sleep. — Profound  or  quiet  sleep  is  the  complete 
cessation  of  the  functions  of  the  cerebral  hemispheres  and  the  sensory 
ganglia,  and  is  attended  with  entire  unconsciousness.  Dreaming  im- 
plies imperfect  rest — some  disturbing  cause,  usually  gasti'ic  irritation, 
exciting  the  brain  to  feeble  and  disordered  functional  action.  Individ- 
uals of  very  studious  habits,  and  those  whose  laHors  are  disproportion- 
ately intellectual,  require  more  sleep  than  those  whose  duties  or  pur- 
suits require  more  manual  and  less  mental  exertion.  But  no  avocation 
or  habit  affects  this  question  so  much  as  the  quality  of  the  ingesta. 

Natural  Term  of  Sleep. — Physiologists  are  not  well  agreed  re- 
specting the  natural  duration  of  sleep.  Historical  data  seem  to  indi- 
cate that  a  great  majority  of  those  who  attained  gi'eat  longevity  were 
long  sleepers,  averaging  probably  at  least  eight  hours.  The  statute  of 
nature  appears  to  read  :  Retire  soon  'after  dark,  and  arise  Avith  the  first 
rays  of  morning  light ;  and  this  is  equally  applicable  to  all  climates  and 
all  seasons,  at  least  in  all  parts  of  the  globe  proper  for  human  habita- 
tions, for  in  the  cold  season,  v/hen  the  nights  are  longer,  more  sleep  is 
required. 

A  general  rule,  and  an  invariable  rule  for  all  whose  voluntary  habits 
are  correct,  and  who  retire  to  rest  early  in  the  evening,  is,  to  sleep  as 
long  as  the  slumber  is  quiet,  be  the  time  six,  seven,  eight,  or  nine 
hours.  Dreamy,  restless  dozing  in  the  morning  is  generally  mucli 
more  debilita'.ing  than  refreshing.  Those  persons  who  indulge  largely 
in  animal  food,  or  eat  gluttonously  of  any  thing,  and  especially  those 
who  are  addicted  to  spirituous  liquors  and  tobacco  in  connection  with 
high-seasoned  animal  food,  are  in  danger  cf  over-sleeping,  even  to  tlio 
extent  of  very  considerably  increasing  the  stupidity  and  imbecility''  of 
mind,  and  indolence  and  debKty  of  body,  naturally  and  necessarily 
consequent  upon  those  habits. 


372  H  Y  G  I E  N  E. 


Sleeping  after  Meals  .-r-Some  persons  are  partial  to  tie  siesLa, 
or  "  dinner  nap,"  and  physicians  are  divided  in  opinion  whether  the 
habit  is  useful  or  injurious.  Dr.  Dunglison,  who  appears  to  be  in  some 
doubt  on  the  subject,  but  rather  inclines  to  regard  a  short  sleep  after 
dinner  favorably,  remarks:  '-It  is  certain  that  after  a  full  meal  both 
man  and  animals  feel  a  propensitj^  to  sleep."  I  regard  it  as  perfectly 
certain  that  there  is  no  such  propensity  in  man,  except  when  his  full 
meal  has  been  an  imjn'oper  one.  If  he  has  slept  too  little  the  niirht 
previous,  he  may  feel  a  propensity  to  sleep  at  any  time  during  the 
next  day,  but  not  more  after  a  meal  than  at  any  other  time,  unless  his 
meal  were  fuller  than  the  wants  of  his  system  demanded,  or  of  too  stim- 
ulating or  concentrated  a  character  to  be  healthful ;  nor  is  the  assertion 
correct  as  respects  the  animals,  excepting  the  carnivorous  and  gor- 
mandizing varieties.  Sleeping  after  meals  is  always  pernicious ;  and 
for  an  adult  to  sleep  at  all  during  the  day  can  be  regarded  no  better 
tlian  the  least  of  two  evils  when  sufficient  sleep  is  not  had  at  niglit. 
All  persons  who  can  should  do  all  their  sleeping  at  once,  and  not  eat 
such  quantities  or  qualities  of  food  as  will  produce  the  unnatural  pro- 
pensity to  sleep  after  meals. 

Sleep  for  Different  Pfhsons. — It  has  long  been  a  popular 
ivliim  that  females  require  more  sleep  than  males,  and  many  physio- 
logical reasons,  as  whimsical  as  the  whim  itself,  have  been  oftered  in 
support  of  the  notion.  I  know  of  no  sound  ai-gument  that  proves  any 
difference  so  far  as  sex  is  concerned ;  and  I  think  a  safe  rule  for  male 
and  female,  young  and  old,  is,  for  children  to  sleep  all  they  are  inclined 
to,  without  the  a-id  of  ^extra-nervine  agencies,  rocking  in  the  cradle,  or 
paregoric  drops ;  and  for  the  middle-aged  and  old,  of  both  sexes,  to 
sleep  all  they  can  at  one  effort,  between  sunset  and  sunrise.  Of  coui-se* 
those  whose  business  or  pleasure  obliges  them  to  reth'e  at  late  or  ir- 
r-egular  hours  should  govern  themselves  accordingly. 

Bodily  Position  during  Sleep. — The  position  of  the  body  in 
bed  is  worth  a  moment's  reflection.  It  should  be  perfectly  flat  or  hor- 
izontal, with  the  head  a  little  raised  ;  one  common-sized  hair  pillow  is 
generally  sufficient.  A  majority  of  people  sleep  with  the  head  too 
high,  often  elevated  on  two  thick  pillows,  with  a  heavy  bolster  for  the 
shoulders  This  is  certainly  a  very  bad  habit.  The  neck  is  bent,  the 
chest  is  compressed,  and  the  whole  body  unnaturally  crooked.  Chil- 
dren often  become  stoop-shouldered,  or  otherwise  crooked,  from  their 
heads  being  placed  on  high  pillows.  Some  physiologists  object  to 
sleeping  on  the  bad .  and  assig-i  as  a  reasoH  that  the  stomach  and  other 


SLEEP.  873 

abdominal  viscera  press  upon  the  large  blood-vessels  below  the  heart, 
and  thereby  produce  a  tendency  to  cerebral  disturbances,  nightmare, 
apoplexy,  etc.  This  argument  only  has  weight  with  those  who  take 
late  or  heavy  suppers,  or  suffer  from  enlarged  livers  or  other  abnormal 
conditions.  Healthy  persons,  of  correct  dietetic  habits,  may  sleep  at 
pleasure  on  the  back,  or  gently  reclining  to  one  side.  All,  however, 
should  carefully  avoid  reclining  nearly  on  the  face,  or  crossing  the  arms 
over  the  chest,  as  that  would  approximate  the  shoulders,  contract  the 
chest,  and  materially  affect  the  respiration.  Sir  Charles  Bell  thinks 
the  incontinence  of  urine,  which  so  frequently  troubles  children,  arises 
from  their  lying  on  their  backs.  A  more  rational  explanation  of  this 
difficulty  may  be  found  in  the  paregorics,  anlimonial  wines,  herb  teas, 
and  other  weakening  drugs  and  debilitating  slops  with  which  they  are 
so  generally  stuffed  by  kind  mothers,  as  per  advice  of  sage  doctors. 

Beds  and  Bedding. — The  nature  of  the  beds  ana  bed-clothing  are 
of  importance  to  those  who  would  preserve  or  attain  health.  Feath- 
ers can  only  be  mentioned  in  reprobation.  Straw,  corn  husks,  hair, 
and  various  palms  and  gi-asses,  make  comfortable  and  healthful  beds. 
In  cold  weather  those  who  are  tender  may  use  over  either  of  them  a 
hght,  thin,  cotton  mattress.  No  bed  should  be  soft  enough  for  tlio 
body  to  sink  into  it ;  and  few  persons  who  have  thoroughly  tried  the 
experiment  of  sleeping  on  feathers  and  on  straw  will  willingly  ex- 
change  the  latter  for  the  former.  Children  and  infants  are  cruelly 
though  unwittingly  abused,  when  compelled  to  sleep  on  feathers.  I 
can  hardly  imagine  that  any  person  would  be  willing  to  have  a  pillow 
of  feathers  under  his  head,  after  once  getting  accustomed  to  one  of 
hair,  chaff,  or  even  straw.  Cotton  is  much  better  for  pillows  than 
feathers.  The  bed-clothes  should  be  as  light  as  possible  consistently 
with  comfort.  Linen  or  cotton  sheets  are  better  than  flannel,  and  for 
outside  bedding  thin  quilts  are  beat  in  summer,  and  light  flannel  blank- 
ets in  addition  in  winter. 

Sleejnng  apartments  always  ought  to  be  large  and  well  ventilated  ; 
but  generally  they  are  neither.  Especial  attention  is  therefore,  as 
intimated  in  a  preceding  chapter,  due  to  these  circumstances.  The 
windows  or  doors  should  be  so  arranged  as  to  allow  a  free  circula- 
tion of  air ;  even  night  air,  which  many  people  and  some  medical 
writers  appear  to  think  is  really  poisonous,  should  have  free  ingress. 
If  the  sleeping-room  is  dark  or  damp,  it  should  be  occasionally  eiried 
and  aired,  by  a  fire  if  necessary,  which  may  be  put  out  before  the 
sleeping  hour.  Whether  fires  in  sleeping-rooms  are  to  be  advised  or 
rliscouFtsnanced,  medical  men  agree  as  little  among  themselves  as  ^hey 
32 


374  If  1  GIENE. 

do  in  relation  to  aliiost  every  other  hygienic  influence  that  can  be 
named.  While  their  expediency  for  some  invalids  is  unquestioned, 
but  little  reflection  seems  necessary  to  convince  any  mind  unprepos 
sessed  with  vague  theories  that,  as  a  habit,  they  cannot  be  otherwisft 
than  pernicious.  When  fires  are  employed  during  the  daytime  in  the 
sleeping-room,  they  shoiJd  be  extinguished  and  the  room  well  aired 
before  going  to  bed.  In  houses  heated  with  warm  air,  particular  at- 
tention should  be  paid  to  ventilating  the  lodging-room. 


CHAPTER  VIII. 

OF   CLOTHING. 


Physiological  Nature  of  Clothing. — It  is  an  obvious  physio- 
logical fact,  that  the  more  the  whole  surface  of  the  body  is  exposed  to 
the  external  air,  within  certain  limits,  the  more  vigorous  is  its  func- 
tional action  performed,  and  the  better  is  it  enabled  to  preserve  its  own 
proper  temperature,  as  well  as  to  resist  all  morbific  impressions  from 
vicissitudes  of  weather,  or  the  extremes  of  heat  and  cold.  Clothing, 
therefore,  which  the  usages  of  society  and  the  severity  of  climates 
render  indispensable,  should,  as  an  invariable  rule,  be  as  light  and  loose 
as  possible  without  bodily  discomfort.  We  must,  however,  recollect 
that  comfort  is  veiy  much  a  matter  of  habit,  and  make  a  due  discrim- 
ination between  the  natural  sensation  of  health  and  the  morbid  sensi- 
tiveness produced  by  false  customs.  Some  persons  wrap  their  whole 
bodies  in  flannel  under-garments,  and  yet  are  ready  to  go  into  a  "shiv- 
ering lit"  at  every  unusual  breath  of  cold  air:  while  others  eschew 
those  garments  entirely,  and  endure  the  coldest  weather  of  this  cli- 
mate with  much  less  discomfort. 

Materials  of  CLOTnmG. — The  substances  principally  employed 
in  the  manufacture  of  clothing  in  civilized  countries  are,  linen,  cotton, 
silk,  wool,  and  hair  or  down.  Those  materials  which  are  bad  con- 
ductors of  caloric,  afford  the  greatest  immediate  protection  from  cold, 
ns  woolens  or  flannels ;  but,  for  the  same  reason,  they  are  more  de- 
bilitating to  the  cutaneous  function;  they  are  only  to  be  preferred  in 
cases  of  temporary  exposure,  or  in  very  cold  climates,  or  as  a  "  neces- 
sary evil"  in  persons  whose  external  surface  is  debilitated  by  bad  habits 
of  dress,  until  its  vigor  can  be  restored  by  bathing  and  other  hygienic 


CLOTHING.  376 


processes.  Cotton  and  linen  are  better  adapted  to  temperate  climates, 
especially  dm'ing  the  warm  season  ;  and  linen  for  under-clothes  is  the 
best  of  the  two  in  hot  vv^eather.  Flannel  next  the  skin,  I  am  per- 
suaded, is  invariably  hurtful  as  a  habit.  When  woolen  clothing  is 
worn,  it  should  be  the  outside  garments ;  these  may  be  of  any  quantity 
or  thickness  necessary  to  keep  the  body  comfortable,  while  cotton  or 
linen  only  comes  in  contact  with  the  skin.  The  discrepancies  among 
medical  authors  on  this  subject  are  almost  ludicrous;  some  advocating 
the  use  of  flannel  next  the  skin,  at  all  times  and  in  all  seasons ;  others 
condemning  it  as  a  fruitful  source  of  colds,  coughs,  pulmonic  and  rheu- 
matic affections,  etc.  "As  regards  the  chest,"  says  Sir  George  Le- 
fcvre,  "  a  veiy  light  kind  of  woolen  waistcoat  should  not  be  dispensed 
with  even  in  the  dog-days."  I  would  much  rather  prohibit  it  in  winter 
than  prescribe  it  in  summer.  In  the  last  cholera  season  (1849)  the 
N'ew  York  Board  of  Health,  by  authority  of  their  Medical  Council, 
recommended,  as  among  the  preventive  measures,  "the  wearing  of 
flannel  next  the  skin,"  during  the  hot  weather  of  June,  July,  and  Au- 
gust. And  on  this  hint  a  medical  adventurer  has  since  invented  med- 
icated aprons  and  bandages  to  keep  the  bowels  ivarm,  or,  as  the 
proprietor  says,  "  retain  the  animal  heat,"  and  thus  prevent  bowel 
complaints.  These  notions  are  too  absurd  for  serious  refutation.  Silk 
is  a  bad  conductor,  and  for  this  reason  females  find  silk  dresses  very  un- 
comfortable in  very  wai'm  weather.  Furs  are  worn  in  this  country 
more  for  ornament  than  use.  They  are  the  warmest  clothing  materials 
known,  and  by  overheating  the  part  of  the  body  to  which  they  are  ap- 
plied, render  it  exti'emely  susceptible  to  cold.  Fur  neckcloths,  caps, 
etc.,  are  very  pernicious. 

Color  of  Clothing. — In  a  strictly  hygienic  regulation  of  dress, 
color  cannot  be  wholly  disregarded.  White  colors  reflect  the  rays  of 
caloric  ;  black  absorbs  them.  Light-colored  clothing  is  therefore  more 
comfortable  and  sanatory  in  warm  weather  than  dark-colored,  because 
the  former  repels  the  heat,  and  the  latter  readily  receives  and  retains 
it.  Various  experiments  have  shown  that  the  heat-reflecting  or  heat- 
retaining  property  of  diflerent  fabrics  varies  exactly  with  their  lighter 
or  darker  shades  of  color.  This  difference  is,  however,  much  greater 
in  the  luminous  rays  of  light  than  in  the  non-luminous.  When,  there- 
fore, we  are  not  exposed  to  the  sun,  the  subject  of  color  is  of  less  im- 
portance. The  absorbing  power  of  dark  surfaces  renders  the  skins  of 
dark-colored  animals,  as  well  as  of  the  darker  persons  or  races  of  the 
human  family,  less  liable  to  be  scorched  or  bliste;  ad  by  the  direct  raya 
of  the  sun,  than  ai"e  those  of  a  lighter  color. 


376  HYGIENE. 


Particular  Garments. — Fashion  seldom  consults  hygiene  in  the 
matter  of  dress.  The  hat  is  generally  too  stiff,  heavy,  and  hot.  It 
ought  to  be  as  ligbt  and  soft  as  possible,  and  as  thoroughly  ventilated  as 
a  bed-chamber.  This  could  easily  be  accomplished  without  marring 
its  beauty.  The  common  neck-stock  or  cravat  is  one  of  the  worst 
articles  known ;  by  confining  and  heating  the  throat  it  predisposes  to 
colds,  rheumatism,  quinsy,  bronchitis,  etc.  I  have  known  several  per- 
sons in  Xew  York  city,  who  were  habitually  the  subjects  of  two  or 
thi'ee  sevei-e  attacks  of  quinsy  a  year,  entirely  cured  by  continually 
exposing  the  neck  in  all  weathers,  and  bathing  it^  daily  in  cold  water. 
That  the  natural  clothing  of  an  unshaveL  beard  is  a  protection  against 
affections  of  the  throat  and  lungs,  T  have  no  doubt.  But  if  we  will 
render  ourselves  preternaturally  susceptible  by  shaving,  we  should  not 
aggravate  the  susceptibility  by  binding  up  the  neck  with  tight  clothing. 
Females  are  generally  debilitated  by  too  heavy  an  amount  of  clothing 
about  the  back  and  hips.  The  custom  with  some  females  of  oiling  the 
hair,  then  combing  it  very  smooth,  and  fastening  it  in  a  bunch  on  the 
top  of  the  head,  is  very  injurious  to  the  scalp  and  brain ;  in  fact,  a  com- 
mon source  of  headache  and  neiTOUsness.  Stockings  of  cotton  and 
linen  are  better  than  flannel,  except  when  the  feet  are  exposed  to  both 
extreme  cold  and  moisture.  Garters  are  a  common  cause  of  varicose 
veins  in  the  lower  extremities.  Fur  gloves  are  a  bad  article ;  so  arc 
India-rubber  shoes,  except  as  over-shoes  to  slip  on  temporarily.  Straps 
for  fastening  the  pantaloons  tightly  to  the  boot  or  shoe,  I  believe  are 
almost  or  quite  out  of  fashion ;  it  is  well  they  are  so,  for  they  render 
all  the  motions  of  the  body  stiff  and  awkward,  and  cause  an  injuriou-s 
pressure  to  be  exerted  on  the  knee-pan  and  shouldei's.  Several  cases 
of  synovitis,  attended  with  extreme  weakness  of  the  muscles  around 
the  knee-joint,  have  lately  come  under  my  notice,  produced,  without 
any  doubt,  by  wearing  pantaloon  straps.  Suspenders,  when  the  trow- 
sere  are  loose  and  easy,  are  not  objectionable ;  although  the  sailor, 
whose  vocation  requires  the  utmost  freedom  from  all  restraint  in  tiie 
muscles  of  the  chest  and  upper  exti'emities,  finds  it  more  conver.ient 
to  support  the  ti*oivsers  by  the  tightened  waistband. 

Custom  has  dealt  more  cnielly  with  infants  than  with  adults  in  the 
style  of  clothing.  Swathing,  bandaging  from  head  to  foot  with  the  view 
of  getting  the  body  in  shape,  and  bandaging  the  abdomen  to  prevent 
the  child  from  becoming  "  pot-bellied,"  are  fashions  happily  fast  going 
into  disrepute,  under  the  teachings  of  hydropathic  and  physiologica! 
writers.  The  new-born  infant  wants  no  bracing  or  supporting  fro!)i 
the  clothes.  All  the  clothing  required  in  infancy  and  childhood  is  easy, 
loose^  flov^iijg  garments.,  sufficient  to  preserve  the  requisite  temperature* 


BATHING.  377 


Bed  and  Body  Linen. — It  is  always  of  importance  that  the  bed 
and  body  linen  be  well  aired  daily,  and  frequently  changed.  Strict  at- 
tention to  the  depurating  function  of  the  skin  requires  that  the  under- 
garment or  shirt  worn  during  the  day  should  never  be  slept  in  during 
the  night.  The  sheets,  too,  which  collect  more  or  less  of  the  matters 
of  perspiration,  should  be  well  exposed  to  the  air  every  day.  How 
often  the  shirts  worn  in  the  daytime  require  changing,  depends  some- 
thing on  the  amount  of  exercise,  perspiration,  etc. ;  generally  tv/o  or 
three  times  a  week  are  advisable. 

General  Rules. — The  first  physiological  rule  of  dress  is,  to  have 
all  garments  as  light  in  texture  and  as  loose  in  fashion  as  is  consistent 
with  bodily  comfort,  and  as  will  admit  of  the  most  perfect  freedom  in 
the  exercise  of  every  muscle  of  the  body.  The  second  is,  to  observe 
regularity  and  uniformity.  Boots,  shoes,  hats,  caps,  thin  and  thick 
stockings,  gloves,  mittens,  neck-dresses,  head-dresses,  etc.,  when  worn 
ut  all,  should  be  always  worn  under  similar  circumstances — not  indis- 
criminately changed  or  alternated.  As  intimated  in  a  preceding  chap- 
ter, inequality  of  clothing  is  a  far  more  frequent  cause  of  "  colds"  than 
deficient  clothing.  If  a  person  exposes  a  part  of  the  body  usually 
protected  by  clothing  to  a  strong  current  of  cold  air,  he  will  take  cold 
sooner  than  by  an  equal  exposure  of  the  whole  body. 


CHAPTER  IX. 

OF  BATHING. 


Keasons  for  Bathing. — Were  human  beings  in  all  other  respects 
to  adapt  themselves  to  the  laws  of  theix*  organization,  and  were  they  in 
all  their  voluntary  habits  in  relation  to  eating,  drinking,  clothing,  exer- 
cise, and  temperature,  to  conform  strictly  to  the  laws  of  hygiene,  I  do 
not  know  that  there  would  be  any  physiological  necessity  or  utility  in 
bathing  at  all.  But  in  civic  society  the  laws  of  life  and  health  are 
transgi-essed  in  a  thousand  ways;  and  the  sura  total  of  all  the  un- 
physiological  habits  of  civilized  life  is,  a  condition  cf  body  characterized 
by  deficient  external  circulation,  capillary  obstruction,  and  internal  con- 
gestion or  engorgement.  To  counteract  this  morbid  condition  no  single 
agent  or  y  rocess  s  more  effectus^  than  bathing  the  whole  surface  of 


HYGIENE. 


the  body  daily  with  cool  or  cold  water.     As  a  general  rule,  therefore, 
a  daily  bath  should  be  as  regularly  atteuded  to  as  are  the  daily  meals. 

Methods  of  Bathing. — For  hygienic  purposes  there  are  various 
methods  of  bathing  equally  advantageous  ;  the  particulai*  process  is 
merely  a  matter  of  convenience.  The  towel  or  sponge  bath,  plunge, 
or  shower,  are,  in  ordinary  cases,  equally  useful.  The  first-named  is 
iccessible  to  all  persons,  at  all  times,  where  a  coarse  towel  and  a  quart 
of  water  exist.  The  others  require  less  time  and  are  more  agreeable 
to  persons  accustomed  to  bathing.  A  portable  apparatus  for  ti'avelers 
has  lately  been  consti'ucted,  which  may  be  conveniently  packed  in  a 
trunk  or  carpet-bag,  and  used  in  t'ne  bedroom  of  the  hotel,  or  state- 
room of  a  steamboat.  After  the  ablution,  in  whatever  manner  per 
formed,  the  whole  body  should  be  riio'-'^uglily  rubbed  with  a  crash  towel 

Time  a>'d  Temperature  of  Baths. — The  best  time  for  a  genera 
bath  is  unquestionably  on  first  rising  frlm  bed  in  the  morning.  Bath 
ing  at  any  time  of  day,  when  the  stomach  is  partially  or  completel} 
empty,  is  better  than  no  bath.  In  warm  w^eather  an  additional  evening 
ablution  is  refreshing  and  invigorating.  The  temperature  of  the  water 
must  be  vai'ied  to  suit  diflferent  circumstances  of  constitutional  health 
and  vigor.  The  general  rule  is,  that  cool  or  cold  water,  short  of  pro- 
ducing any  permanently  disagreeable  chill,  is  the  best.  Of  course, 
persons  of  deficient  blood  and  low  vitality  should  use  tepid  water ;  and 
extremely  feeble  individuals  should  commence  with  warm  water,  gi-ad- 
ually  reducing  the  temperature  as  "reaction"  improves.  The  cold 
bath  may,  for  general  purposes,  include  all  temperatures  below  60° 
Fahr. ;  the  cool,  from  60"  to  72° ;  the  tepid,  from  72°  to  85° ;  the  warm, 
from  85°  to  100°;  and  the  liot,  above  100°. 

Infants  ought  to  be  bathed  daily  from  birth.  The  water  should  be 
at  the  temperature  of  about  72°  for  the  first  three  months,  and  reduced 
about  five  degrees  every  three  months  for  a  year,  after  which  time,  if 
the  child  has  been  well  managed  in  other  respects,  it  may  be  bathed  in 
water  of  any  medium  temperature — say  between  50°  and  65°. 

Precautions  in  Bathing. — No  person  should  bathe  in  very  cold 
water  when  the  body  is  chilly  from  cold,  nor  when  exhausted  or  over- 
fatigued  from  violent  exercise,  nor  when,  fi-om  any  cause,  the  respira- 
tion is  materially  disturbed,  nor  soon  after  eating.  Heat  and  perspira- 
tion are  no  objections  to  going  into  cold  air  or  cold  water,  provided  the 
body  is  not  in  a  state  of  relaxation  from  confined  or  bad  air,  or  debility 
from  over-exertion,  and  the  broatli  aa  is  easy  and  natural. 


EXCRETIONS  879 


CHAPTER   X. 

OF    THE     EXCRETIONS 

Relation  of  Excretion  to  Nutrition. — From  the  physiology 
of  the  nutritive  and  the  depurative  functions  we  learn  that  an  exact 
equilibrium  must  exist  between  the  deposition  of  new  material  and  the 
removal  of  old,  in  order  to  sustain  the  vital  machinery  in  its  perfect 
integrity  of  health  and  'strength.  If  the  nutritive  functions  be  defi- 
cient, debility  and  inanition  result ;  if  the  excretory  functions  are  im- 
perfectly performed,  obstruction,  congestion,  inflammation,  and  fever 
prevail. 

The  Involuntary  Evacuatiovs.  —  As  ah-eady  explained,  the 
lungs,  liver,  and  skin  are  constantly  eliminating  from  the  body  the 
gi'eater  portion  of  its  waste,  worn-out,  useless,  effete,  and  putrescent 
particles,  their  office  being  quite  independent  of  the  action  of  the  will 
and  voluntary  muscles.  If  the  food  and  drink  is  rightly  apportioned  in 
quantity  and  quality,  and  all  other  hygienic  circumstances  are  duly  re- 
garded, their  functional  office  will  only  cease  when  the  body  consoli- 
dates to  a  state  of  motionless  density  in  a  natural  death.  But  when 
the  voluntary  habits  are  unhealthful,  or  when,  from  any  morbific  agen- 
cies, the  mvoluntary  excretions  are  checked  or  suppressed,  we  see  a 
variety  of  phenomena  indicative  of  disease.  If  the  lungs  fail  in  func- 
tional power,  the  whole  surface  is  leaden  and  bloodless,  the  eye  is  dull, 
the  face  is  wan  and  blue,  the  complexion  is  inanimate,  and  the  extrem- 
ities are  cold.  If  the  liver  does  not  duly  eliminate  the  bile,  the  blood 
is  thick  and  viscid,  the  skin  is  dingy  and  cadaverous,  the  head  is  op- 
pressed, the  mind  is  confused,  the  nerves  are  weak  and  irritable,-  and 
the  eyes  yellowish  or  livid.  If  the  skin  fails  to  throw  off  the  mattera 
of  perspiration,  the  lungs  arc  oppressed,  the  head  is  giddy  and  painful, 
the  mouth  is  parched  and  feverish,  the  heart  is  troubled  with  pal})ita- 
tion,  the  kidneys  are  irritated  by  excess  of  duty,  and  the  bowels  arc 
liable  to  gi-ipings,  spasms,  exhausting  diarrheas,  or  inflammatory  attacks. 

The  Voluntary  Evacuations. — The  bowels  and  kidneys  cleanse 
the  body  of  the  grosser  fecal  matters,  and  most  of  the  surplus  or  ex- 
traneous saline  and  earthy  particles     If  the  bowels  are  torpid,  the  ind' 


39C  HYGIENE 

rkloal  b  troubled  with  fetid  breath,  bad  taste  in  the  mouth,  cojiMhI 
tongue,  gnawing  or  other  uneasy  sensations  at  the  stomach,  dry  and 

: J.  colic,  sick  headache,  acrid  en    * 
hemorrhoids  or  piles.      If  the 
secretion  is  deficient,  dropsical  accumulations  take  place,  the  head  is 

^  even  ;  • 

.jcutaneo  -       .      _ 

a  urinous  odor,  and  a  low,  irritatire,  and  exhausting  fever  evhices 

jn  of  the  whole  bcdr.     The  imp 

w  .    ...     ^ ...  .  -^as  of  nature,  so  far  as  these  evi.c..- 

are  i  bv  volition,  cannot  be  overrated.     Many  persons  have 

beeu  serwusly  injured  by  retaining  the  urinarj*  secretion  for  some  time 
after  its  sertsible  accumulation.  Few  persons  who  live  in  the  ordinary 
niauiicr  a5'j>ear  to  have  any  mteDigible  idea  of  what  constitutes  a  health- 
ful and  natural  action  of  the  boweb.  Many  imagine  that  periodical 
-    -  -hat  b  desired.     Bc  *""■■  •  •^ny  have  a  movement  of 

irly  every  day,  and  y  at  a  particular  time  of 

day,  and  still  be  very  constipated.     The  alimentary  canal  may  still 


regularly,  and  uoiformly,  but  that  each  discharge  be  free,  easy,  and 

c"T>!Ous,  but  not  watery,  and  without  pain,  straining,  or  :'  1 

have  seen  many  persons  who  assured  me,  on  a  professior. .,  .na- 
tion, that  their  evacuations  from  the  boweb  were  always  *'  perfectly 
regular,**  when  the  furred  tongue,  foul  breath,  and  turgid  abdomen, 
:iS5ured  me  tliat  thb  depurating  function  was  very  imperfectly  per- 
formed. 

Hardly  a  disease  can  be  named  but  may  have  its  origin  in  constipated 
}.-  —-  '    '       --  .    r  .1  .    _      .   .  artificia!    '  --  ^  .      pfy 

c  .        ilogue  o  cu- 

liar  to  females,  a  large  proportion  of  the  fatal  maladies  of  children,  end 
a  vast  riiajority  of  the  cases  of  dyspepsia  -^    '  ' 

among  a  Jults  of  b'jth  sexes,  have  one  of  :.  .:   ,  ,       

condition.  I  need  hardly  add  that  no  one  can  permanently  enjoy  good 
heahb.  v.  ^  habits,  in  to  diet  and  exercise,  do  not 

tecure  x  -f  thb  f^' '  ...ty.     It  b  a  sad  commentary 

on  the  V-  _•  art  of ;.  practice,  that  its  professors  doc- 

tor, physic,  force,  and  purge  the  torpid  boweb  of  their  patients,  year 
aftfr  year,  and  leave  them  •••-•'■-  -  -  -  »'  _  ..  i  —11^  they 
permit  each  and  aU  of  the  cat  -  to  ope- 

rate cootinoaDy,  uncontrolled,  unattended  to,  and  almost  nnthought  of. 


PASSIONS  .^1 


CHAPTER  XT. 

OF    THE    PASSIONS. 

Mental  Hygie.xe. — We  may  religiously  observe  ail  the  laws  oi' 
hygiene  in  relation  to  air,  light,  drink,  food,  temperature,  exercise, 
fcleep,  clothing,  bathing,  and  the  excretions,  and  yet  "  lack  one  thing." 
If  the  passions  are  our  masters,  and  not  our  slaves,  they  will  rule  and 
ruin,  instead  of  obeying  and  serving  us.  There  is  no  single  hjgienic 
influence  more  conducive  to  health,  happiness,  and  long  life,  than  a 
cheerful,  equable  temper  of  mind  ;  and  there  is  nothing  that  will  more 
surely  disorder  the  bodily  functions,  exhaust  the  vital  energies,  and 
stamp  premature  infirmities  on  the  constitution,  and  hurry  us  on  to  an 
early  grave,  than  an  uneven,  irritable,  fretful,  or  passionate  mental  habit. 

Different  Passions  as  Affecting  Health. — There  is,  in  the 
vigorous  exercise  of  the  higher  mental  powers — the  moral  affections 
and  the  intellectual  faculties — an  elevating,  sustaining,  self-supporting 
influence  ;  while  the  violent  indulgence  of  the  lower  order  of  passions — 
the  animal  propensities — rapidly  w^eais  out  the  mental  machinery,  and 
enervates  all  the  physiological  powers.  Who  that  has  ever  felt  the 
holy  inspiration  of  love,  and  the  depressing  influence  of  hatred,  can 
fail  to  appreciate  the  importance  of  mental  hygiene  ?  Contrast  the 
emotion  of  benevolence,  or  gratitude,  or  veneration,  or  conscientious- 
ness, or  mirthfulness,  or  faith,  or  hope,  with  that  of  envy,  revenge,  jeal- 
ousy, fear,  grief  remorse,  or  despair!  One  energizes  the  mind  and 
reanimates  the  body — the  other  sinks,  chills,  and  enfeebles  both ;  one 
manufactures,  creates,  as  it  were,  vital  powder — the  other  wastes  and 
destroys  it. 

Healthful  Exercise  of  the  Pas<5"^t«'  . — ^It  is  vrue  that  all  the 
propensities  with  which  we  are  endowea  were  intended  to  be  exer- 
cised actively  and  vigorously,  but  always  in  relation  to  the  uses  or  pur- 
poses for  which  they  were  given — never  with  violence,  or  in  mere 
wantonness.  Wlien  they  are  all  exercised  Imrmoniously  with  each 
other,  their  combined  influence  is  to  invigorate,  ennoble,  r\nd  exalt  the 
whole  being ;  but  if  one  or  several  "  grow  mutinous  and  rave,"  the 
whole  physiological  and  psychological  nature  experiences  a  deteriora- 


882  HYGIENE. 

tion  proportioned  to  the  time  and  degree  in  -which  ungoverned  passion 
is  in  the  ascendant. 

Those  who  would  maintain  permanent  and  uniform  health  and  attain 
longevity,  should  cultivate  the  "  better  passions"  with  the  same  sedu- 
lous and  unremitting  care  that  they  would  cultivate  the  best  fruits  and 
vegetables.  That  anger  which  "  dwells  only  m  the  bosom  of  fools," 
should  be  a  rare  or  unknown  visitant,  and  the  "  evils  of  hfe"  should  be 
met  with  courage,  fortitude,  and  resolution,  instead  of  wailing,  com- 
plaining, and  lamentation.  That  unhappy  disposition  which  treats  all 
the  little  or  great  perplexities,  crosses,  trials,  disappointments,  or 
troubles,  which  are  incidental  to  existence,  and  which  more  ot  less 
beset  the  earthly  pilgi-image  of  every  individual,  with  fretting,  scold- 
ing, and  fault-finding,  not  only  aggi'avates  all  the  "necessai-y  evils"  of 
life,  but  gi-eatly  multiplies  them ;  and,  w^hat  is  worse,  dissipates  fool- 
ishly those  talents  and  energies  which  should  be  devoted  to  overcom- 
ing obstacles,  and,  by  profiting  from  the  lessons  of  experience,  "bring 
ing  good  out  of  evil." 

The  Passions  as  Coj^nected  with  Longevity. — In  all  ages  of 
the  world  philosophers,  divines,  naturalists,  statesmen,  and  other  men 
whose  studies  and  avocations  w^ere  especially  calculated  to  develop  and 
maintain  the  supremacy  of  the  moral  and  intellectual  powers,  have 
been  proverbially  long-lived.  In  this  connection  we  may  name  among 
the  ancients.  Homer,  Hippocrates,  Pythagoras,  Plutai'ch,  Plato,  Thales, 
Xenophon,  Carneades,  Sophocles,  Zeno,  Galen,  Democritus ;  and 
among  the  moderns,  Locke,  Newton,  Galileo,  Boyle,  Liebnitz,  Buf- 
fon,  Olbers,  Blumenbach,  Hahnemann,  Swedenborg,  Sir  Edward  Coke 
Fontanelle ;  and  in  our  own  country,  Marshall,  Jeiferson,  Franklin, 
Adams,  Jay,  and  Madison.  All  of  the  persons  above  quoted  were  dis- 
tinguished for  active  and  laborious  habits,  and  some  of  them  were  in- 
tense if  not  intemperate  workers.  The  experience  of  a  host  of  men 
renowned  for  great  attainments  in  inorali-,  theology,  and  various  de- 
partments of  science,  proves  thht  an  immense  amount  of  mental  labor 
can  be  accomplished  by  an  individual  of  ordinary  natural  capacity,  when 
the  propensities  are  harmoniously  balanced,  and  an  even,  cheerful, 
hopeful  spirit  constantly  cherished  and  maintained. 

The  Passions  as  Affecting  the  Secretions. — It  is  well  known 
to  medical  men  that  violent  fits  of  passion  will  arrest,  alter,  or  modify 
the  various  organic  secretions  as  suddenly  as  will  an  electric  shock. 
They  may  be  depraved  or  vitiated  as  readily  by  excessive  mental  emo- 
tion as  by  a  drug-poison  taken  into  the  stomach.     A  paroxysm  of  anger 


LONGEVITY.  38S 

will  render  tiie  bile  as  acrid  and  imtating  as  a  full  dose  of  calomel : 
excessive  fear  will  relax  the  bowels  equal  to  a  strong  infusion  of  to- 
bacco ;  intense  gi'ief  will  arrest  the  secretion  of  gastric  juice  as  effect- 
ually as  belladona ;  and  violent  rage  will  make  the  saliva  as  poisonous 
as  will  a  mercurial  salivation.  Many  a  nursing  mother  has  sent  her 
babe  to  the  grave  by  indulging  a  furious  emotion,  which  changed  the 
character  of  her  milk  from  a  bland  nutriment  tc  a  deadly  poison. 
These  facts,  which  could  be  multiplied  to  a  great  extent,  demonstrate 
the  law,  that  a  sound  body  cannot  exist  unless  connected  with  a  well- 
balanced  mind. 

Phtsiological  Law  or  the  Passions. — The  grand  essential  of  a 
cheerful  mind  is  self-control.  This  is  the  great  law  of  mental  hygiene. 
Those  who  cannot  govern  the  lower  range  of  propensities — the  corpo- 
real and  social  groups — by  the  moral  sentiments  and  intellectual  facul- 
ties, should  study  to  acquire  self-government  as  "the  one  thing  need- 
ful" in  the  mental  operations.  It  may  require  long,  patient^  and 
thorough  discipline ;  it  may  cost  much  self-denial,  ar.d  appear  to  de- 
mand great  temporary  sacrifices,  but  it  is  worth  all  it  costs.  Occasion- 
ally it  is  acquired  through  long  years  of  bitter  experience  ;  and  some- 
times the  greater  part  of  a  life  is  spent  in  suffering,  disappointments, 
troubles,  and  crosses,  ere  the  mind  is  found  at  peace  with  itself,  and  in 
right  relations  to  all  suiTOunding  nature.  Happy  are  they  who  can, 
even  in  such  expensive  schools,  learn  the  art  of  adapting  themselves  to 
i.ne  invariable  laws  of  the  universe,  which  they  cannot  successfully  o*p- 
pose,  or  in  any  respect  alter !  Without  self-control,  let  it  be  well  un- 
derstood, no  one  is  competent  to  govern  others.  To  mothers  this 
principle  appeals  with  more  momentous  interest  than  to  any  or  aH 
other  persons ;  for  it  is  their  influence  and  example  which  infuse  or- 
der or  disorder  into  the  infant  mind,  to  "  grow  with  its  gi'owth,  and 
strengthen  with  its  strength." 


CHAPTER  XIL 

OF   LONGEVITY, 


Natural  Duration  of  Life. — The  Scriptures  inform  us  that  at 
one  particular  age  of  the  world  and  state  of  society,  "three  score  and 
ten"  years  were  allotted  to  man ;  that  at  a  preceding  period,  sur- 


384  HYGIENE. 


rounded  by  difterent  circumstances,  it  was  ordained  that  '*liis  days 
should  be  an  hundred  and  twenty  years ;"  and  that  soon  after  the 
creation,  when  the  air  was  free  from  infection,  the  soil  exempt  fi-om 
pollution,  the  food  of  man  plain,  simple,  and  natural,  and  the  ways  of 
debauchery  and  dissipation  almost  unknown,  individuals  lived  on  the 
average  four  or  five  hundred  years,  the  maximum  point  of  longevity 
recorded  being  nine  hundred  and  sixt}"-nine  years. 

Without  speculating  upon  the  problem,  whether  the  years  of  the 
early  historians  included  tne  same  period  of  time  as  the  years  of  our 
present  almanacs,  it  is  suflicient  for  all  practica.  purposes  to  know  the 
general  law,  that  human  lives  may  be  lengthened  to  one  or  tAvo  hun- 
dred years  or  more,  or  "dwindled  to  the  shortest  span,'  by  our  own 
voluuLaiy  individual  and  social  habits.  I  can  discover  no  physiological 
or  natural  law  why  man  should  not  live  some  centuries,  when  placed 
under  every  possible  favorable  condition  of  constitution,  climate,  food, 
occupation,  etc.  It  is  obvious  that,  at  the  present  day,  a  large  propor- 
tion of  our  population  is  born  with  organizations  incafable  of  manifest- 
ing the  phenomena  of  life  for  a  longer  period  than  sixty  or  seventy 
years ;  many,  indeed,  have  not  original  vitality  sufficient  to  reach  the 
age  of  manhood,  and  others  are  born  too  feeble  to  survive  the  days  of 
childhood  ;  but,  on  the  other  hand,  all  ages  of  the  world,  and  nearly 
all  countries,  give  us  many  examples  of  individuals,  even  under  many 
unfavorable  influences,  reaching  various  periods  of  life  over  a  hundred 
years ;  some  of  them  nearly  completing  the  second  century,  and  some 
few,  if  we  may  credit  the  records,  enduring  into  the  third  century. 
If  it  can  be  proved  that  one  man  may  live  two  or  three  hundred  yeai-s 
under  the  most  favorable  hygienic  circumstances,  we  want  no  farther 
evidence  of  the  existence  of  a  physiological  kw  that  all  may,  under 
precisely  similar  circumstances.  The  learned  Lichtenberg,  who  col- 
lected many  statistics  on  the  subject  of  longevity,  declared,  "  Facts 
answer  that  man,  in  general,  can  live  fi-om  one  hundred  and  fifty  to  one 
hundred  and  seventy,  and  even  tsyo  hunJred  yoars." 

Examples  of  Longevity. — Haller  collec'ed  most  of  the  cases  of 
longevity  known  in  Europe  in  his  time.  Among  them  were  over  a 
thousand  who  attained  to  ages  between  100  and  110  years;  sixty  from 
110  to  120;  twenty-nine  from  120  to  130;  fifteen  from  130  to  140; 
Bix  from  140  to  150;  one  reached  169  years.  The  Russian  statistics 
of  1830  give  examples  of  two  hundred  and  fifty-five  individuals  between 
the  ages  of  100  and  160.  In  England  and  Wales,  during  a  period  of 
eighteen  years  preceding  1830,  over  seven  hundred  persons  were 
buried  each  of  whose  age^exeepded  100  years.     Baker's  "Curse  of 


LONGEVITY.  386 

Britain"  gives  a  list  of  about  one  hundred  individuals  whose  ages  ranged 
from  95  to  370 !  Twenty-one  of  them  reached  the  age  of  150  and 
upward,  and  about  thirty  exceeded  120  years.  Pliny  copied  from  the 
records  of  the  census  in  the  time  of  Vespasian,  the  cases  of  one  hun- 
dred and  twenty-four  men,  living  between  the  Po  and  the  Apennines, 
who  had  attained  ages  from  100  to  140  years.  At  the  same  time 
there  were  living  in  Parma  five  men  of  ages  from  120  to  130 ;  in 
Placentia  one  of  130  ;  at  Facentia  a  woman  of  132  ;  and  in  Vellagacian 
ten  persons,  six  of  whom  were  110  and  four  120  yeai*s  of  age.  Hero- 
dotus informs  us  that  the  average  life  of  the  Macrobians  was  120  years. 
The  Circassians,  according  to  the  traveler,  Mr.  Spencer,  attain  a  very 
advanced  age.  Modern  statistics  exhibit  numerous  examples  of  persons, 
in  vainous  parts  of  the  United  States,  in  Norway,  Sweden,  Denmark, 
Scotland,  Ireland,  Poland,  Greece,  and  among  the  vegetarian  Bramins 
of  India,  attaining  more  than  one  hundred  yeai's  of  age.  France, 
Spain,  and  Germany  afford  a  few  examples.  Many  places  on  Long 
Island,  in  the  state  of  New  York,  will  compare  advantageously  with 
almost  any  equal  number  of  places  on  the  globe,  as  regards  the 
longevity  of  their  inhabitants,  and  the  number  who  have  attained 
100  years  of  age.  The  American  Indians,  previous  to  the  inti'o- 
duction  of  the  white  man's  "  fire-water,"  frequently  lived  to  the 
age  of  100  years.  The  following  catalogue  of  names  and  ages 
of  persons  distinguished  for  length  of  years  has  been  collected  by 
Baker,  Horsell,  and  others.  There  is  a  discrepancy  of  a  few  years  in 
relation  to  four  or  five  of  the  individujils  between  the  ages  here  stated 
and  those  given  by  other  authors.  The  difference,  however,  is  not  mate- 
rml,  and  can  in  no  way  affect  our  argument  or  inferences.  William 
Dwpe  95,  William  Dupe's  father  102,  his  grandfather  108,  Michell 
Vivian  100,  John  Crossley  100,  Lewis  Cornaro  100,  Admiral  H.  Rol- 
venden  100,  Jane  Milner  102,  Eleanor  Aymer  103,  Eleanor  Pritchard 
103,  her  sisters  104  and  108,  William  Pepman  103,  William  Marmon 
103,  wife  of  Cicero  103,  Stender  103,  Susan  Edmonds  104,  St.  John 
the  Silent  104,  James  the  Hermit  104,  Hippocrates  104,  Bar  Decapel- 
lias  104,  Mrs.  Hudson  105,  Helen  Gray  105,  Mrs.  Alexander  105, 
St.  Theodosius  105,  Mazarella  105,  John  Pinklam  105,  St.  Anthonj 
105,  Mary  Nally  106,  Thomas  Davies  106,  his  wife  105,  Ann  Parker 

108,  Gorgies  108,  Simon  Stylites  109,  Coobah  Lord  109,  Democrates 

109,  De  Longueville  110,  Ant.  Senish  111,  Ann  Wall  111,  Luceja  112, 
Mittelstedt  112,  J.  Walker  112,  W.  Kauper  112,  W.  Cowman  112, 
E.  M.  Gross  112,  Paul  the  Hermit  113,  F.  Lupatsoli  113,  M.  Mahon 
114,  John  Weeks  114,  R.  Glen  114,  St.  Epiphamus  115,  George 
Wharton  115,  Louis  Wholeham   118,  Bamberg   120.  Arsenius  120, 

t~33 


386  HYGIENE 


Roraualdus  120,  John  Bailes  leO,  Margaret  Darley  130,  Fi-ancis  Peat 
130,  William  Ellis  130,  Bamberger  130.  Peter  Gorden  132,  John 
Garden  1S2,  Richard  Lloyd  132,  John  Taylor  133,  Catharine  Lopez 
134,  Margaret  Forster  136,  John  Mount  136,  Margaret  Patten  137, 
Juan  Marroygota  138,  Rebecca  Perry  140,  Galen  140,  Dumitor 
Radaloy  140,  Laurence  140,  Countess  of  Desmond  140,  Mr.  Ecleston 
143,  Solomel  Nibel  143,  William  Evans  145,  Joseph  Bam  146,  Colonel 
Thomas  Winsloe  14 G,  Llywark  Ken  150,  Judith  Crawford  150, 
Catharine  Hyatt  150,  Thomas  Garrick  151,  Francis  Consist  152, 
James  Bowels  152,  Thomas  Parr  152,  Thomas  Damma  154,  Epi- 
menides  157,  Robert  Lynch  160,  Letitia  Cox  160,  Joice  Heth  162, 
Sarah  Rovin  164,  William  Edwards  168,  Heniy  Jenkins  169,  John 
Rovin  172,  Peter  Porton  185,  Mongate  185,  Petratsch  Czarten  185, 
Thomas  Cam  207,  Numes  de  Cugna  370. 

Zeao,  the  founder  of  the  stoical  sect,  lived  100  years;  Titian,  the 
painter,  nearly  100 ;  Francis  Secardia  Hongo  died  a.d.  1702,  aged 
114 ;  in  1757,  J.  Eflingham  died  at  Cornwall,  aged  144 ;  Alexander 
Macintosh,  of  Marseilles,  lived  112  years;  James  le  Measurer,  of 
Navai're,  118  years  ;  Valentine  Cateby,  of  Preston,  England,  118 
years;  Henry  Grosvenor,  of  Wexford,  Ireland,  115  years;  John  de 
la  Somet,  of  Virginia,  130  years  ;  Elizabeth  Macpherson,  of  Caithness, 
Scotland,  117  years;  Owen  Carollan,  of  Ireland,  127  years;  Ann  Day, 
an  English  gipsy,  108  years;  Cardinal  de  Salis,  of  Seville,  110  years. 

Natural  Dp:ath. — Diseases  which  produce  violent  or  accidental 
death,  destroy  the  whole  human  race,  with  few  exceptions.  Probably 
not  one  in  a  thousand  dies  a  natural  death.  Even  of  those  whose 
names  have  been  held  forth  in  the  preceding  paragrapli  as  examples 
of  extraordinary  longevity,  several  were  cut  off  prematurely  by  disease. 
Thomas  Parr,  at  the  age  of  152,  was  desti'oyed  by  plethora,  resulting 
fi-om  high  living  at  court.  Mrs.  Hudson  died  of  an  acute  disease  re- 
sulting from  taking  cold  at  the  age  of  105.  Richard  Lloyd  was  in  full 
health  and  strength  at  132  years  of  age ;  out  being  persuaded  to  eat 
flesh-meat  and  drink  malt  liquors,  to  which  he  had  not  been  accus- 
tomed, he  soon  sickened  and  died. 

Natural  death  results  from  a  gradual  consolidation  of  the  structures. 
In  inf^mcy,  the  proportion  of  the  fluids  of  the  body  to  the  solids  is 
much  greater  than  in  adult  age,  but  this  relation  is  constantly  changing; 
the  fluidity,  flexibility,  and  elasticity'  of  youth,  as  the  structures  harden 
and  condense,  is  succeeded  by  the  firmness,  stiff'ness,  and  immobility 
of  age;  yet  this  change  is  not  necessarily  attended  with  infirmity 
or  decrepitude.     If  the  life  h:is  been  very  nearly  in  conformity'  with 


LONGEVITX".  387 

the  laws  of  life,  the  vital  energies,  so  powerfully  expended  upon  the 
muscular  system  during  the  period  of  growth  and  development,  are, 
after  the  maturity  of  the  body,  mainly  concentrated  in  the  region  of 
intellect.  There  is  less  activity,  and  vivacity,  and  impulse,  but  more 
serenity,  and  thoughtfulness,  and  meditation.  The  mora!  and  intellect- 
ual nature  seems  not  to  reach  its  full  development  until  actual  decHne 
has  commenced  in  the  functions  of  organic  life.  We  are  accustomed 
to  notice,  as  the  earliest  marks  of  senility,  the  decay  of  the  teeth,  and 
the  disproportionate  destruction  of  the  functions  of  the  external  senses, 
especially  seeing  and  hearing.  But  such  is  not  the  natural  decline  of 
life.  In  a  perfectly  normal  condition  of  the  organism,  all  the  functions, 
powers,  and  senses  decline  in  the  same  harmonious  relation  in  which 
they  were  developed.  As  the  process  of  condensation  goes  on  equally 
and  imperceptibly  throughout  the  organic  domain,  the  motive  powers 
grow  torpid,  the  nuti'itive  functions  are  enfeebled,  the  sensibility  be- 
comes dull,  the  external  senses  are  obtunded,  and,  lastly,  the  nienta^ 
manifestations  disappear — death  occurs  without  a  struggle  or  a  groan. 

Advantages  of  Longevity. — Some  speculative  wTiters,  w"hose 
minds  have  been  more  directed  to  the  narrow"  science  of  "  political 
economy"  than  to  an  enlarged  view  of  the  economy  of  the  universe, 
have  lately  found  a  perplexing  problem  in  the  relation  of  the  means  of 
subsistence  to  the  facilities  for  propagation.  While  population,  say 
they,  increases  geoiftetrically,  the  alimentary  productions  of  the  earth 
only  increase  arithmetically.  On  this  bare  proposition  longevity  seems 
to  be  one  of  the  greatest  evils  that  can  befall  the  human  family.  Some 
scheme  of  death  appears  to  be  indispensable,  to  "kill  off"  the  surplus 
population,  to  clear  the  ground  of  existing  human  beings  as  fast  as  the 
"coming  generations"  demand  their  places.  But  such  a  theory  places 
us  in  an  awkward  dilemma,  and  is  not  very  well  calculated  to  "vindi- 
cate the  ways  of  God  to  man,"  nor  give  us  the  most  exalted  views  of 
what  constitutes  "  man's  humanity  to  man."  But  the  whole  puzzle 
comes  from  mistaking  the  present  social  disorder  for  natural  order.  It 
is  very  true  that  in  some  parts  of  the  world  there  is  a  dense  population 
in  a  state  of  starvation ;  but  it  is  equally  true  that  the  earth  has  capacity 
even  there,  to  produce  food  enough  for  all,  and  to  spare.  Undei 
existing  governments  and  social  aiTangements,  more  than  three  fourths 
of  all  the  land  and  all  the  labor,  as  far  as  the  production  of  the  means 
of  human  sustenance  is  concerned,  is  waited,  or  worse  than  wasted. 
A  large  extent  of  the  earth's  surface  has  never  yet  been  brought  under 
cultivation,  and  that  part  of  it  which  is  cultivated  the  best  admits  of  vast 
improvement.     There  i?  als:  an  immense  waste  in  raising  domestic 


588  HYGIENE. 


animals  for  food,  for  it  requires  not  less  than  twenty  times  more  extent 
of  soil  to  nourish  animuls  enough  to  furnish  our  ^ood,  than  is  necessary 
to  supply  us  with  food  directly  from  the  soil  itself.  And  again,  miHiona 
of  acres  of  excellent  land  are  worse  than  wasted  in  raising  the  filthy 
tobacco,  and  fi"uits  and  gi-ains  to  convert  into  alcoholic  poisons. 

But  there  is  a  much  more  cogent  argument  derived  from  the  phys- 
iological principles  we  have  been  considering,  against  the  position  that 
"  creation  is  a  failure ;"  for  the  idea  I  am  controverting  amounts  to 
nothing  less.  It  is  a  philosophical  maxim  that  "  intensive  life  cannot 
be  extensive."  The  present  races  of  human  beings  have  a  hurried, 
stimulated,  forced,  disorderly  existence.  Population  is  as  much  more 
numerous,  as  a  general  rule,  as  it  is  more  depraved ;  the  causes  of 
multiplying  the  species  increase  with  the  causes  of  their  destniction. 
Males  and  females  mai'ry  at  twenty,  become  the  fathers  and  mothers 
of  a  "  numerous  offspring"  at  forty,  find  themselves  old  at  fifty,  and 
ai-e  compelled  to  die  at  sixty ;  in  this  way,  supposing  the  majoiity  of 
the  children  to  arrive  at  maturity,  and  "do  likewise,"  the  world  will 
surely  fill  up  pretty  fast,  and  there  will  be  a  perpetual  demand  for 
"  new  countries,"  for  the  surplus  population,  or  for  those  other  less 
pleasant  resources,  "war,  pestilence,  and  famine."  But  philosophers 
ought  always  to  discriminate  between  the  existing  state  of  affairs,  and 
a  state  of  aflairs  that  may,  can,  or  should  exist. 

There  are  many  forcible  reasons  for  believing  that  the  earth  now 
has,  and  always  will  have,  room  enough  for  all  the  po))ulatiou  that  can 
be  produced  by  human  beings  who  live  according  to  the  laws  of  their 
being,  and  till  the  gi'ound  according  to  the  best  lights  of  science  and 
experience.  If  the  human  body  develops  slowly  and  healthfully,  the 
periods  of  infanc}',  childhood,  and  adolescence  will  be  greatly  pro- 
longed ;  the  period  of  j^outh  may  extend  to  what  we  now  call  old  age, 
while  vigorous  manhood  may  reach  onward  to  some  point  between 
one  and  two  hundred  years,  or  even  beyond ;  and  under  such  chcum- 
Btances  it  is  probable  that  the  number  of  offspring  in  each  family  would 
be  less  instead  of  greater  than  the  average  of  the  present  day ;  at  least 
such  was  the  fact  with  the  early  inhabitants  of  the  earth  with  whose 
histories  we  are  familiar. 

Again,  we  have  many  evidences  tliat  the  surface  of  the  earth  actually 
enlarges  continually.  The  proportion  of  the  land  is  gi-adually  gaining 
upon  the  water.  Not  only  are  the  lakes,  and  seas,  and  oceans  filling 
up,  and  the  wild,  frozen  wastes  of  the  polar  regions  destined  to  become, 
in  due  process  of  time,  luxuriant  harvest  fields  and  flowery  gardens, 
but  it  is  even  probable  that  the  entire  magnitude  or  bulk  of  the  earth 
enlarges  by  constant  accessions  of  matter,  absorbed  and  condensed  from 


LONGEVITY.  88& 


the  gaseous  elemeii!:s  floating  in  what  we  call  space.  If  these  views 
are  correct,  and  they  are  certainly  not  wholly  speculative,  they  afford 
a  complete  solution  of  the  problem  of  population  and  subsistence,  and 
furnish  politicians  with  a  key  to  a  system  of  legislation  that  shall  not 
be  limited  to  acts,  enactments,  and  amendments  of  acts,  almost  exclu- 
sively relating  to  the  "rights  of  property,"  but  which  shall,  in  its  higher, 
broade^r,  nobler  grasp,  comprehend  also  the  progress  of  humanity. 
But  the  chief  use  and  purpose  of  a  long  life  are  yet  to  be  named.  As 
society  is  now  constituted,  the  principal  force  of  the  mental  energies 
of  the  world  is  expended  in  contriving  a  thousand  ways  and  providing 
a  thousand  means  to  gratify  the  corporeal  and  animal  passions,  ren- 
dered insatiate  by  morbid  cravings  and  disorders  of  all  kinds,  and  in 
repairing,  or  rather  attempting  to  repair,  the  mischiefs  and  miseries 
induced  by  bad  habits.  The  intellectual  and  moral  mind,  the  spiritual 
nature,  has  but  little  opportunity  for  cultivation  and  development  until 
the  later  periods  of  life,  and  then  the  body  is  worn  out,  and  the  mind 
has  nothing  to  sustain  it.  Even  the  rich  stores  of  knowledge  accumu- 
lated by  those  who  are  placed  in  circumstances  peculiarly  fortunate 
for  moral  research  and  scientific  investigation  are  mostly  lost  to  others, 
because  their  voluntary  habits  have  so  disordered  the  body,  that  the 
lamp  of  life  goes  out  before  they  have  time  to  arrange,  compare, 
prove,  and  demonsti'ate  the  results  of  their  study  and  experience,  and 
communicate  them  to  the  world.  The  "uncertainty^  of  life,"  which  hangs 
like  a  depressing  incubus  upon  the  majority  of  minds,  has  a  blighting 
effect  on  human  intellect,  and  a  demoralizing  influence  on  human  affec- 
tions. As  most  people  live,  they  feel  an  assurance  of  a  special  liability 
to  some  "  mysterious  providence,"  which  may  at  any  moment  termi- 
nate their  existence,  and  that  entirely  independent  of  any  natural  cause 
or  law  which  they  can  either  understand  or  control.  The  state  of  mind 
induced  by  such  confused  fears  and  apprehensions  must  be  exceedingly 
superstitious,  and  nothing  is  more  stupefying  to  all  the  powers  of  intel- 
lect than  superstition.  Such  persons  cannot  reason  well  because  their 
reflective  powers  are  spell-bound  by  an  absurd  fantasy,  and  they  dare 
not  attempt  to  reason  much  for  fear  they  will  reason  wrong.  Imagin- 
ing their  safety  to  consist  in  he  passive  instead  of  the  active  state  of 
mind,  they  make  "  discretion  Jie  better  part  of  valor,"  and  try  harden* 
to  believe  than  to  understand.  But,  moreover,  this  blinded  and  bigoted 
state  of  mind  renders  its  possessor  eminently  short-sighted  and  selfish. 
He  is  unwilling  to  trust  God,  man,  or  nature,  and  aims  to  make  sure 
of  eveiy  thing,  and  enjoy  as  he  goes  along.  Hence  he  is  always  pur- 
suing petty  expedients  for  momentary  pleasure,  instead  of  seeking  per- 
manent and   substantinl   happiness   ii    following  out  the   laws  of  his 


390  HYGIENE 

organization.  He  becomes  in  society  one  who  seeks  to  appropriate 
as  much  as  possible,  and  impart  as  little  as  possible.  He  is  always 
pre-eminently  conservative,  uniformly  goes  for  keeping  all  things  as 
they  are,  and  invariably  opjjoses  all  new  creeds,  or  innovations  upon 
established  usages.  So  fai*  as  society,  or  the  world,  or  the  human 
family  is  concerned,  he  is  useless,  or  rather  worse  than  useless.  But 
let  the  same  person  be  w^ell  insti'ucted  in  the  philosophy  of  life,  let 
him  feel  competent  to  preserve  his  own  health,  and  have  a  full  assur- 
ance that,  casualties  excepted,  his  days  may  be  long  in  the  land,  and 
he  will  sti'aightw^ay  look  forward  to  a  better  and  higher  destiny,  forego 
many  present  temporary  gratifications,  discipline  his  mind  for  the  more 
important  future,  and  become  a  more  useful  as  well  as  more  happy 
member  of  the  social  compact.  Instead  of  finding  his  pleasure  in 
abstracting  all  he  can  from  the  enjoyments  of  others,  he  wiU  seek  and 
find  his  highest  happiness  in  some  pursuit  which  wiU  be  conducive  to 
the  general  good. 

Special  Means  Conducive  to  Longevity. — In  strict  ti-uth  there 
are  no  special  means  for  promoting  health  and  attaining  longevitj-,  ex- 
cept in  the  negative  sens* — the  avoidance  of  special  en*ors.  The  gen- 
eral adaptation  of  all  the  hygienic  agencies  to  the  particular  circum- 
stances in  which  we  are  placed,  constitutes  our  proper  rule  of  action. 
But  there  is  one  principle  involved  in  this  subject  more  important 
than  any  other,  and  as  it  is  more  disregarded,  and  probably  less  under- 
stood, by  people  generally  than  any  other,  it  may  be  well  to  notice  it 
specifically  in  this  place. 

We  have  seen  that,^from  the  cradle  to  the  gi*ave,  the  proportions 
of  the  solid  particles  of  the  body  are  constantly  gaining  upon  the  fluids; 
natural  death  resulting  when,  provided  no  disease  intervener,  the  con- 
solidation of  the  structures  has  progressed  so  far  that  the  fluids  cannot 
permeate  the  capillaries  sufficiently  to  maintain  the  functions  of  assim- 
ilation and  depuration.  As  the  fluids  and  solids  are  both  formed  mninly 
from  the  materials  taken  into  the  stomach  as  food  and  drink,  it  follow^s 
that  the  character  of  the  aliment  has  a  controlling  influence,  beyond  that 
of  any  other  hygienic  circumstance,  in  determining  the  period  when  nat- 
ural death  shall  take  place.  Gross,  concentrated,  obsti'ucting  food,  and 
all  extraneous  earthy  or  saline  ingredients  accidentally  mingled  with  our 
food  and  drink,  or  employed  as  condiments,  must  necessarily  abridge  tlie 
term  of  our  existence.  All  the  early  historians  agree  that  the  primitive 
inhabitants  of  the  earth  were  frugivonus,  subsisting  maluly,  if  not 
wholly,  on  fruits.  But  if  the  primitive  inhabitants  eniployed  as  food 
roots,  and  teuier  leavof-  and  plants  as  well  as  fruits,  they  still  had  a 


LONGEVITT.  3^ 


kind  of  aliment  remarkably  fluid  and  unconcenti-ated  as  compared  with 
the  dishes  generally  eaten  at  the  present  day.  And  if,  fm-ther,  they 
employed  any  of  the  cereal  grains — ai  flonring-mills  were  then  un- 
known, and  no  method  had  been  devised  for  separating  the  bran  from 
flour — they  were  used  in  their  most  perfect  condition,  both  as  respects 
quality  and  preparation.  The  flesh  of  animals,  it  is  conceded  on  all 
hands,  was  not  then  even  thought  of  as  food  for  human  beings.  So 
far,  then,  as  the  dietetic  habits  of  the  immediate  descendants  of  the 
first  pair  were  concerned,  they  united  all  the  conditions  requisite  to 
prolong  life  to  the  utmost  limit  of  the  laws  of  life. 

The  principle,  therefore,  seems  established,  that  the  kind  -of  food 
which  contains  a  large  proportion  of  fluid,  as  compared  with  its  solid 
matter,  and  a  large  proportion  of  bulk,  as  compared  with  its  nuti'iment, 
is  best  adapted  to  sustain  permanently  the  integrity  of  the  organism, 
provided  it  contain  also  the  requisite  elements  for  prolonged  nuti-ition. 
Those  who  employ  a  diet  lai-gely  farinaceous — tliose  who  make  bread 
"  the  staff  of  life"  in  their  dietetic  system,  reqMhe  a  large  proportion 
of  cruder  vegetables,  less  nutritious  roots,  or  succulent  fruits.  True, 
an  individual  might  do  very  well  on  ^' bread  alone,"  if  he  were  rigidly 
abstemious,  but  the  tendency  would  be,  if  the  habit  were  extended 
through  several  generations,  to  hasten  the  consolidation  of  the  struc- 
tures, and  bring  on  premature  old  age. 

Nearly  all  the  arts  of  commerce  and  of  cookery  are,  and  have  been 
for  many  centm-ies,  directly  calculated  to  disorder  the  human  body, 
and  shorten  the  duration  of  its  existence.  Concentration,  stimulati-on, 
and  complication,  with  many  extraneous  additions,  have  generally  been 
the  aim  of  the  cook,  and  the  prescription  of  the  physician ;  and  the 
result  is,  that  disease  is  the  general  rule  of  society,  and  health  the  ex- 
ception, while  the  average  period  of  time  between  birth  and  death  has 
been  fearfully  diminished. 

Anotlier  advantage  in  employing  a  large  proportion  of  watery  fruits 
and  vegetables  is,  in  supplying  the  system  in  this  wa}'  with  the  water 
It  requires,  in  its  purest  state.  Most  of  the  water  used  as  a  beverage 
and  for  cooking  purposes  is  more  or  less  impregnated  with  deleterious 
particles,  while  that  found  in  the  juices  of  fruits  and  vegetables  is 
nearly  free  of  every  thing  of  the  kind.  We  know  that  the  organic 
economy  requires  a  due  supply  of  certain  earthy  mattei-s,  as  phosphate 
and  carbonate  of  lime,  for  the  sustenance  of  the  osseous  system ;  but 
it  is  obvious  that  an  undue  supply  must  obstruct  the  minute  rami-fica- 
tions  of  vessels,  and  render  the  fibres  rigid  and  friable.  The  depurat- 
ing organs  have  the  £:nctional  ability  to  secrete  and  expel  fi-om  the 
Vody  the  surp'"' saline   «ind  earthy  matters  to  a  certain  exteiit;  but  if 


192  HYGIENE. 


they  are  taken  into  the  sjstem  beyond  that  ability,  they  must  neces 
sarily  accumulate  constantly,  and  exercise  a  very  important  influence 
in  bringing  the  functions  of  life  to  an  early  termination. 

I  admit  thai"-  a  stimulating,  concentrated,  and  even  constipating  and 
obstnicting  regimen,  may  produce  a  rapid  development  of  the  body 
it  may  produce  extraordinaiy  precocity  in  mind  or  body,  or  both 
But  it  is  a  kind  of  development  uufortrinate  for  its  possessor  and  for 
society.  It  is  a  jn'ocess  which  makes  the  c!ii.  1  a  giant  and  the  man  j>. 
dwarf.  It  may  produce  manifestations  of  matui'ity  at  twelve,  and 
symptoms  of  deofjy  at  twenty.  Besides,  it  always  and  invariably  die- 
orders  the  individual ;  and  if,  haplessl}',  the  forced  production  of  a  man 
propagate  his  kind,  the  offspring  will  inherit  a  malformed  and  imperfect 
organization. 

It  has  been  urged,  with  reason,  too,  that  the  difficulties  and  pains  of 
child-bearing  are  closely  connected  with  the  quality  of  food,  as  regards 
concentration.  There  is  httle  doubt,  1  think,  that  the  structures  of 
both  mother  and  child  are  more  inflexible,  inelastic,  and  unyielding, 
when  the  food  has  been  too  stimulating,  too  concentrated,  or  in  anj 
respect  obstructing — a  condition  which  obviously  complicates  the  dan 
gers  and  aggravates  the  sufferings  of  parturition.  In  fact,  this  subjec'; 
has  been  amply  and  practically  illustrated  during  the  last  seven  or  eigh): 
years  in  the  city  of  New  York,  where  nearly  all  the  mothers  and  in- 
fants treated  on  the  ordinary  or  allopathic  system  have  experiencec* 
great  suffering,  and  been  " doctored  through"  many  diseases;  whilf' 
all,  as  far  as  I  have  any  knowledge,  treated  hy-dropathically,  have  es- 
caped a  great  degree  of  the  usual  suffering,  and  all  of  the  diseases 
usually  incident  to  the  lying-in  period. 

A  late  author,  who  has  perpetrated  the  very  common  mistake  of 
taking  a  fact  for  a  principle,  and  a  principle  for  a  theorj',  and  a  theory 
for  a  system,  and  then  turning  the  system  into  a  hobby,  has  undertaken 
to  show  that  all  kinds  of  foo^s  and  drinks  are  conducive  to  or  detractive 
from  longevity,  exactly  in  the  ratio  that  their  constituents  contain  less 
or  more  of  saline  or  other  earthy  ingredients.  According  to  his  nx»tion 
wheat  is  the  very  icorst  article  of  food  known  ;  the  other  grains  are 
highly  deleterious,  while  all  kinds  of  "  fish,  flesh,  and  fowl,"  and  even 
ardent  sjnrits  and  tobacco,  are  healthful,  because  they  cor.tnin  scarcely 
any  phosphate  of  liyne  or  other  earthy  matters !  As  a  spocimen  of  his 
reasoning,  or,  rather,  misapplication  of  facts,  I  make  the  following  ex- 
tract from  his  work,  especially  as  it  is  a  fair  sample  of  the  manner  in 
which  facts  are  generall}^  misapprehended  or  misapplied  by  the  medi- 
cal profession : 

"Tlie  peasantry  of  those  parts  of  Ireland  where  wheaten-bi  £ad.  on 


LONGEVITY.  393 


any  kind  of  grain  food  is  scarcely  ever  tasted,  but  where  potatoes,  fish, 
turnips,  gi-eens,  and  fresh  vegetables,  generally  form  their  principal 
diet,  all  of  which  things  contain  a  moderate  amount  of  earthy  matter 
are  proverbial  for  health,  activity,  and  a  tolerable  longevity.  The  En- 
glish peasantry  consume  one  half  more  solid  grain  food,  as  bread  and 
pastry,  than  the  Irish,  and  are  greatly  inferior  both  in  health,  activity, 
duration  of  life,  and  in  temper  and  disposition.  Although  the  samp 
external  conditions,  fresh  air  and  exercise,  and  much  better  clothing 
and  lodging,  are  enjoyed  by  the  English,  thej*  are  more  bony,  rigid 
ctumsy,  and  stupid  than  the  Irish." 

I  think  the  fine  Jlour,  with  the  gi'eater  portion  of  beer,  beef,  and 
plum-pudding,  accessible  to  the  English  peasantiy,  explain  these  phe- 
nomena perfectly. 

OccurATioN  x\s  Affecting  Longevity. — The  industrial  relations 
of  individuals,  though  important,  are  less  so  than  domestic  conditions 
and  circumstances,  as  influencing  the  duration  of  life.  The  acknowl- 
edged theories  and  the  collected  statistics  of  physiologists  exhibit  some 
discrepancies,  with  regard  to  the  connection  between  occupation  and 
ongevity ;  and  medical  men  have  been  utterly  unable  to  explain  or 
reconcile  these  discrepancies.  Thus,  while  agriculture  is  universally 
allowed  to  be  the  most  healthful  occupation  known,  the  average  lives 
of  farmers,  though  comparing  favorabl}^  with  mechanics,  tradesmen, 
laborers,  factory  operatives,  etc.,  is  lower  in  the  scale  of  longevity 
than  that  of  several  other  classes.  In  some  parts  of  England,  where 
this  subject  has  been  investigated,  particularly  in  Manchester  and  Rut- 
landshire, the  "upper  classes,"  or  "gentry"  were  found  to  be  nearly 
twice  as  long-lived  as  the  "  lower  classes,"  or  "  workers."  These 
facts  require  a  thorough  analysis,  or  we  shall  be  led  into  the  monstrous 
absurdity  that  idleness  and  dissipation  are  more  conducive  to  health 
than  industry  and  temperance. 

With  regard  to  a  farmer's  life,  it  must  be  remarlced  that,  although 
accompanied  with  good  air,  early  rising,  out-door  exercise,  and  regular 
habits,  these  advantages  are  in  a  great  measure  counterbalanced  by 
bad  water  and  bad  food.  It  is  true  that  farmers  ought  to  be  the 
healthiest  people  in  the  world ;  but,  unfortunately,  they  are  very  igno- 
rant or  negligent  of  the  means  of  health  which  are  so  abundantly  at 
their  disposal.  With  ample  facilities  for  enjoying  the  best  possible 
diet,  they  generally  employ  the  very  worst.  Hard  water  is  usually 
drank,  and,  in  this  country  particularly,  stale  salted  meats,  superfine 
fiour,  greasy  compounds  of  all  kinds,  and  butter  and  cheese,  constitace 
tljc  essentials  of  their  dietary  sj-sten  •,    fruits  and  the   more  watery 


894  HYGIENE 


vegetables  being  regarded  almost  entirely  in  the  light  of  luxuries  or 
seasonings,  which  may  be  dispensed  with  or  sent  to  market,  or,  if  em- 
ployed at  all,  are  so  saturated  with  sugar,  butter,  vinegar,  salt,  pepper 
etc.,  as  to  be  really  worse  than  none. 

Cities  are  universally  reputed  to  be  unhealthful  residences;  and  this 
fact  puts  the  inhabitants  on  their  guard — compels  them  to  study,  in 
some  degree,  the  laws  of  life  and  health.  Their  greater  exposure  tf 
danger  becomes  the  means  of  rendering  them  more  intelligent ;  and 
the  caution  they  exercise  in  the  selection  of  the  articles  and  qualities 
of  their  foods,  very  nearly  balances  the  natui'al  advantages  of  the  rural 
districts.  The  difference  between  fresh  meat  and  salted,  as  an  article 
of  diet,  is  very  great ;  and  in  this  respect  the  inhabitant  of  the  city 
has  a  vast  advantage,  because  in  cities  fresh  meat  is  the  staple  article 
of  animal  food,  and  salted  the  exception ;  the  reverse  being  true  in  the 
countiy.  It  is  not  easy  to  convince  the  farmer  that  he  can  labor  with- 
out old  pork,  bacon,  or  salted  beef;  but  these  articles  are  nevertheless 
among  the  principal  causes  of  his  rigid  muscles,  stiff  gait,  numerous 
infirmities,  and  premature  old  age. 

The  "upper  classes"  have  the  advantages  of  selected  locations  for 
their  dwellings,  plenty  of  room,  clean  yards,  well-ventilated  sleeping 
apartments,  and  favorable  external  circumstances  generally.  The 
poorer  classes  generally  occupy  the  insalubrious  localities  because  they 
are  cheaper,  real*  buildings,  gaiTets,  cellars,  etc.,  circumstances  which 
will  always  very  materially  abridge  the  period  of  existence.  It  is  ti'ue 
that  laborers  are  not  generally  fairly  dealt  with  by  capitalists,  but  it  Is 
equally  true  that  laborers  have  all  the  means  requisite  to  improve 
their  condition,  and  become  completely  independent.  Their  misfortune 
is,  they  know  not  how  to  use  those  means.  Their  great  error,  and 
the  grand  source  of  their  slavery  from  generation  to  generation,  is  in 
their  dietetic  habits.  Three  or  four  times  as  much  money  is  expended 
on  articles  of  food  which  give  them  imperfect  nourishment,  and  render 
them  liable  to  diseases,  with  loss  of  time,  and  doctors',  nui-ses",  and 
apothecaries'  bills  accumulating,  as  is  necessary  to  afford  them  healthful 
sustenance,  if  rightly  applied.  The  money  saved  by  a  correct  regimen 
would  procure  them  better  residences,  and  admit  of  an  annual  deposit 
in  some  savings'  bank,  in  view  of  a  future  homestead.  It  is  a  flict 
that,  in  the  United  States,  and  indeed  in  almost  any  other  country, 
perhaps  in  all,  wages  are  suflficient  to  emancipate  the  laborers  from  the 
thralldom  of  capital  in  a  very  few  j^ears,  if  the  "  toiling  millions"  would 
but  mako  a  judicious  application  of  their  earnings. 

There  are  some  occupations  necessarily  unwholesome,  and  requiring 
special  j'vecautions  on  the  pnit  of  those  who  pursue  them.     Millers, 


LONGEVITY.  895 


cotton-spinners,  tea  and  coffee-roasters,  paper  and  machine-makers, 
iron  and  brass-filers,  glue  and  size-boilers,  tallow  chandlers,  etc.,  are 
exposed  to  an  atmosphere  loaded  with  powders  or  gases  which  exert  a 
deleterious  influence  on  the  lungs.  Thorough  ventilation,  and  a  posi- 
tion "to  windward"  of  the  current  of  floating  particles,  are  indispensa- 
ble considerations.  Plumbing,  painting,  and  the  arts  of  the  operative 
chemist,  potter,  and  coppersmith,  are  deleterious,  to  some  extent, 
from  the  substances  which  are  volatilized  by  various  processes  being 
inhaled.  Experiments  in  relation  to  lead-poisoning,  however,  have 
shown  that  workmen  in  smelting  establishments,  house-painters,  etc., 
are  injured  far  more  from  the  metallic  particles  which  adhere  to  their 
hands  and  clothes,  thence  finding  their  way  into  the  stomach,  than  from 
absorption  through  the  skin,  or  inhalation  into  the  lungs.  The  proper 
precautions  consist  in  changing  the  clothes  before  going  to  meals,  and 
thoroughly  washing  the  hands,  carefully  removing  eveiy  particle  of 
paint  or  metallic  matter  from  under  the  finger-nails.  Gold-finders  ai"e 
exposed  to  sulphureted  hydrogen  gas,  which  is  exceedingly  poisonous. 
Severe  mental  exercise,  or  close  application  to  study,  has  usually 
been  considered  as  unfavorable  to  long  life.  This  is  undoubtedly  ti'ue 
as  relates  to  childhood  and  early  youth.  The  bodily  powers  are  often 
stunted,  the  mental  functions  blunted,  and  the  whole  constitution  ruined 
by  too  early  confinement  to  study.  But  there  is  another  evil  of  immense 
magnitude  connected  with  this  view  of  our  subject.  Children  and 
youth  require  much,  varied,  and  regular  muscular  exercise  during  the 
period  of  bodily  development.  If  the  natural  instinct  for  abundance 
of  out-door  exercise  is  repressed,  the  whole  system  becomes  morbidly 
sensitive  and  irritable,  and  this  condition,  under  the  usual  stimulating 
and  enervating  habits  to  which  youth  are  so  generally  the  subjects  and 
the  victims,  such  as  tea  and  coftee,  flesh  eating,  excessive  clothing, 
feather  beds,  etc.,  is  aggravated  and  intensified,  until  inflammatory  se- 
cretions and  ungovernable  passions  disorder  the  whole  body,  and  un- 
balance the  mind.  In  this  state  young  persons  are  easily  led  into 
any  habits  of  dissipation  and  debauchery  which  their  associates  or 
superiors  are  addicted  to.  The  numerous  examples  of  self- pollution 
or  masturbation  among  studious  young  men  and  boarding-school  girls, 
aiirely  undermining  the  constitution,  and  laying  the  foundation  for  a 
brief  life  of  infirmity  and  suffering,  are  melancholy  evidences  of  mis- 
directed educational  enterprises.  The  duty,  therefore,  of  bringing 
every  child  up  to  some  useful  business  pursuit,  in  which  the  sur  )lus 
animal  energies  may  be  prafitably  and  regularly  expended,  &e  -ms 
absolutely  indispensable  to  its  safety  as  we  1  as  to  the  good  of  soci.  ty; 
ft  duty    the  neglect  of  which  has  cause;  so  many  sons  of  wea.ch/ 


396  HYGIENE. 

parents,  who  were  so  mistaught  as  to  look  with  contempt  upon  honest 
toil,  to  turn  out  debauchees  and  vagabonds. 

But  intellectual  pursuits,  or  avocations  which  severely  tax  the  moral 
powers  and  higher  propensities,  do  not  seem  tc  be  inimical  to  high 
health  and  great  longevity,  when  followed  with  *i  consistent  regard  to 
general  hygienic  precepts.  Dr.  3Iaddeu,  in  his  "Infirmities  of  Genius," 
has  given  us  tabular  statements  which  go  to  show  that  those  literary 
pursuits  in  which  the  imagination  is  vigorousl}-  exerted  are  more 
inimical  to  longevity  than  scientific  and  philosophical  avocations.  He 
also  thinks  that  "the  earlier  the  mental  powers  are  developed,  the 
sooner  do  the  bodily  powers  begin  to  fail ;"  a  remark  which  is  correct 
only  so  far  as  it  applies  to  the  prevalent  method  of  forcing  the  intellect 
into  premature  and  precocious  exertion,  at  the  expense  of  the  body. 
Poets  and  artists  are  rather  noted  for  early  deaths,  but  they  have 
usually  been  in-egular  and  dissipated  in  their  habits.  Eminent  theo- 
logians, philosophers,  physicians,  lawyers,  jurists,  etc.,  have  died  very 
frequently  of  apoplexy  or  palsy;  but  they  were  frequently  addicted  in 
the  later  periods  of  life  to  "luxurious  feeding."  Many  individuals 
are  designated  by  historians  as  "victims  of  excessive  mental  applica- 
tion," who  were  truly  victims  of  intemperance.  Dr.  James  Johnson, 
mistaking  the  ahuse  of  the  body  for  the  use  of  the  mind,  has  expressed 
the  absurd  opinion  that  "  a  high  range  of  health  is  probably  incompati- 
ble witii  the  most  vigorous  exertion  of  the  mind,  and  that  this  last 
both  requires  and  induces  a  standard  of  health  somewhat  below  par." 
This  error  of  Dr.  Johnson  has  arisen  from  observing  that  certain  in- 
tellectual geniuses — Virgil,  Horace,  Pope,  and  others — were  of  feeble 
bodily  health.  It  is  much  more  rational  to  suppose  that  if  "  men  of 
genius"  would  take  better  care  of  their  bodies,  they  would  manifest 
still  more  vigorous  and  enduring  minds,  than  to  impute  what  mental 
talent  they  do  possess  to  bodily  infirmity. 

Sad  examples  of  the  same  mistake  may  be  seen  at  all  our  seminaries 
of  learning,  where  bodily  infirmity  and  mental  genius  appear,  to  the 
superficial  observer,  to  stand  in  the  relation  of  cause  and  eftect.  But, 
however  satisfied  and  gratified  teachers  and  parents  may  be  with  the 
"  highest  prizes"  won  by  haggard  fiices,  contracted  chests,  gaunt  abdo- 
mens, and  dreamy  slumbers,  the  true  physiologist  can  only  see,  in 
the  not  distant  future,  sure-wasting  consum{:)tion,  hydra-headed  dys- 
pepsia, crippling  palsy,  or  nameless  debility,  as  tlie  probable  consequence 
of  this  working  of  the  machinery  of  mind  out  of  all  proportion  to  the 
bodily  development;  he  nr.ust  lament,  while  short-sighted  friends  rejoice 
at  the  prospect. 


PART     IV. 


DIETETICS. 

Preliminary  Remarks. — All  intelligent  physicians  of  a'i  :ichool3 
of  medicine  agree  in  the  general  proposition  that  plain,  simple,  natural 
food  is  most  conducive  to  the  recovery  or  preservation  of  health ;  but 
when  we  come  to  the  details  as  to  what  constitutes  plain,  simple,  and 
natural  food,  these  same  physicians  are  at  all  points  of  the  compass. 
Even  hydropathic  writers,  who  are  singularly  harmonious  on  every 
other  subject  in  relation  to  their  system  of  the  healing  art,  are  some- 
what discordant  on  this.  The  fact,  however,  may  not  result  so  much 
from  differences  of  opinion  as  to  what  is  intrinsically  true  in  theory,  as 
from  different  views  as  to  what  is  expedient  to  attempt  in  practice. 

One  remark  of  the  author  of  the  "Science  of  Human  Life,"  all  true 
hydropaths  will  have  abundant  opportunity  to  verify,  viz. :  "  The  more 
the  practice  of  the  physician  conforms  to  the  appetites  of  his  patients, 
the  more  cheerfully  and  generously  is  he  rewarded."  Two  dollars  a 
day  is  not  regarded  as  extravagant  at  a  "first-class  hotel,"  where  the 
guests  are  provided  with  "every  comfort"  which  renders  them  inva- 
lids ;  but  one  dollar  a  day  at  a  hydropathic  establishment,  where  they 
ai'e  forced  to  bear  with  all  the  privations  that  are  necessary  to  restore 
them  to  health,  is  considered  exorbitant;  so  difficult  is  it  for  the 
majority  of  people  to  reason  against  the  current  of  their  appetites,  and 
understand  in  opposition  to  the  impulses  of  passion  and  habit.  This 
consideration,  too,  which  all  persons  who  practice  a  reform  system  in 
opposition  to  the  acquired  desires  and  immediate  pleasures  of  their 
customers  must  be  fi-equently  reminded  of,  may  not  be  without  its  in- 
fluence in  determining  the  general  character  of  many  hydropathic 
tables,  and  possibly  of  biasing  the  opinions  of  hydropathic  practitioners; 
for  that  man  must  be  ignorant  of  human  nature  who  does  not  know 
how  easily  judgment  is  warped  by  interest. 

I  do  not  know  that  it  is  practicable  or  possible,  amid  the  prevailing 
Ignorance  and  error,  to  sustain  a  hydropathic  establishment,  or  any 
34 


398  DIETETICS. 


other  public  institution,  on  a  dietary  system  sti'ictly  physiological.  A 
majority  who  are  compelled  to  resort  to  the  water-cures,  of  course, 
have  been  more  or  less  mistaught;  nor  can  their  errors  be  wholly  edu- 
cated out  of  them  at  a  single  interview.  "Line  upon  line,  and  precept 
upon  precept,*'  even  when  commended  and  enforced  by  personal  ex- 
ample, are  necessary  to  change  the  cuiTent  of  deeply-rooted  habits 
and  ever-craving  propensities. 

A  large  proportion  of  patients  who  for  the  first  time  visit  these 
"cures"  for  the  purpose  of  treatment,  expect  a  change  from  their 
accustomed  habits  of  eating  and  drinking  to  something  more  healthful. 
But  such  a  change  !  Many  of  them  are  startled  with  astonishment  on 
their  first  appearance  at  a  hydropathic  table.  They  had  heard  of  the 
beautiful  brown  bread,  the  exhilarating  cold  water,  the  substantial 
hominy,  the  admirable  rice,  the  tempting  fruits,  the  dainty  baked 
potatoes,  the  delicious  greens,  and  the  keen  appetites ;  but  while  it 
was,  perhaps,  "  distance  that  lent  enchantment  to  the  view,''  they 
were  pampering  the  artificial  appetite  with  rich  dishes,  and  condi- 
ments, and  seasonings.  When,  therefore,  the  matter  is  submitted  to 
the  evidences  of  the  senses,  the  wheaten  grits  scratch  the  throat,  the 
beef-steak  is  too  dry  to  swallow  without  gravy,  the  bread  will  not  go 
down  smoothly  without  buttei*,  spinach  is  insipid  without  vinegar,  pud- 
ding is  flat  without  wine-sauce,  pea-soup  is  uninviting  without  pepper, 
pumpkin  pie  is  odious  without  ginger,  pastry  has  no  relish  without  the 
accompaniment  of  cheese,  and  the  biscuits  are  too  tough  to  "  melt  in  the 
mouth"  without  shortening.  If  perchance  an  article  finds  its  waj'  to 
the  table  by  accident,  or  by  the  carelessness  or  connivance  of  the  cook, 
in  all  respects  what  it  should  not  be,  it  is  morally  certain  to  receive  a 
warm  eulogium ;  while  the  articles  selected  with  the  greates':  care, 
and  prepared  with  the  utmost  pains-taking,  and  in  every  way  precisely 
adapted  to  cure  their  maladies  in  the  shortest  possible  period  of  time, 
are  as  certainly  treated  with  dignified  neglect  or  open  ridicule. 

This  I  know  is  an  exti'emo  view,  but  not  an  uncommon  reality,  and 
these  circumstances  maj/  justify,  if  they  do  not  compel,  hjdropathic 
tables  to  be,  to  some  extent,  compromises  with  custom.  Manj'^  pa- 
tients, with  a  full  understanding  of  the  subject,  prefer  to  have  a  greater 
indulgence  in  matters  of  appetite,  and  submit  to  the  severer  water- 
processes  such  indulgence  renders  indispensable,  in  order  to  eflect  a 
cure.  But  the  evil  is  not  wholly  on  tho  side  of  the  inveterate  errors 
and  perverse  appetites  of  patients.  Some  persons  who  undertake  to 
get  up  a  hydropathic  table  are  entirely  ignorant  of  the  whole  subject 
of  diet;  some  pretended  establislnnents  are  merely  "watering  places," 
the  table  being  Tsholly  oc  : le  ordinary  hotel  plan.    There  is,  too,  some 


DIETETIC    CHARACTER    OF    MAN.  390 

difficulty  always  attending  the  prepEQ-ation  and  maintenance  of  a  well- 
regulated  table  for  invalids,  for  the  reason  that  competent  help  is  not 
easily  found ;  and  again,  the  commercial  adulterations  of  the  materials 
of  food,  and  the  bad  qualities  so  profusely  furnished  to  our  markets, 
require  the  closest  attention  and  the  most  careful  scrutiny. 

But  all  of  these  difficulties  are  surmountable ;  errors  of  education 
are  not  necessarily  fatal,  morbid  appetites  are  not  absolutely  incorrigi- 
ble, and  a  clear  understanding  of  the  causes,  sources,  nature,  and  rem- 
edies of  all  of  them,  is  the  pre-requisite  for  introducing  a  better  order 
of  things.  •  The  aim  of  the  enlightened  hydropath  in  directing  the 
dietetic  practices  of  his  patients,  will  be  not  only  to  cure  then*  present 
infirmities,  but  to  teach  them  "the  way  of  life"  in  relation  to  eating  as 
well  as  to  all  other  voluntary  habits.  And  to  this  end  he  should  for 
himself  well  understand,  and  for  otl.>ers  ever  hold  out  to  view,  correct 
physiological  principles,  although  he  may  rightfully  exercise  a  wide 
range  of  discretion  in  the  particular  manner  of  conforming  and  reform- 
ing the  habits  and  appetites  of  his  patients,  so  as  to  induce  them  intel- 
ligently to  love  and  permanently  to  practice  "  the  better  way." 


OHAPTER   I. 

DIETETIC   CHARACTER  OF   MAN. 


The  arguments  involved  in  the  question  whether  man  is  by  nature 
best  adapted  to  subsist  on  a  vegetable  diet  exclusively,  or  on  a  mixed 
diet  of  vegetable  and  animal  food,  can  hardly  fail  to  be  interesting  and 
profitable  to  all,  although  all  may  not  draw  the  same  inferences  from 
the  facts  presented.  Those  who  will  attentively  study  Sylvester 
Graham's  work  on  the  Science  of  Human  Life,  will  find  this  whole 
subject  critically  investigated  and  philosophically  demonstrated.  In  the 
present  work  it  is  impossible  to  give  more  than  a  brief  absti'act  of  the 
positions  and  evidences  bearing  on  the  general  proposition. 

The  Bible  Evidence. — We  learn  fiom  the  first  chapter  of  Genesis 
that,  as  soon  as  man  was  created,  and  placed  on  the  earth,  to  "multi- 
ply, and  replenish,  and  subdue  it,"  his  food  Vi^as  appointed  in  the  fol- 
lowing words :  "And  God  said,  Behold,  I  have  given  you  every  herb 
bearing  seed,  which  is  upon  the  facr3  of  al  t.33  earth,  and  every  tre^ 


400  D 1 E  T  E  C 1 C  3. 

in  the  which  is  the  fruit  of  a  tree  yielding  seed;  to  you  it  shall  be 
FOR  MEAT."  Cei'taiuly  nothing  can  be  more  clear  and  explicit  than 
this  dechu-ation,  that  the  vegetable  kingdom  is  the  ordained  source  of 
maivs  sustenance. 

But  after  the  flood  it  is  said  that  animal  food  was  permitted.  It 
seems  to  me  a  very  strange  moral  hallucination  that  arrays  a  permis- 
sion to  do  one  thing  against  a  command  to  do  the  contraiy !  Those 
Avho  prefer  to  make  a  permission  instead  of  a  command  their  rule  of 
action  will  find,  on  a  careful  examination  of  the  Scriptures,  that  wars, 
murders,  polygamy,  pestilences,  famines,  and  many  other  vices  and 
evils,  have  been  permitted,  "  for  the  hardness  of  men's  hearts."  This 
doctrine  of  permission  is  derived  from  Genesis  ix.  2,  3,  4 :  "  And  the 
fear  of  you,  and  the  dread  of  you,  shall  be  upon  every  beast  of  the 
earth,  and  upon  every  fowl  of  the  air,  upon  all  that  movetli  upon  the 
earth,  and  upon  all  the  fishes  of  the  sea ;  into  your  hand  are  they  de- 
livered. Every  moving  thing  that  liveth  shall  be  meat  for  you  ;  even 
as  the  gi'een  herb  have  I  given  you  all  things.  But  flesh  with  the  life 
thereof,  which  is  the  blood  thereof,  shall  ye  not  eat." 

To  my  understanding  this  permission  only  more  strongly  enforces 
the  prior  commandment.  If  we  may  suppose  that  man,  after  the 
earth  had  been  peopled  for  several  centuries,  by  reason  of  some  set  of 
circumstances  we  cannot  now  ascertain,  resorted  to  flesh-eating,  ia 
consequence  of  which  he  became  so  brutal,  and  ferocious,  and  de- 
praved, and  wicked,  and  filled  the  land  with  so  much  violence,  that  it 
was  found  necessary  to  wash  the  whole  surface  of  the  earth  cleai-  of 
his  polluting  presence,  saving  only  a  single  family  to  preserve  the  race 
from  utter  extinction ;  and  if  then  Jehovah  had  seen  fit  to  reafl^irm 
His  origintd  law  in  the  appointment  of  man's  food,  the  language  em- 
ployed, it  seems  to  me,  is  admirably  adapted  to  the  purpose. 

The  fear  and  the  dread  of  man  was  stamped  upon  the  whole  ani- 
mal creation.  This  implies  that  man's  supremacy  above  the  lower 
animals  was  again  pointed  out.  It  did  not  ordain  man  to  be  a  prcda- 
ceous  animal  himself,  but  affirmed  his  superiority.  But  into  man's 
hands  was  the  whole  animal  kingdom  delivered.  Well,  for  what  pur- 
pose ?  To  eat  ?  Not  to  devour,  but  to  protect.  To  rule  and  hold 
dominion  over,  not  to  ravage  and  prey  .jpon.  Or  even  if  man  Avere 
ordained  to  destroy  and  exterminate  the  anima  kingdom,  it  would  not 
follow  that  it  was  his  duty  to  eat  and  digest  it.  God  constituted  man 
the  lord  of  creation ;  was  it  not  an  egregious  blunder  in  man  to  mis- 
take himself  for  the  tyrant  of  aH  ? 

The  inferior  races  of  men  fear  and  dread  the  superior;  in  fact,  for 
aV  practical  purposes,  the  weake    fire  "  delivered"  into  the  hands  of 


DIETETIC    CHARACTER    :F    MAN.  4(h 

tlie  stronger.  But  would  it  not  be  a  perversion  of  privilege  for  the 
more  powerful  to  eat  the  more  feeble,  especially  when  there  was 
abundance  of  good  wdiolesome  food  obtainable  otherwise?  If  man  is 
placed  at  the  head  of  creation,  formed  and  fashioned  but  little  lower 
than  the  angels,  and  so  much  above  the  animal  kingdom  as  to  have  do- 
minion over  it,  his  duty  seems  to  be  to  protect  and  govern  it,  not  sen- 
sualize and  riot  upon  it.  The  fear  of  God  and  the  dread  of  the  Al- 
mighty is  upon  eveiy  human  being  who  walks  the  earth ;  but  human 
beings  look  up  to  that  Deity  whom  they  both  fear  and  dread,  as  the 
best  of  protectors,  the  most  merciful  of  rulers,  the  kindest  of  fathers. 
If  Queen  Victoria  has  dominion  over  thirty  millions  of  her  fellow- 
creatures,  she  would  be  a  very  cannibal  to  eat  a  single  one  of 
them;  and  if  a  hundred  millions  of  semi-civilized  human  beings  are 
delivered  into  the  hands  of  Nicholas  of  Russia,  it  does  not  imply  his 
right  to  maltreat  or  destroy,  much  less  devour  them ! 

No  one  pretends  to  say  that  aR  sorts  of  dtad  animals  were  meant 
by  the  phrase,  "  every  thing  that  liveth ;"  and  if  it  does  not  include 
all  animals,  why  does  it  mean  a7iy  ?  Surely  the  language  is  as  broad 
as  creation  itself.  But  mark!  Vegetable  food  is,  indeed,  a  "living 
thing,"  after,  harvest,  and  even  when  prepared  for  the  table.  The 
grains,  and  fruits,  and  roots  still  retain  the  living  seed,  the  germ  of 
vitality,  even  at  the  moment  wdien  they  are  ready  for  man's  repast 
True,  their  germinating  property  may  be  destroyed  by  a  process  of 
cooking,  but  this  militates  nothing  against  our  position. 

Now,  animal  food  (save  those  trifling  exceptions,  raw  fresh  eggs  ane 
raw  fresh  oysters)  of  whatever  kind,  is  not  "living:"  and  it  imme- 
diately commences  puti*efying  the  moment  it  is  deprived  of  life ;  and 
this  process  of  decomposition  can  only  be  arrested  by  powerful  anti- 
septics, as  salt,  vinegar,  sugar,  alcohol,  nitre,  arsenic,  etc. 

Again,  while  man's  dominion  was  to  be  over  all  that  jnoveth  upon  the 
earth.,  his  ordained  fsod  was  to  be  every  moving  thing  that  liveth. 
Those  things  that  move  ujion  the  earth  are  most  indubitably  the  ani- 
mals that  creep,  crawl,  walk,  run,  jump,  climb,  fly,  and  swim.  The 
moving  things  that  live,  when  gathered  and  preserved  for  food,  as  well 
as  when  gi-owing  in  the  fields  and  woods,  are  the  waving  grains,  the 
spreading  vines,  the  branching  roots,  ithe  svs'^elling  fruits,  etc. 

Lastly,  those  who  contend  for  flesh-eating  on  Bible  authority  admit 
that  blood  is  peremptorily  forbidden.  This  admission  on  their  part 
completely  refutes  all  the  appearance  of  force  they  draw  from  their 
own  interpretation  of  the  doctrine  of  permission,  for  they  never  eat  a 
particle  of  flesh,  and  would  not  eat  it,  witi  3ut  a  large  admixture  of 
blood.     A  piece  of  flesh  deprived  of  its  bloi.  1  is  a  dry,  fibrous,  stringy 


i02  DIETETICS. 


unsavory  mass  ;  no  one  would  eat  it  sooner  than  he  would  eat  a  piece 
of  sponge  or  India-rubber.  Yet  who  does  not  know  that  "steaks" 
and  "roasts"  rare-done,  so  as  to  bleed  a  little  when  carved,  ai'e  consid- 
ered by  Christian  epicures  generally  as  the  sweetest,  daintiest  cuts  ? 
Even  blood-puddings  are  considered  a  famous  luxury  by  svome  of  those 
good  Christians  who  profess  to  be,  and  no  doubt  really  imagine  they 
ai*e,  obeying  the  commands  of  holy  writ  in  the  use  of  aninial  fcod. 

It  is  admitted  that  both  the  Old  and  the  New  Testaments  furnish 
examples  of  good  men,  and  inspired  men,  who  ate  flesh ;  but  good  and 
inspired  men  were  neither  all-wise  in  intelligence,  nor  all-virtuous  in 
conduct.  Though  good  and  inspu-ed,  they  were  still  the  subjects  of 
ignorance  and  error — they  were  human.  Nothing,  however,  is  more 
apparent  than  the  superiority  which  the  whole  tenor  of  Scripture 
teaching  assigns  to  vegetable  food.  The  history  of  Daniel,  and  John 
the  Baptist,  and  Elijah  the  Prophet,  are  sti-iking  illustrations.  Whether 
our  Saviour  ate  the  animal  fish  is  a  question  perhaps  not  easily  solved, 
nor  is  its  solution  material  to  our  purpose.  But  it  is  worthy  of  notice 
that  the  lotus  plant  of  the  Eg^^ptiaus  is,  even  at  this  day,  made  into  an 
edible  preparation  called  fish.  The  Greek  word  opsarion,  it  is  said  by 
some  lexicogi'aphers,  does  not  signify  fish,  but  some  other  delicate 
preparation  eaten  with  bread.  James  and  John  were  fishermen,  with 
Zebedee  their  father,  yet  Calmet  says  that  they  never  ate  fish  or 
flesh.  Ezekiel  speaks  of  an  abundance  of  fishers  who  should  live  on 
the  borders  of  the  Dead  Sea,  yet  Josephus  says  no  animal  fish  wiJJ 
live  in  it.  The  balance  of  testimony  is  certainly  strongly  against  the 
supposition  that  fishermen  were  fishers  of  aumials  in  those  days,  or 
that  the  fish  employed  as  food  was  not  a  vegetable  production. 

The  Mosaic  regulations  in  relation  to  animal  food  were  evidently  in- 
tended to  resti-ain  its  employment,  as  fin*  as  the  sensual  people  he  had 
to  deal  with  could  be  controlled,  and  to  restrict  those  who  would  per- 
sist in  its  use  to  the  best  or  least  injurious  kinds.  But,  stranger  truth 
than  the  strangest  fiction,  many  of  our  good  modern  Bible-professing 
Christians,  who  devoutly  believe  in  "  Moses  and  the  prophets,"  make 
their  dainty  delicacies  and  luxuries  on  the  very  kinds  of  animals  and 
parts  of  animals  which  jMoses,  with  the  authority  of  "  thus  saith  the 
Lord,"  peremptorily  prohibited. 

The  Anatomical  Evidknce. — To  the  Bible  testimony  in  favor  of 
vegetable  diet,  may  be  added  that  of  comparative  anatomy.  Natural 
history  alone  solves  the  problem  bej'ond  all  controversy.  Medical 
writers  are  constantly  jisserting,  and  newspaper  scribblers  are  contin- 
ually reiterating  the  statement    that  the  conforn;ation  of  the  human 


DIETETIC    CHARACTER    OF    MAN.  403 

bowy  shows  that  man  is  intended  to  live  on  a  mixed  diet  of  animal  and 
vegetable  food;  but  neither  of  them  support  the  position  with  a  particle 
of  evidence  which  can  bear  criticism.  On  the  contrary,  all  the  eminent 
naturalists  the  world  has  ever  produced,  as  far  as  I  know,  are  unanimous 
in  the  opinion  that  the  anatomical  structure  of  the  human  body,  as 
compared  with  other  animals,  places  man  among  the  frugivorous  or 
herbivorous  animals,  and  affords  no  testimony  whatever  of  his  carniv- 
orous or  omnivorous  character. 

Baron^Cuvier,  whose  name  stands  at  the  very  head  of  ^comparative 
anatomists,  says:  "The  natural  food  of  man,  therefore,  judging  from 
his  structure,  appears  to  consist  of  fruits,  roots,  and  other  succulent 
parts  of  vegetables,  and  his  hands  offer  him  every  facility  for  gathering 
them.  His  short  and  moderately  strong  jaws,  on  the  one  hand,  a-nd 
his  cuspidati  being  equal  in  length  to  the  remaining  teeth,  and  his 
tubercular  molares  on  the  other,  would  allow  him  neither  to  feed  on 
grass  nor  devour  flesh,  were  not  these  aliments  previously  prepared  by 
cookmg." 

Professor  La^^Tence  states  that  "the  teeth  of  man  have  not  the 
slightest  resemblance  to  those  of  carnivorous  animals,  except  their  ex- 
ternal enamel,  and  that  the  whole  human  structure  most  closely  resena- 
bles  those  animals  which  ai"e  naturally  frugivorous — the  simice,  or 
monkeys." 

Thomas  Bell,  surgeon-dentist  to  Guy's  Hospital,  declares  that  "every 
fact  connected  with  the  human  organization  goes  to  prove  that  man 
was  originally  formed  a  frugivorous  animal." 

Linnaeus  asserts  that  "the  organization  of  man,  compared  with  that 
of  other  animals,  shows  that  fruits  and  esculent  vegetables  constitute 
his  most  suitable  food." 

Sir  Everard  Home  admits  that  "while  mankind  remained  in  a  state 
of  innocence,  their  only  food  was  the  produce  of  the  vegetable  king- 
dom." 

Lord  Monboddo,  also  a  celebrated  naturalist,  says:  "It  appears  to 
me  that  by  nature,  and  in  his  original  state,  man  is  a  fi*ugivorous  animal, 
and  that  he  only  becomes  an  animal  of  prey  by  acquired  habits." 

Dr.  William  Lambe,  of  London,  after  a  critical  examination  of  the 
question,  came  to  the  conclusion  that  "man  is  herbivorous  in  hi«  struc- 
ture," and  his  conclusion  has  been  ve/ified  by  more  than  forty  years 
of  personal  vegetarian  experience.  He  declares  that  "the  adherence 
to  the  use  of  animal  food  is  no  more  than  a  persistence  in  the  gross 
customs  of  savage  life,  and  evinces  an  insensibility  to  the  progress  of 
reason,  and  to  the  operation  of  intellectual  improvement." 

Sylvester  Graliam,  of  Northampton,  Mass.,  w  th  a  :niud  singularly 


404  DIETETICS. 


constituted  to  gi-asp  first  principles,  has  cai'efully  examined  the  whole 
organization  of  the  human  body,  and  minutely  investigated  all  its  com- 
plicated parts,  with  direct  reference  to  this  question,  more  thoroughly 
probably  than  any  other  person  who  has  ever  lived.  His  theoretical 
conclusion  corresponds  with  that  of  all  other  naturalists  whose  attention 
has  been  directed  to  the  subject,  and  the  experience  of  hundreds  who 
have  adopted  the  vegetarian  system,  partially  or  wholly,  in  consequence 
of  his  teachings,  singularly  exemplifies  its  truth. 

Against  such  testimony  we  have  nothing  bat  the  bare  assumption 
of  medical  and  dietetical  writers  who  have  never  examined  the  subject 
at  all,  and  who  are  as  profoundly  ignorant  in  relation  to  it  as  are  those 
for  whose  edification  they  wi'ite.  It  is  common  and  customary  for 
such  persons,  whenever  they  make  a  book  ©n  any  subject  pertaining 
to  medicine  or  hygiene,  to  repeat  the  stereotyped  phrase  that  the 
teeth  of  the  human  animal  combine  the  characters  of  both  herbivorous 
and  carnivorous  animals,  and  constitute  him  an  omnivorous,  or  all- 
devouring  animal.  This  makes  him  one  of  the  connecting  links  be- 
tween the  two,  and  places  him  dietetically  in  the  same  dignified  rank 
in  the  scale  of  being  as  the  bear,  hog,  etc.  The  manner  in  which  the 
omnivorous  side  of  the  question  is  supported  is  much  more  amusing 
than  convincing.  Dr.  Dickson,  tWe  author  of  Chrono-Thermalism, 
modestly  observes :  "  The  most  cursory  examination  of  the  human 
teeth,  stripped  of  every  other  consideration,  should  convince  any  body 
ivith  the  least  jrretensions  to  brains,  that  the  food  of  man  was  never  in- 
tended to  be  restricted  to  vegetables  exclusively." 

Dr.  Carpenter  (Principles  of  Human  Physiology),  in  allusion  to  the 
carnivora  and  herbivora,  remarks:  "Now,  the  condition  of  man  may 
be  regarded  as  intermediate  between  these  two  extremes.  The  con- 
eti-uction  of  his  digestive  apparatus,  as  well  as  his  own  instinctive  pro- 
pensities, point  to  a  mixed  diet  as  that  which  is  best  suited  to  his 
wants." 

Dr.  Dunglison  {Human  Health)  makes  the  following  singularly 
ridiculous  assertion :  "  There  is  no  doubt  whatever,  that  if,  from  in- 
fancy, man,  in  the  temperate  regions,  were  confined  to  an  animal 
banquet,  it  would  be  entirely  in  accordance  with  his  nature,  and  would 
probably  develop  his  mental  and  corporeal  energies  to  as  great  a  degree 
US  the  mi?vod  nutriment  on  which  he  usually  subsists." 

Professor  Lee,  who  has  a  happy  talent  for  "coinciding"  in  the  opin- 
ions of  others,  fully  endorses  the  "veiy  judicious  remarks"  of  Dr. 
Dunglison,  and  also  remarks,  on  his  own  responsibility  :  "The  physical 
organization  of  man  proves  that  he  is  destined  for  a  mixed  kind  of  ali- 
ment." 


DIETETIC    CHARACTER    0?    MAN. 


405 


\  A  volume  of  similar  quotations  could  be  extracted  from  the  medical 
authors  of  the  allopathic  school ;  but  all  alike  are  deficient  in  argument 
or  evidence.  When  an  attempt  at  argument  is  made,  it  always  turns 
on  the  teeth  and  masticatory  organs.  These  are  said  to  be  in  man  a 
little  different  from  both  carnivorous  and  herbivorous  animals  ;  and 
hence  the  inference  is  drawn  that  man,  because  he  is  unlike  either,  is 
actually  both.  There  is,  indeed,  a  resemblance  between  the  teeth  of 
man  and  the  teeth  of  both  the  carnivora  and  herbivora,  as  well  as  those 
of  the  omnivora;  but  there  is,  too,  a  difiierence,  and  the  difference  is 
just  as  significant  as  the  resemblance.  The  truth  is,  that  there  is  a 
very  wide  difference  between  the  teeth,  masticatory  organs,  and  whole 
digestive  apparatus  of  man  and  carnivorous  animals ;  a  great  difference 
between  man  and  omnivorous  animals  in  these  respects ;  a  lesser  dif- 
ference between  man  and  the  herbivorous  or  graminivorous  animals ; 
and  an  exact  resemblance  between  man  and  those  animals  known  to  be 
frugivorous.  The  single  fact  that  man  possesses  the  lateral  or  grind- 
ing motlojuof  the  lower  ja,w,  peculiar  to  frugivorous  and  gi-aminivorous 
animals,  while  he  is  destitute  of  the  pointed,  projecting,  irregular,  and 
tearing  teeth,  belonging  to  carnivorous  and  omnivorous  animals,  is  per- 
fectly conclusive,  in  my  estimation,  as  far  as  anatomy  is  concerned, 
that  man  is  by  nature  in  no  sense  or  degree  associated,  dieteticaliy, 
with  the  latter  classes  of  animals. 

But  for  the  satisfaction  of  those  who  desire  to  see  as  well  as  hear 
the  discussion  of  this  subject,  the  following  ocular  demonstration  is 
subm»itted : 

Fig.  152. 

Fig.  152  exhibits  the  masticatory  or- 
gans of  the  carnivorous  tiger.  There 
is  a  resemblance  between  these  teeth 
and  those  of  the  human  animal ;  yet 
no  one  will  dispute  that  the  differ- 
ence is  more  striking  than  the  resem- 
blance. 

OccasionaDy  the  human  teeth  exhibit 
those  deviations  fi'om  the  orchnary  form 
which  are  denominated  tushes ;  but 
such  deviations  are  universally  regarded  as  deformities,  and  such  de- 
formities always  give  a  carnivorous  and  ferocious  expression  to  the 
countenance.  How  Irttie  do  human  beings  suspect  the  intimate  con- 
nection that  exists  betw^een  mental  impressions  and  exercises  and  bodily 
conformation.  Those  tribes  of  the  human  family  whose  minds  are 
most  associated  with  animal  food,  and  whose  teeth  are  most  frequently 


TJJN'DER    JAW. 


lOQ 


DIETETICS. 


employed  m  masticating  it,  are  most  distinguished  for  a  sti'uctm-e  of 
teeth  peculiarly  irJiuman. 


Fig.  153, 


JATTS    AND    TEETH    OF    A    PANTHER. 


In  Fig.  153  we 
have  a  represent- 
ation of  the  jaw3 
and  teeth  of  an- 
other purely  car- 
nivorous animal. 
It  affords  a  good 
idea  of  the  man- 
ner in  which  the 
jaws  of  the  car- 
uivora  open  and 
shut,  like  a  pair 
of    shears,    being 


wholly  incapable  of  the  least  gi'inding  or  rotaiy  motion. 


Fig.  154. 


JAWS    AND    TEETH    OF    A    MINK. 


Fig.  154  represents  another 
modification  of  carnivorous  masti- 
cators. The  teeth  are  nearly 
closed,  and  the  dagger-like  tusks 
are  seen  to  be  very  different  from 
those  teeth  which,  in  the  human 
jaw,  have  received  the  appella- 
tion of  canine. 


The  face  of  the  young  lion.  Fig.  155, 
does  not  make  any  very  near  approach 
to  humanity,  m  the  conformation  of  the 
teeth  or  jaws.  A  resemblance,  of  course, 
must  be  acknowledged ;  yet,  when  the 
genei-al  contour  and  expression  of  tb^ 
human  face  approximates  to  that  of  a 
carnivorous  animal,  it  is  by  common  con- 
sent denominated  "savage,"  "  rufifianly," 
etc. 

The  poets  and  painters  who  vimlertake 
to  represent  to  us  their  ideal  of  humanity 
invariably  divest  the  features  and  expression  of  every  trace  character- 
istic of  the  ascendency  of  the  lower  range  of  animal  propensities 
How  would  the  "Portrait  of  a  Gentleman,"  the  "Flower  Girl,"  "The 
Bride,"  or  "The  Cavalier,"  appear  in  the  gallery  of  the  American  Art 


7 


YOUNG   LION. 


DIETETIC    CHARA'JTER    OF    MAN. 


407 


Union,  with  the  angles  of  the  mouth  drawn  down  to  the  carnivorous 
range,  and  the  canine  teeth  projecting  omnivorously  beyond  the  rest? 

Fig.  156. 


TINDER    JAW    AND    TEETH    OF    THE    HOG. 

We  may  now  examine  the  intermediate  class — the  omnivora.  The 
back  teeth  of  the  hog,  Fig.  156,  resemble  exactly  those  of  herbivorous, 
and  the  front  teeth  those  of  carnivorous  animals.  But  if  there  is  any 
thing  peculiarly  human  about  the  masticatory  apparatus  of  the  swine. 
I  am  unable  to  perceive  it. 

Fig.  157. 


JAW   AND    TEETH    OF    THE    CAMEL. 

The  masticatory  organs  of  the  camel,  Fig.  157,  particularly  the  cus- 
pid or  canine  teeth,  show  a  much  stronger  resemblance  to  those  of 
carnivorous  animals  than  do  those  of  the  human  animal;  hence  man, 
judging  from  the  point  of  comparative  onatomy  alone,  would  be  re- 
moved further  from  the  carnivora  than  even  the  camel,  which  subsists 
on  the  coarsest  herbage. 

The  irregular  arrangement  of  teeth  are  hero  peculiarly  fitted  for 
tiincliing  and  breaking  up  the  sprouts,  stalks,  b  -anches,  etc.,  which 
tonstitute  a  large  propoition  of  this  animal's  food. 


408 


DIETETICS. 


Fin.  1j8. 


In  the  jaw  of  the  horse,  Fig.  158,  another 
herbivorous  animal,  the  incisors,  or  cutting 
teeth,  are  placed  in  front  to  crop  the  grass  or 
other  herbage  ;  and  the  grinding  teeth  for 
mashing  and  comminuting  the  food  occupy  the 
back  part.  There  is  no  appearance  of  tearing 
or  carnivorous  teeth. 


Ascending   the    scale    of  the    animal    crea- 
tion, we  may  next  look  at  the  masticatory  ap- 
BKULL  OF  THE  HORSE.    P^ratus    of   a  purely  frugivorous   animal.      In 
the  orang-outang,  Fig.  159,  the  articulations  of 
the  jaw,  as  with  all  herbivorous  animals  and  with  man,  are  adapted  to 
the  rotary  or  grinding  motion.     The   teeth  of  the   ape,  or  monkey 

Fiir.  159. 


JAWS    AND    TEETH    OF    AN    ORANG-OUTANG. 

tribe,  have  a  nearer  resemblance  to  those  of  carnivorous  animals  than 
nave  human  teeth,  which  fact  would  place  men,  if  possible,  at  even  a 
greater  distance  than  th^  orang-outanj  Proni  the  cnrnivora      It  should 


DIETETIC    CHARACTER    OF    MAN. 


40y 


"•«iii2^2SS2ii^;a£8^SGi.a2iiii»i! 


HUMAIv"    JAW    AND    TEETH. 


be  noticed,  however,  that  in  some  species  of  monkeys — the  baboon 
for  example — the  cuspids  da  resemble  the  corresponding  teeth  of  car 
nivorous  animals,  an  arrangement  which  serves  them  for  weapons  of 
offense  and  defense,  but  not  for  cutting  and  tearing  flesh. 

It  will  be  ob-  ^''■^''- 

served  at  a  glance 
that  the  mastica- 
tory organs  of  the 
human  animal, 
Fig.  160,  ai'e  still 
further  removed 
from  all  resem- 
blance to  those 
of  carnivorous  or 
omnivorous  ani- 
mals    than     are 

those  of  the  purely  frugivorous  orang-outang,  or  the  purely  herbivo- 
rous animals.  The  incisors  (I)  are  evidently  intended  for  biting  and 
cutting  the  fruits,  grains,  roots,  or  other  vegetables  designed  for  his 
subsistence;  the  cuspid,  corner,  or  canine  tooth  (C)  enables  him  to 
grasp  more  firmly  and  retain  more  securely  the  alimentary  substance ; 
and  the  bicuspids  (B)  and  molares  (G),  or  small  and  large  grinders, 
are  fitted  to  mash  and  grind  all  dry,  solid,  or  hard  articles  of  food. 

The  human  masticatory  organs,  on  the  whole,  exhibit  no  evidence 
of  any  structural  ari'angement  which  is  not  precisely  fitted  for  and  ex- 
clusively adapted  to  a  vegetable  diet.  The  human  teeth  can,  however, 
cut  and  tear  flesh  to  some  extent;  and  so  can  carnivorous  animals  break 
and  mash  fruits  and  seeds  to  some  extent.  Experiments  have  also 
proved  that  each  class  of  animals  may  be  made  to  approximate  the 
other,  to  some  extent,  in  character  and  disposition,  by  changing  their 
dietetic  habits.  Young  tigers  and  young  lions  have  been  restricted  to 
vegetable  food,  during  which  time  they  remained  docile  and  govern- 
able;  but  on  tasting  raw  meat,  the  dormant  propensity  to  tear  the 
warm,  quivering  flesh,  and  drink  the  red  blood  of  other  animals,  was 
immediately  aroused,  and  all  the  ferocity  and  cruelty  of  a  carnivorous 
nature  was  again  in  the  ascendant. 

"Just  as  the  twig  is  bent  the  tree  is  inclined,"  physiologically  as 
well  as  morally.  Those  mothers  who  force  their  little  children,  even 
before  they  are  capable  of  masticating  a  particle  of  it,  to  swallow  flesh, 
and  thus  develop  an  early  appetite  for  it,  are  little  aware  how  seriously 
(Jiey  are  injuring  the  organizations  an(3  corrupting  the  whole  nature 
f  the  future  men  and  women. 
I— 3i3 


tlO  D I  E  T  E  r  1  C  S. 


Lastly,  we  h:ive,  in  Fig.  161,  a  view  of  iLe  entire  skeleton  of  man, 
compared  with  that  of  a  pm*ely  frugivurous  animal.  Not  only  is  the 
agreement  perfect  with  respect  to  the  masticatory  organs,  but  the 
whale  digestive  apparatuses  of  both  aie  precisely  alike  ;  and  even  the 
entire  conformation  of  the  body  of  the  orang-outang,  considered  die- 
tetically  or  physiologically,  resembles  the  human  animal,  incomparably 
more  nearly  than  any  other  animal  does.  How,  then,  can  we  draw 
from  the  structure  of  man,  as  compared  with  other  animals,  any  infer- 
ences at  war  with  the  divine  commandment  recorded  in  the  Scriptures  ? 

The  Physiological  Evideivce. — Phj'siologists  have  noticed  that 
the  blood  of  flesh-eating  animals  undergo  ^«  putrefaction  much  sooner 
than  that  of  a  vegetable-eating  animal.  The  chyle  of  flesh-eating 
men,  when  taken  out  of  the  body,  decomposes  and  becomes  putrescent 
in  less  than  a  quarter  of  the  time  required  for  that  of  the  vegetarian 
to  undergo  the  same  process.  All  the  secretions  of  vegetarians  are 
more  pm*e,  bland,  and  copious,  and  the  excretions — the  sweat,  urine, 
fecal  matters,  etc. — are  less  offensive  to  the  senses,  and  less  injm'ioiis 
in  their  exhalations,  than  are  those  of  persons  M^ho  subsist  on  a  mixed 
diet.  The  teeth  of  vegetarians  are  less  affected  with  tartarous  in- 
crustations, and  their  breath  is  mostly  or  entirely  free  from  the  rank, 
cadaverous,  pestilent  odor  so  connnon  to  flesh-eaters.  ^Medical  author- 
ities generally  agi-ee  that  flesh  diet  makes  the  blood  prone,  and  the 
whole  body  disposed  to,  the  inflammatory  and  puti-id  diatheses.  Some 
few  medical  writers  have,  however,  asserted  that  an  exclusively  vege- 
table diet  predisposes  to  scurvy ;  but  as  they  have  not  sustained  the 
assertion  with  any  sort  of  evidence,  it  is  hardly  worth  refuting.  The 
vegetarian  can  always  endure  hunger  and  thirst  longer  without  loss  of 
strength,  and  susJain  entire  privation  of  food  with  much  less  suftering 
man  flesh-eaters.  The  appetite  of  vegetable-eaters  is  invariably  good, 
and  food  has  always  a  keen  relish,  while  it  often  fails  with  flesh-eaters  • 
requiring  frequent  changes  of  dishes,  or  a  variety  of  seasonings,  to 
render  it  palatable.  Digestion  with  the  vegetarian  is  unattended  with 
that  disturbance,  heat,  irritation,  oppression  of  the  stomach,  and  dull- 
ness or  drowsiness  of  the  head,  which  flesh-eaters  generally  experi- 
ence after  dinner,  and  which  some  physiologists,  on  the  mistaken 
supposition  that  it  was  natural,  have  called  the  "  fever  of  digestion.'* 
Drowsiness,  sleepiness,  and  mental  stupidity,  so  common  after  a  full 
meal  with  flesh-eaters,  are  wholly  unknown  to  vegetarians,  when  their 
other  habits  are  correct.  Th^se  can  resume  any  bodily  or  mental 
labor  immediately  after  a  meal,  with  incomparably  less  discomfort,  and 
greater  immunity'  from  evil  consequences,  than  can  flesh-ei.ters. 


DIETETIC    CHARACTER    OF    MAN 


411 


Fig.  161. 


THE  HTTMAIV  SKELETON  COMPAREr  WITH  THAT  OF  THE  ORArrG-OUTANQ 


412  DIETETICS. 


All  the  mental  passions  of  the  vegetarian  are  more  governable  and 
better  balanced,  more  easily  regulated  by  the  judgment  and  controlled 
by  the  will,  less  violent,  but  more  enduring  than  those  of  flesh-eatei-s. 
The  firmest  and  most  vigorous  structures  of  body  are  found  among 
vegetable-eatei-s,  in  proof  of  which  we  need  only  refer  to  the  toiling 
millions  of  Europe  and  the  Eastern  nations.  Vegetable -eaters  possess 
an  elasticity  and  flexibility  of  moving  fibres,  and  a  tenuity  and  purity 
of  circulating  fluids,  which  enable  them  to  work  theii-  bodies  and  brains 
mor-e  severely,  more  constantly,  with  greater  ease  and  facility,  and  W'th 
less  "wear  and  tear,"  than  flesh-eaters  can;  and  when  fatigued  by 
excessive  exertion  of  body  or  mind,  they  will  recover,  by  resting,  in  a 
much  less  period  of  time. 

Extremes  of  heat  and  cold,  and  exposures  to  atmospheric  vicissitudes, 
are  better  endured  by  vegetable-eaters.  When  in  ordinary  health, 
those  who  subsist  on  an  exclusively  vegetable  diet  are  never  very  fat 
nor  extremely  lean.  All  the  senses  of  the  vegetable-eater — tasting, 
smelling,  hearing,  seeing,  and  feeling — are  more  healthfully  acute,  and 
less  morbidly  sensitive  than  are  those  of  flesh-eaters.  Bodily  sym- 
metiy  and  personal  beauty  have  always  distinguished  those  who  have 
subsisted  mainly  on  vegetable  food  from  those  whose  principal  diet  has 
been  animal  food,  other  circumstances  being  equal. 

The  Medical  Evidence. — That  vegetable-eaters  are  not  only  less 
liable  to  epidemical  and  infectious  diseases  of  all  kinds,  but  much  more 
easily  cured  of  them,  either  by  the  efforts  of  nature  or  ordinary  reme- 
dial mewis,  is  a  fact  pretty  well  established  by  the  observations  of  med- 
ical men.  AVounds,  bruises,  burns,  and  scalds  are  also  more  easily  and 
more  perfectly  cured.  The  united  testimony  of  the  English  Vegetarian 
Societies,  many  of  whose  members  have  abstained  from  flesh  for  thirty 
or  forty  years,  and  some  during  their  whole  lives,  is  in  fjivor  of  its 
superior  healthfulness.  The  American  Vegetarian  Society,  instituted  in 
the  city  of  New  York  in  April,  1850,  contains  in  its  ranks  old  men  who 
have  for  an  ordinary  lifetime  enjoyed  almost  uninterrupted  health,  and 
several  who  have  almost  regenerated  broken-down  cxsnstitutions  on  an 
exclusively  vegetable  diet.  The  Bible  Christians,  of  Philadelphia,  who 
have  adopted  vegetable  diet  on  religious  convictions,  have  always,  as  a 
society,  been  remarkably  exempt  from  epidemics,  which  have  fre- 
quently prevailed  around  tliem.  During  the  cholera  seasons  in  New 
York — 1832,  1834,  and  1849 — no  persons  whose  habits  of  living  ap- 
proximated very  nearly  to  the  •' Graham  system"  died  of  the  disease  ; 
and  no  one  who  lived  strictly  according  to  his  teachings  had  an  attack. 
Missionai'ies  and  teachers  have,  within  a  few  years,  gone  fi-om  the 


DIETETIC    CHARACTER    OF    MAN.  413 

United  States  to  the  sickly  parts  of  Africa,  and,  by  adopting  an  exclu^ 
sively  vegetable  diet,  escaped  all  the  attacks  of  disease  which  others 
have  experienced,  and  which  are  usually  considered  as  incidental  to 
the  climate.  The  same  is  true  of  Northern  men  who,  in  removing  to 
or  traveling  throu|:h  the  Southern  states,  have  adopted  the  vegetable 
system  of  diet. 

But  more  striking  and,  to  many  minds,  more  convincing  evidence,  is 
furnished  in  the  numerous  examples  of  chronic  diseases  and  malignant 
ulcers,  which  have  resisted  all  remedial  agencies  under  a  mixed  diet, 
yet  have  been  readily  healed  under  a  vegetable  regimen.  Dr.  Lambe 
succeeded,  in  cases  of  cancer,  scrofula,  consumption,  and  other  mala- 
dies which  had  progressed  to  the  incurable  stage,  in  arresting  the  rav- 
ages of  the  diseases,  and  protracting  the  period  of  life  for  many  years,  i 
by  a  strict  vegetable  regimen,  and  the  use  of  distilled  water  for  drink.  \ 
The  celebrated  Dr.  Twichell,  of  New  England,  has  recently  cured 
himself  of  a  malignant  tunTor  of  the  eye,  which  has  troubled  him  for 
ten  years,  and  which  had  been  once  excised  and  once  cauterized,  uith 
but  temporary  benefit,  by  adopting  a  diet  of  bread  and  cream.  I  have 
now  a  patient  under  treatment  for  a  tubercular  affection  of  the  lungs, 
who,  two  years  ago,  was  a^/licted  with  a  foul  and  malignant  ulcer  of 
the  cheek,  deeply  involving  the  upper  maxillary  bone.  After  trying 
the  ordinary  medication  in  vain,  and  submitting  to  the  operations  of 
cutting  and  cauterization  without  avail,  the  patient,  against  the  remon- 
strances of  friends  and  physicians,  abandoned  flesh-eating,  after  which 
the  ulcer  healed  rapidly. 

The  Chemical  Evidence. — All  the  light  which  chemistry  is  able 
to  throw  on  the  subject  of  diet  is  in  favor  of  vegetable  food  exclusively. 
Nothing  is  more  common  than  for  medical  books  and  writers  to  tell  us 
that  animal  food  is  more  nutritious,  more  concentrated,  and  more  di- 
gestible than  vegetable.  But  these  terms  are  generally  employed 
without  any  very  precise  meaning.  The  ti'uth  is,  some  kinds  of  vege- 
table food,  as  the  cereal  grains,  are  more  nutritive,  pound  for  pound, 
than  any  kind  of  animal  substance ;  other  kinds,  as  fi'uits  and  most 
esculent  roots,  are  less  nutritive.  The  terra  concentration  has  scarcely 
any  meaning  applied  to  animal  food,  for  although  some  kinds  of  animal 
food  are  more  nutritive  than  others,  there  is,  except  in  the  separation 
of  the  curdy  and  oily  matters  of  milk  from  the  watery  part,  no  method 
known  of  separating  the  nutritious  from  the  innutritious  element ;  and 
such  an  invention,  should  it  ever  be  produced,  v/ould  tend  powerfully 
to  bring  animal  food  into  disuse.  Some  vegetables,  and  some  kinds  of 
fruit,  dige?",  or  rathei'  dissjb:e  in  the  stomach  sooner  than  some  kinda 


414  DIETETICS. 


of  animal  food,  but  not  as  rapidly  as  other  kinds;  but  the  length  of  tiine 
necessary  for  the  digestion  of  an  ai'ticle  of  food  proves  nothing  for  or 
against  it. 

If  we  determine  the  value  of  foods  strictly  by  the  rule  of  chemical 
analysis,  according  to  the  Liebig  school,  we  shall  find  that  good  wheaten 
bread,  rice,  and  lentils,  contain  four  times  as  much  nuti'itive  virtue  as 
the  best  flesh-meat,  while  potatoes  contain  at  least  an  equal  amount. 
If  we  admit  Liebig's  theory  of  the  combustion  of  carbon  to  sustain  the 
animal  temperature,  we  shall  find  abundance  of  carbon,  and  the  best 
hind  of  carhon,  in  vegetable  food.  And  if  we  accede  to  the  doctrine 
of  the  nitrogenous  and  non-nitrogenous  distinctions  of  alimentary  prin- 
ciples, we  find  nitrogen  supplied  in  nearly  fdl  kinds  of  vegetation,  and 
an  inexhaustible  resource,  in  case  of  accidental  scarcity  in  the  vegetable 
kingdom,  in  the  atmosphere  which  surrounds  us. 

The  Experimental  Evidence. — We  have  no  account  that  Adam 
and  Eve  ever  departed  from  the  commandment  of  God  in  then*  dietetic 
habits,  and  in  the  absence  of  all  evidence  to  the  contrary,  we  are  bound 
to  believe  they  were  consistent  vegetarians.  Although  the  children 
of  men  went  ash-ay  in  an  early  period  of  the  world's  history,  '*by  dip- 
ping their  tongues  in  gore,"  and  a  large  proportion  of  the  human  family 
has  continued  in  the  trangi-ession  ever  since,  yet  there  have  been,  at 
all  times,  men  of  superior  intelligence  and  high-toned  morality,  who 
have  rigidly  abstained  from  flesh-eating.  Among  them  we  find  poets, 
philosophers,  and  prophets,  distinguished  alike  for  "temperance  in  all 
things,"  purity  of  life,  rectitude  of  deportment,  and  length  of  years. 

Pythagoras  raised  up  a  society'  of  vegetarians  550  years  before 
Christ.  Josephus  testifies  that  the  Essenes,  a  sect  of  the  ancient 
Jews,  numbering  several  thousands,  were  long-lived  because  of  their 
regular  course  of  life  and  simplicity  of  diet,  which  Pliny  tells  us  con- 
sisted of  the  fruit  of  the  palm-tree.  It  is  certain,  however,  that  they 
were  vegetarians  after  the  Pythagorean  philosophy.  The  Bramin 
priests,  who  are  a  very  numerous  sect,  are  all  strict  vegetarians.  San- 
choniathan,  a  Phoenician  historian,  Hesiod,  the  Greek  poet,  Pythagoras, 
the  philosopher,  Herodotus,  a  celebrated  ancient  historian,  Hippocrates, 
the  father  of  medicine,  Diodorus  Sicculus,  the  historian,  Ovid,  the  poet, 
JEtianus,  a  Greek  historian,  and  Pliny,  the  Roman  naturalist,  all  testify 
that  the  primitive  inhabitants  of  the  earth  subsisted  on  a  vegetable  diet 
alone. 

Pliny,  Plutarch,  Galen,  and  Porphyry,  testify  to  the  good  effects  of 
vegetable  diet  in  developing  bodily  vigor,  and  enabling  men  to  bear 
hunger,  *:hirst,  heat,  or  cole: 


DIETETIC    CHARACTER    OF    MAN.  415 


Among  the  modern  names  of  distinguished  individuals  who  have 
borne  testimony  in  favor  of  vegetable  diet  as  conducive  to  the  highest 
physiological  and  psychological  interests  of  man,  derived  from  observa- 
tion, reflection,  and  in  most  instances  from  personal  experience,  we 
may  notice  the  celebrated  Dr.  Cheyne,  of  England ;  Sir  John  Sinclair, 
an  eminent  British  surgeon;  Dr.  Cullen,  of  Edinburg  ;  Dr.  Iv.  Jackson 
and  Gen.  Elliot,  of  the  British  army;  Sir  William  Temple;  Professor 
Adam  Ferguson;  Rosseau ;  Newton;  Dr.  Whitlaw;  Lord  Bacon; 
Sir  Richard  PhillijDs ;  Howard,  the  philanthropist ;  Dr.  Hufeland  ; 
Peter  Gassendi,  a  famous  French  philosopher;  Dr.  Taylor;  Dr.  Aber- 
nethy;  Lord  Kaims  ;  Professor  Dick ;  Shelley,  the  poet;  Mr.  Shillitoe ; 
Rev.  John  Wesley;  Lamartine ;  the  Abbe  Gallani ;  Benjamin  Frank- 
lin; Dr.  Muzzey,  of  Cincinnati;  Dr.  Jennings,  of  Oberlin ;  "Father 
Sewall,  of  Maine  ;  Dr.  S.  Graham,  of  Northampton  ;  Dr.  Alcott,  of 
West  Newtown  ;  Rev.  William  Metcalf,  of  Philndelphia  ;  Dr.  James, 
of  Wisconsin  ;  Dr.  Grindrod,  author  of  Bacchus  ;  O.  S.  Fowler,  the 
phreno^ "'^st ;  and  a  host  of  others  v/ho  could  be  named. 

But  ail  human  experience,  rightly  apprehended,  is  in  favor  of  vege- 
tarianism. It  is  a  fact  which  no  intelligent  historian  will  dispute,  that 
the  most  robust  and  enduring  laborers  of  all  ages  and  countries  ever 
have  been,  and  still  are,  in  the  main,  vegetable-eaters.  The  peasantry 
of  England,  Scotland,  Ireland,  Italy,  Turkey,  Greece,  Germany,  Swit- 
zerland, France,  Spain,  Portugal,  Norway,  Sweden,  Denmark,  Poland, 
and  many  parts  of  Russia,  subsist  principally,  and  many  of  them  en- 
tirely, on  vegetable  food ;  and  the  finest  specimens  of  health,  strength, 
and  activity  are  found  among  that  portion  of  the  peasantry  of  several 
of  the  above  counti'ies,  who  use  no  animal  food  at  all.  The  greater 
portion  of  the  inhabitants  of  Asia  and  Africa  use  but  an  insignificant 
ti'ifle  of  animal  food.  The  millions  of  Hindostan  and  China  use  so 
httle  animal  food  that  it  may  be  regarded  as  a  seasoning  rather  than  a 
substantial  pait  of  their  diet.  The  Greek  and  Russian  laborers,  and 
the  lazzaroni  of  Naples,  subsist  on  a  diet  principally  of  coarse,  farina- 
ceous food,  and  they  are  as  athletic  and  powerful  a  race  as  can  be 
found.  The  Irish  immigrants,  whose  brawny  arms  and  powerful 
sinews  perform  the  hard  work  of  excavating  our  canals  and  construct- 
ing our  railroads,  which  our  flesh-bred  American  laborers  have  not 
strength  to  do,  have  generally  acquired  good,  vigorous  constitutions  on 
the  coarse,  vegetable,  potato  diet  of  the  old  country.  The  Georgians 
and  Circassians,  the  natives  of  the  Otaheite,  Sandwich,  and  Pitcairn's 
Islands,  the  people  of  the  Marquesas  and  Washington  Islands,  the  In- 
dians of  Mexico,  on  the  Tobasco,  the  Polish  and  Hungariaa  peasants 
from  the  Carpathian  Mountains,  the  Spaniards  of  Rio  Saladc.  in  So^tJ^ 


416  DIETETICS. 


America,  and  the  Peruvians,  subsist  mostly  on  coarse,  plain,  vegetable 
food,  and  they  are  among  the  most  beautiful  as  well  as  the  most  hardy 
and  enduring  people  on  earth.  The  slaves  of  Brazil,  the  laborers  of 
Laguira,  the  Moorish  porters  at  Gibraltar,  and  the  porters  at  Terceria 
and  Smyrna,  subsist  on  a  spare,  simple,  vegetable  diet,  scarcely  ever 
partaking  of  animal  food  ;  they  possess  a  most  powerful  muscular 
development,  and  are  able  to  carry  burdens  .^f  from  two  hundred  to 
eight  hundred  pounds. 

A  glance  at  those  nations  and  tribes  whose  inhabitants  subsist  mostly 
on  animal  food,  will  set  the  argument  in  a  stronger  light  by  the  con- 
trast. TiiG  Laplandei-s,  Ostiacs,  Samoides,  Tungooses,  Burats,  Kamt- 
schatdales,  and  Esquimaux,  in  the  north  of  Europe,  Asia,  and  America; 
the  inhal)itants  of  Terra  del  Fuego,  in  Southern  America;  the  people 
of  Andeman's  Island  in  the  Pacific,  the  natives  of  New  Holland  and 
Vun  Diemen's  Land,  an.d  the  Calmuck  Taitars,  all  possess  a  low,  de- 
formed, and  demi-brutal  organization ;  some  of  them  are  stunted  and 
dwarfish,  others  are  coai'se,  rough,  and  hideous.  Their  principal  food 
is  fish,  flesh,  and  all  kinds  of  animal  fats  and  oils  which  they  are  able  to 
procure.  It  should  be  remarked,  too,  that  the  intellectual  and  moral 
constitution  of  these  inferior  races  of  men  is  as  degi'aded  and  depraved 
as  is  their  bodily  organization. 

But  it  will  be  readily  admitted  by  most  persons  that  a  diet  nearly  all 
vegetable  is  better  than  a  diet  nearly  aU  animal,  while  they  will  con- 
tend that  a  due  admixture  of  animal  and  vegetable  substances  is  the 
golden  mean  between  the  two  exti'emes;  and  in  support  of  this  position 
we  shall  be  referred  to  the  well-fed  of  the  Anglo-Saxon  race,  and  partic 
ularly  the  better  classes  of  Europe  and  America.  But  this  objection  is 
easily  met.  We  have  but  to  compare  flesh-eating  Englishmen,  Irishmen, 
Scotchmen,  Americans,  etc.,  with  vegetable-eating  Englishmen,  Irish- 
men, Scotchmen,  Americans,  etc.,  of  the  same  class,  and  of  the  same 
general  habits  in  other  respects,  and  the  problem  is  solved.  The  con- 
trast ever  has  been,  and  I  am  fully  persuaded  ever  will  be,  in  favor  of 
the  superiority  of  an  exclusively  vegetable  diet. 

If,  however,  the  past  experience  of  the  whole  human  family  for  six 
thousand  years,  and  the  coincident  testimony  of  all  respectable  scientific 
authors  who  have  ever  investigated  the  subject  is  not  satis  factor}-,  we 
can  furnish  living,  acting,  moving,  practicing  demonstrations  in  the 
present  tense.  James  Simpson,  Esq.,  president  of  the  English  Vege- 
tarian Society,  stated  at  a  public  meeting  held  at  Glasgow,  June  17,, 
1851,  that  of  the  individuals  belonging  to  the  societ}',  numbering  be- 
tween 600  and  700  adult  members,  203  have  abstained  from  all  kinds 
of  flesh  for  upward  often  years:   153  for  more  than  twenty' years ; 


HYDROPATHIC    COOKERY.  417 

91  for  thirty  years ;  29  for  forty  years ;  and  85  have  abstained  the 
whole  of  tiieir  lives.  Tiiese  vegetarians  belong  indiscriminately  to  all 
trades  and  professions,  and  have,  as  a  body,  ahvays  a  much  higher  and 
more  uniform  standard  of  health  than  flesh-eaters  under  similar  genera] 
circumstances,  and  many  of  them  have  experienced  a  wonderful  im- 
provement in  bodily  vigor  and  mental  vivacity. 

But  we  have  equally  interesting  facts  in  the  United  States.  The 
American  Vegetarian  Society,  though  of  more  recent  date  and  fewnr 
numbers,  has  in  its  ranks  full-grown  men  and  women  who  have  never 
tasted  "flesh,  fish,  or  fowl."  Rev.  Mr.  Metcalfe,  who  is  the  correspond- 
ing secretary  of  the  societj^,  and  also  pastor  of  the  Society  of  Bible 
Christians,  who  have  adopted  vegetarianism  from  religious  motives, 
has  practiced  the  vegetarian  system  for  more  than  forty-one  years,  as 
has  also  his  wife.  In  a  late  number  of  the  Vegetarian  Advocate  he 
says :  "We  have  raised  a  family  of  five  children,  none  of  whom  have 
ever  eaten  flesh.  They  are  all  married  to  vegetai-ians ;  they  all  have 
children,  none  of  whom  have  ever  used  animal  food;  thej  are  healthy, 
vigorous,  and  intellectual."  In  this  society  there  are  now  fifty-one 
persons  who  have  never  eaten  flesh,  nor  tasted  intoxicating  drinks. 


CHAPTER  II. 

HYDROPATHIC   COOKERY. 


Practical  Considerations. — Though  I  am  most  thoroughly  con- 
vinced of  the  superiority  of  a  properly-regulated  vegetable  over  the 
best  plan  of  a  mixed  diet,  yet  I  am  equally  well  av/are  of  the  many 
difficulties  in  the  way  of  the  practical  application  of  this  truth.  The 
greatest  difficulty  of  all  is  the  fact  that  any  considerable  change  of 
dietetic  habits,  whether  it  be  to  better  or  worse,  usually  produces 
more  or  less  disturbance  of  the  aigestive  apparatus ;  and  if  the  change 
be  from  a  more  concentrated  and  stimulating  to  a  more  simple,  coarse, 
watery,  and  unirritating  diet,  the  change  will  be  attended  with  a  degree 
of  languor,  depression,  and  sense  of  debility,  proportioned  \ery  nearly 
to  the  extent  that  the  individual  has  been  injured  by  stimulation  and 
concentration.  This  is  an  exceedingly  important  principle  in  hydro- 
therapeutics,  as  well  as  the  most  difficult  point  to  manage  successfully 
in  the  Vv'hole  Water-Cure  system ;  hence  it  ought  to  be  well  under 
•^io!>■:l  by  both  pi'actitioner  and  patien*. 


418  DIETETICS 


It  may  be  stated  as  a  general  rule,  that  the  greater  i,\e  necessity  for 
a  change  of  dietelu  habits,  the  more  will  the  individual  suffer  tempor- 
arily in  making  such  change ;  the  M'orse  the  physiological  condition 
produced  by  dietetic  errors,  the  more  will  the  feelings  rebel  against  a 
removal  of  the  cause.  This  perverted  sensibility  is  the  rock  on  which  » 
so  many  have  been  wrecked  in  their  attempts  to  reform  their  dietetic 
habits.  Reason  points  in  one  direction,  but  feeling  impels  another 
way,  and  usually  the  latter  ti'iumphs. 

All  pel-sons  know  hoiv  they  feel ;  but  all  do  not  apprehend  the  true 
sources  of  their  good  or  bad  feelings,  and  the  majority  mistake  the 
sense  of  mere  stimulation  for  the  condition  of  actual  strength ;  they  do 
not  distinguish  between  the  feeling  of  strength  and  vital  power ;  they 
do  not  consider  that  strength  or  power  is  only  shown  in  its  waste  or 
expenditure,  not  in  its  accumulation  oi  possession.  To  illustrate  :  A 
man  who  has  long  been  accustomed  to  the  habitual  use  of  intoxicating 
liquor  of  any  kind,  will  experience  a  great  degree  of  prostration,  some- 
times amounting  to  delirium  tremens,  on  abstaining  from  it.  The 
apparent  exhaustion  will  be  in  the  exact  ratio  that  his  system  has  been 
morbidly  affected  by  the  alcohol.  The  habitual  tobacco-chewer,  on 
abandoning  the  use  of  that  narcotic,  feels  himself  to  be  but  the  wi'eck 
of  a  man;  his  limbs  tremble,  his  brain  reels,  and  "horrors  on  horror's 
head  accumulate."  His  perverted  instincts  cry  out,  as  it  were,  for 
more  tobacco,  and  his  feelings  tell  him  that  the  weed  is  the  true 
"elixir  of  life,"  and  if  he  takes  another  quid  he  is  at  once  happy  within 
himself,  and  at  peace  with  all  the  world  again.  Those  who  have  stim- 
ulated freely  on  tea  and  coffee  will  often  suffer  intense  headache,  gid- 
diness, and  nervous  debility  for  several  days,  sometimes  for  weeks,  on 
discontinuing  them,  before  the  systetn  will  recover  its  normal  balance, 
and  feel  natural  without  artificial  aid-  Here  we  discover  the  law  of 
conformity.  The  human  "organism  has  a  wide  range  of  adaptability ; 
it  conforms  itself  as  well  as  possible  to  every  thing  brought  in  contact 
with  or  forced  upon  it.  This  principle  of  adaptability  is  essential  to  its 
existence ;  for  if  every  succeeding  dose  of  spirituous  liquor,  tobacco, 
tea,  coffee,  or  other  injurious  agent,  produced  an  effect  equal  to  the 
first,  the  body  would  very  soon  be  destroyed.  The  vital  powers  may 
have  the  ability  to  defend  themselves  against  deleterious  stimulants  for 
half  a  century,  more  or  less,  and  have  natural  ability'  to  sustain  exist- 
ence two  or  three  times  as  long,  if  not  wasted  in  this  unnatural  war- 
fare.    Let  us  apply  these  considerations  to  the  employment  of  food. 

A  person  long  accustomed  to  the  use  of  animal  food  two  or  three 
times  a  <3ay.  or  of  several  kinds  at  a  meal,  will  fgel  usually  a  great 
Bense  of  weakness,  or  rati  3r  a  disagreeable  craving  Knd  want  of  satis- 


HYDROPATHIC    COOKERY.  419 


faction,  in  the  region  of  the  stomach,  on  the  adoption  of  an  exclusive 
vegetable  diet ;  so,  too,  one  accustomed  to  the  employment  of  nearly 
all  concentrated  preparations,  as  fine  or  superfine  flour,  for  the  farina- 
ceous part  of  his  diet,  will  find  the  first  employment  of  coarse,  unbolted 
meal,  and  many  kinds  of  watery  vegetables  and  fruits,  attended  with 
unpleasant  distension  of  the  stomach,  flatulence,  acidit}%  etc.,  also,  those 
accustomed  to  stimulating  condiments,  as  pepper  and  mustard,  generally 
find  nearly  all  sorts  of  food  to  feel  heavj'-  and  sit  uneasily  on  the  stom- 
ach, on  first  adopting  plain,  unseasoned  dishes ;  and  even  many  per- 
sons who  have  used  animal  food  very  moderately  once  a  day,  experi- 
ence considerable  disquietude  in  the  digestive  organs,  with  a  constant 
craving  for  some  kind  of  stimulus,  on  totally  abandoning  flesh-meat; 
and  this  craving  may  re-occ^ir  occasionally  for  r.ionths. 

Now  if  all  persons  were  tc.  follow  their  feelings  as  the  proper  dietetic 
guide,  all  persons  would  forever  continue  on  in  whatever  dietetic  sys- 
tem should  once  become  with  them  an  established  habit.  It  is  clear, 
therefore,  that  in  prescribing  a  dietetic  course  for  invalids,  our  reason, 
and  not  their  feelings,  is  the  better  guide.  Our  aim  is  not  to  pamper 
morbid,  but  to  restore  healthy  appetites.  I  have  had  many  patients 
under  treatment  whose  first  meal  of  wheaten  grits  and  milk,  or 
brown  bread  and  baked  apples,  raised  a  tremendous  commotion  in  the 
stomach,  producing  distension,  nausea,  and  headache ;  and  yet  in  a 
few  days  the  same  persons  would  partake  of  them  with  a  keen  relish, 
and  with  perfect  satisfaction  to  the  stomach. 

But  in  laboring  to  introduce  better  habits  of  living,  and  in  dealing 
with  invalids,  we  must  take  mankind  in  general,  and  patients  in  partic- 
ular, as  we  find  them,  not  as  we  would  have  them ;  and  in  advising  a 
particular  course  of  diet,  or  in  recommending  changes  in  the  accus- 
tomed regimen  of  individuals,  we  must,  to  be  useful,  have  regard  to 
what  is  possible  in  practice,  as  well  as  to  what  is  ti'ue  in  theory.  Our 
advice  is  sought  by  thousands  who  have  not  the  means  to  carry  out  a 
well-regulated  plan  of  vegetable  diei ;  and  a  well-regulated  mixed  diet 
IS  far  preferable,  theifipeutically,  to  a  very  bad  selection  of  vegetable 
food.  At  ordinary  hotels  and  boarding-houses,  the  fruits  and  vegetables 
are  not  selected  with  especial  reference  to  their  dietetic  qualities,  and 
their  attractiveness  depends  much  more  on  the  butter,  sugar,  vinegar, 
or  spices,  with  which  they  are  served,  than  upon  their  own  intrinsic 
gustatory  properties,  while  nearly  all  the  farinaceous  parts  of  the  food 
are  brought  from  the  baker's  shop,  or  prepared  according  to  the  recipes 
of  "French"  and  "domestic"  cook-books,  which  teach  little  else  than 
the  art  of  compounding  dishes  so  as  to  produce  the  greatest  possible 
uraount  of  dise/ise  in  the  human  bod\-.     Here,  then,  is  a  predicament 


420  DIETETICS. 

Many  persons  find  it  convenient  or  necessary  to  take  their  meals  at 
these  hotels  and  boarding-houses,  where  animal  food  constitutes  the 
best  articles  of  the  table.  Plain  flesh-meat  is  not  liable  to  the  objection 
of  concentration  or  complication,  and  if  of  good  quality  it  contains  the 
proper  relations  of  bulk  and  nutriment.  All  the  objections  to  animal 
food  may  be  summed  up  in  a  single  word — impurily ;  yet  if  it  be  of 
the  best  quality  and  properly  cooked,  it  is  an  absolute  advantage,  a  cor 
rective  to  a  diet  consisting  mainly  of  baker's  bread  and  sweet  cakes. 

How  fai-,  therefore,  it  is  expedient  for  a  Wate.-Cure  patient,  who 
intends  remaining  at  an  establishment  a  few  weeks,  and  then  returning 
to  liis  former  boai'ding  place,  or  usual  dietetic  habits,  to  adopt  vegetarian- 
ism, must  be  left  to  the  intelligent  physician,  in  view  of  all  the  circum- 
stances of  each  particular  case.  It  is  very  certain  that  many  patients 
require,  for  successful  treatment,  total  abstinence  from  all  animal  food, 
not  even  excepting  milk,  and  that  the  majorit}^  will  obtain  more  speedy 
and  thorough  cures  under  a  well-regulated  vegetable  diet;  yet  it  is 
equally  certain  that  a  large  proportion  of  invalids  can  be  cured,  and  can 
subsequently  enjoy,  corapai-atively  speaking,  very  good  health,  on  a 
plain  mixed  diet.  But  the  duty  of  the  true  hydropath  is  not  limited  to 
being  a  mere  curer  of  disease.  His  is  a  higher,  nobler  mission.  He 
is,  or  should  be,  a  reformer  in  the  broadest  sense.  It  may  do  for  the 
dnig-tinkerer  who  only  studies  the  philosophy  of  death,  who  contem- 
plates the  machinery  of  life  only  in  its  abnormal  manifestations,  whose 
ambition  is  mainly  to  silence,  scatter,  subdue,  change,  cr  otherwise 
modify  the  phenomena  of  morbid  symptoms,  and  who  is  as  profoundly 
ignorant  of  the  philosophy  of  Hfe  as  of  any  other  subject  he  has  never 
studied — it  may  do  for  him  to  medicate  the  existing  maladies  of  mortals 
with  all  his  might,  while  he  leaves  the  causes  in  operation  which  pro- 
duce other  maladies  as  fast  as  he  can  modify  existing  ones.  But  better 
things  are  expected  of  a  hydropathic  physician,  who  claims  a  knowledge 
of  the  laws  of  life  and  health,  and  professes  to  cure  disease  by  remov- 
ing the  conditions  upon  which  it  depends,  and  preserve  health  by  avoid- 
ing the  causes  which  produce  disease. 

While,  therefore,  we  yield  to  circumstances  we  cannot  control,  until 
society  can  be  more  thoroughly  indocti-inated  in  the  ti-ue  science  of 
life,  we  should  make  the  best  w^e  can  of  unavoidable  evils.  We  can 
and  should  at  once  reject  all  the  immense  vai'iety  of  complicated  dishes 
of  animal  food,  all  unclean  and  filthy  animals,  and  all  the  unclean  and 
unwholesome  parts  of  animals,  confining  our  dietetic  prescriptions  to  a 
few  of  the  veiy  best  articles  and  pre})arations.  That  patient  or  that 
individual  whose  appetite  cannot  be  satisfied,  as  far  as  fles-h,  fish,  and 
fowl  are  ronrerned,  on  seven  dishes  po;  wepk.  vsith  a  ;hange  for  everv 


HYDROPATHIC    COOKERY.  421 

Ah}  in  the  week,  furnishes  an  example  of  a  deeply-depraved  appetite, 
and  an  additional  evidence,  if  any  is  wanted,  that  all  flesh-eating  is  a 
departure  from  the  physiological  laws  which  the  Creator  has  implanted 
in  the  constitution  of  man. 

Preparations  of  Animal  Food. — Consistently  with  the  principles 
advocated  in  this  work,  all  animal  broths,  soups,  teas,  all  pickled,  salted, 
and  smoked  meats,  all  kinds  of  shell-fish,  all  fried  dishes,  all  dishes 
cooked  in  butter  or  other  grease,  all  minced  or  other  meat  pies,  all 
very  oily  or  greasy  animals  or  parts  of  animals,  all  and  every  thing 
pertaining  to  the  swine — pork,  bacon,  lard,  sausages,  etc.,  and  all  very 
young  or  very  old  animals,  are  to  be  considered  as  among  the  things 
prohibited. 

Beefsteak,  cut  from  the  sirloin,  well-pounded  and  broiled,  is  proba- 
bly the  very  best  food  that  can  be  obtained  from  domesticated  animals. 
The  pieces  called  "  porter-house  steaks"  are  more  tender,  but  too 
fatty. 

Mutton  chops,  prepared  in  the  game  way,  are  next  in  the  order  of 
preference.  For  those  who  have  feeble  teeth  they  are  better  stewed 
in  water  until  they  are  very  tender.  These  chops  should  be  well 
cleaned  of  the  fatty  matters. 

Boiled  mutton  is  nearly  equal  to  the  former  in  healthfulness ;  the  leg 
is  the  preferable  part. 

Slighilu  corned  beef,  boiled  till  the  fibres  cut  easily,  is  admissible. 
The  lean  pieces  are  to  be  selected ;  the  rump  piece,  or  round,  is  one 
of  the  best. 

Roast  beef  is  also  an  admissible  article.  The  sirloin  piece  is,  on  all 
accounts,  to  be  selected  for  roasting.  As  the  roasting  process  of  cook- 
ing renders  the  fitty  matter  particularly  obnoxious,  this  should  be 
carefully  trimmed  off  before  cooking. 

Beef  hash,  made  by  chopping  cold  corned  beef  or  beef -steak  fine, 
and  warming  it  up  with  three  or  four  time*.'  the  quantity  of  cold  boiled 
potatoes  and  water,  no  butter  or  gi'ease  being  employed,  is  not  objec- 
tionable. The  flesh  of  some  wild  animals  of  the  herbivorous  kind  is  at 
least  as  healthful  as  that  of  any  domestic  animals,  as  the  deer,  hnre, 
rabbit,  etc.,  and  may  be  prepared  and  employed  under  the  same  regu- 
lations. 

White  fish,  which  are  not  oily  nor  strong,  broiled  or  boiled,  may  be* 
occasionally  substituted  for  flesh.     The  cod,  halibut,  trout,  black-fish, 
white-fish,  and  perch,  are  among  the  best.     Eels,  salmon,  mackerel, 
herrings,  shad,  sprats,  etc.,  are  among  the  greasy  varieties.     Fish  aro 
more  dry  nnd  unsavory  Hian  flesh  without  gravies.     If  a  gravy  is  em- 


4:12  DIETETICS. 


ployed,  it  should  be  made  of  water,  milk,  a  little  salt,  and  tliickened  with 
a  little  flour  or  meal. 

The  barn-yard  fowl  is  the  best  kind  of  domestic  poultry.  The 
turkey  does  not  dilier  much  in  wholesomeness  from  the  common 
chicken,  yet  its  flesh  is  not  as  well  relished  without  gravies  or  season- 
ings. Geese  and  ducks  should  be  ruled  away  from  the  table.  Chickens 
may  be  broiled,  boiled,  or  stewed  in  water  with  eriual  advantage,  taking 
care  to  skim  olT  the  floating  particles  of  oil  whoj  cooked  in  either  of 
the  last  two  methods. 

Eggs,  rare-boiled,  are  admissible  occasionally  '^hey  should  always 
be  very  fresh,  and  cooked  by  standing  seven  minutes  in  water,  which 
is  to  be  poured  upon  them  at  the  boiling  point,  but  not  allowed  to  boil 
afterward.  This  method  deprives  them  of  the  raw  taste,  and  yet 
leaves  both  the  white  and  yolk  soft  and  digestible.  Po?''hRd  eggs, 
omelettes,  etc.,  are  outrages  upon  human  stomachs. 

Here  we  have  a  list  of  the  best  or  least  objectionable  kinds  of  animal 
food,  which  can  be  so  managed,  if  desirable,  that  the  same  ai'ticle  need 
not  occur  but  once  in  two  weeks ;  and  surely  the  appetite  that  cannot 
be  satisfied  on  this  extent  of  variety,  would  still  want  something  more 
if  it  had  all  the  beasts  of  the  field,  and  fishes  of  the  sea,  and  birds  of 
the  air,  spread  out  before  it.  But  the  true  policy  of  a  dietaiy  system, 
as  far  as  relates  to  animal  food,  is  to  simplify  as  mucli  as  possible,  and 
to  employ  as  few  kinds  as  may  be  ;  therefore  the  very  best  articles  in 
our  list — beef  and  mutton — ought  to  come  upon  the  table  much  oftener 
than  fish  and  fowl. 

Milk,  when  employed  at  all,  should  always  be  used  moderately  by 
invalids,  rather  as  a  seasoning  than  a  part  of  the  food.  Very  little 
should  be  taken  at  the  evening  meal,  as  it  is  apt  to  irritate  the  kidneys, 
or  produce  restlessness  and  uneasy  sleep,  with  fevei'ishness,  and  dry- 
ness or  bad  taste  in  the  mouth.  Sour  milk,  whey,  or  buttermilk,  are 
no  better  in  any  case  than  pure  water ;  but  many  persons  ai*e  fond  of 
them,  and  I  regard  them  as  entirely  harmless.  Boiled  inilk  is  regarded 
by  some  as  more  suitable  for  dyspeptics.  No  doubt  it  will  feel  more 
agreeable  in  cases  wherein  raw  milk  pi-oduces  flatulence ;  but  it  is 
constipating,  and  in  such  cases  milk  had  better  be  avoided  entirely. 

Pot  cheese,  fresh  curd,  and  very  new  pressed  cheese  are  not  objection- 
able when  used  moderately  as  relishes.  The  former  article  should 
never  be  made  in  the  common  brown  earthen  vessels,  as  the  lead  em- 
ployed in  glazing  them  is  acted  on  by  the  acid  of  the  milk,  and  a  poison 
ous  salt  of  the  metal  produced.  Sevend  cases  of  poisoning  from  this 
cause  hara  been  lately  reported  in  the  newspapers. 

Bu.tr.    should    always    be   as    fresli    as    possible,    but    moderately 


HYDROPATHIC    COOKERY.  423 

salted,  and  eaten  cold.  Dr.  Johnson  (Domestic  Hydropathy)  gives  us 
an  excellent  rule  in  relation  to  bread  and  butter.  He  says :  "  For 
breakfiist  and  supper  there  is  nothing  better  than  bread  and  butter. 
JBut  the  butter  should  be  as  small  as  possible  in  quantity.'^' 

Preparations  of  Vegetable  Foods. — Vegetarians  can  prepare 
an  unlimited  variety  of  dishes,  and  still  preserve  the  characters  of  sim- 
plicity and  healthfuhiess.  All  pure  and  undepraved  appetences,  how- 
ever, are  satisfied  witli  moderation  in  variety  as  well  as  in  quantity. 
Invalids  should  not  study  so  much  to  ascertain  how  many  kinds  of  food 
they  can  bear,  as  to  learn  what  particular  combination  of  articles  is 
most  conducive  to  the  recovery  of  health.  But  we  can  easily  present 
an  ample  variety,  so  that  all  can  select  according  to  taste,  fancy,  or 
convenience,  or  in  reference  to  personal  peculiarities.  This  part  of 
our  subject  may  be  conveniently  arranged  under  the  following  heads  : 

a.  Breads. — Unquestionably  the  best  bread  is  that  made  of  coarse- 
gi'ound,  unbolted  meal,  mixed  with  pure  water,  and  baked  in  any  con- 
venient way.  The  earliest  bread-makers  pounded  the  grain  on  a 
smooth  stone  or  in  a  mortar,  wet  it  with  water,  and  baked  it  before 
the  fire  or  in  the  ashes.  Various  savage  tribes  have  made  corn-bread 
in  a  similar  manner,  and  all  who  have  partaken  of  it  testify  to  its  delicious 
flavor  and  excellent  quality.  The  inhabitants  of  new  countries,  where 
flouring-mills  are  not  to  be  found,  frequently  resort  to  this  method  of 
bread-making  from  necessity,  and  they  have  a  sweet  and  wholesome 
aiticle  when  they  do  not  spoil  it  with  grease,  or  shortening.  Many  of 
the  New  England  housewifes  formerly  had  a  method  of  making  bread 
without"  raising  or  fermentation  of  any  kind,  and  I  believe  it  is  still 
practiced  to  some  extent.  It  is  made  generally  of  a  mixture  of  wheaten 
and  rye  flours  and  Indian  meal.  Wheat-meal,  with  a  small  proportion 
of  Indian,  makes  a  fine  unleavened  bread.  It  may,  however,  be  made 
of  wheat-meal  alone,  or  of  rye  and  Indian,  or  of  various  other  admix- 
tures. Fine  wheaten  flour  alone  will  not  make  good  bread  in  this 
way.  Of  whatever  meal  or  flour  composed,  it  is  to  be  wet  up  with 
water  or  milk,  or  both,  into  a  moderately  stiflf  dough,  and  baked  in  the 
old-fashioned  iron  baking-kettle  for  several  hours.  The  New  England 
custom  was  to  make  the  bread  in  the  evening,  put  it  in  the  kettle,  cover 
it  sufficiently  with  hot  ashes  and  coals,  and  let  it  remain  until  morning, 
when  as  good,  sweet,  and  wholesome  bread  as  mortal  ever  tasted, 
would  be  found  on  the  breakfast  table. 

For  making  unleavened  bread,  the  grain  should  be  thoroughly 
cleaned,  all  foreign  ingredients  removed,  the  husks  of  oats  and  buck- 
wheat ani  the  hulls  of  corn  ca:  ^rully  separated-      if  ground  at  an 


424  DIETETICS 


ordinary  flour ing-mill,  the  mill-stones  should  be  sharp,  so  as  to  cut  th* 
seeds  into  fine  particles.  If  mashed  by  dull  stone;?,  the  bran  appears 
in  flakes  or  scales.  The  meal  should  never  be  bolted.  Great  pains 
should  be  taken  to  procure  a  j)lump,  sound  article  of  grain,  and  families 
would  do  wfll  to  keep  a  hand-mill,  and  gi'iud  it  for  themselves,  as  all 
kinds  of  flour  and  meal  are  much  better  and  sweeter  fresh-ground 
than  when  kept  a  long  time.  A  large  cofFee-mili  will  answer  very 
well,  akhough  it  usually  makes  the  meal  rather  too  coarse  and  uneven. 

Wheat-meal  makes  the  very  best  un'«avened  bread.  New  meal  is 
to  be  wet  with  2Jure  soft  water — it  is  impoitant  that  the  water  be  pure ; 
then  formed  into  very  thin  cakes,  and  well  baked  in  an  oven,  stove,  re- 
flector, or  before  the  fire  on  a  plate  or  board.  Indian  meal,  msmaged 
in  the  same  manner,  makes  an  excellent  bread.  It  may  be  made 
thicker  than  the  wheat-meal  cakes.  It  is  called  in  this  coKatrj,  Johnny- 
cake,  or  hoe-cake.  The  fine  Indian  meal  often  found  at  gi'oceries  and 
provision  stores,  does  not  make  good  bread  or  cake ;  it  is,  when  cooked, 
heavy,  sticky,  and  clamm}',  whereas  the  coarse  is  light,  dry,  and  porous. 
Oatmeal  may  be  prepared  in  the  same  way ;  it  is  more  pleasant  mad© 
into  extremely  thin  cakes,  or  wafers.  Rye,  buckwheat,  millet,  and 
barley  may  be  formed  into  similar  preparations  of  bread  ;  but  they  are 
less  agreeable,  and,  as  the  other  grains  are  more  plentiful  and  more 
economical,  as  well  as  more  pleasant,  it  is  hardly  worth  while  to  extend 
this  list.  In  making  any  of  the  above  breads,  cold  or  Avarm  water  may 
be  employed ;  some  prefer  scalding  the  meal. 

The  most  common  as  well  as  the  best  kinds  of  unleavened  bread 
made  from  mixtures  of  various  coarse  meals  are:  1.  Wheat  and  Indian 
meals  in  e]ual  proportions.  2.  Two  parts  of  wheat-meal  to  one  of 
Indian.  3.  Three  parts  of  wheat-meal  to  one  of  Indian.  4.  Four 
parts  of  wheat-meal  to  one  of  Indian.  5.  Equal  parts  of  wheat-meal 
and  oatmeal.  6.  Six  parts  of  wheat-meal  to  one  part  of  soft-boiled 
rice.  7.  Equal  parts  of  lye  and  Indian  meals.  8.  Equal  parts  of  rye, 
Indian  and  wheat-meals.  9.  Two  parts  of  rj^e-meal  to  one  of  Indian. 
10.  Two  parts  of  Indian  to  one  of  rye-meal.  11.  Two  parts  of  Indian 
meal  to  one  of  rye-flour. 

Very  good  and  wholesome  breads  can  also  be  made  of  wheat  or 
other  meal,  and  the  addition  of  some  one  of  a  variety  of  vegetables  and 
fruits.  Among  the  best  are  :  1.  Three  parts  of  wheat-meal  to  one  of 
soft-boiled  beans.  2.  Three  pounds  of  wheat-meal  to  one  pound  of 
good  mealy  potatoes.  3.  Seven  pounds  of  wheat-meal  to  two  of  soft- 
boiled  split  peas.  4.  Three  or  four  parts  of  wheat-meal  to  one  of  soft- 
ooiled  chestnuts.  5.  Two  or  three  parts  of  wheat-meal  to  one  part 
of  good  sweet  or  m'^derately  t?.rt  aj  ydes,  pared,  cored,  and  stewed  or 


HYDROPATIITC    COOKERY.  425 

baked.  6.  Three  or  four  parts  wheat-meal  to  one  of  West  India 
pumpkin,  oi  marrow  squash,  or  cream  squash.  A  fair  article  of  bi-ead 
can  also  be  made  of  three  parts  of  wheat,  corn,  or  barley-meal,  to  one 
of  powderec.  comfrey  root ;  also  of  three  parts  of  wheat-meal  to  one 
(if  boiled  and  pounded  green  corn. 

I  am  satisfied  that  if  our  good  mothers  and  intelligent  sisters  would 
give  their  attention  less  to  mixed  meat  dishes  and  cake  compounding, 
and  more  to  bread-making,  they  would  improve  very  much  on  all  th'-* 
methods  of  preparing  bread-food  now  in  use.  For  one  I  ran  greatly 
in  fiivor  of  the  combination  of  meal  witli  roots  and  fruits ;  and  the  few 
experiments  I  have  been  enabled  to  make  in  this  line  have  satisfied  mo 
that  most  delicious  bread,  and  more  advantageous,  considered  in  refer- 
ence to  the  usual  dietetic  habits  of  society,  than  even  the  best  wheat- 
meal  bread,  can  be  made  of  wheat-meal  and  good  mealy  Irish  potatoes, 
or  sweet  potatoes,  or  good  mealy  apples  and  pears,  and  probably  a 
variety  of  other  fruits  and  vegetables ;  nor  can  I  see  any  reason  why 
dried  or  preserved  fi-uits  can  not  be  advantageously  employed  in  this 
way,  although  I  have  never  seen  the  experiment  tried.  I  know  il 
may  be  replied  to  this,  that  people  may  as  well  eat  the  clear  meal-bread, 
and  a  due  supply  of  the  less  nutritious  fruits  or  vegetables  with  it.  So 
the}'  may.  But  if  they  will  not,  and  loill  use  the  proper  proportions 
of  each  when  compounded  into  the  shape  of  bread,  they  had  better 
have  the  bread.  This  kind  of  bread  would  also  be  a  great  conveni- 
ence, to  say  the  least,  to  persons  who  are  obliged  to  travel  much, 
and  who  desire  to  "  eat  to  live"  while  on  a  journey  as  well  as  when 
at  home. 

Fermented  hreuds  may  be  made  of  any  or  of  all  the  articles  or  com- 
binations mentioned  above,  liut  wheat,  from  its  larger  proportion  of 
gluten,  is  greatly  superior  to  all  other  grains  for  making  fermented 
bread.  The  best  ferment  /s  good  hop  yeast  or  potato  yeast.  Milk 
yeast  makes  a  very  good  bread,  but  it  will  not  keep  well.  Distillery 
yeast,  though  much  used  in  cities  where  distilleries  and  breweries  are 
common,  never  makes  good,  sweet  bread,  but  always  imparts  to  it  a 
strong,  disagreeable,  musty  flavor.  There  are  several  ways  of  making 
good  yeast,  either  of  which  may  be  employed,  as  most  convenient.  I 
know  no  better  recipe  for  hoi)  yeast  than  the  folloAving,  copied  from 
Graham's  Science  of  Human  Life;  "Boil  a  double  handful  of  hops 
in  a  gallon  of  water  for  fifteen  or  twenty  minutes  ;  strain  off  the  liquor 
while  scalding  hot ;  stir  in  Avheat-meal  or  flour  till  a  thick  batter  is 
formed ;  let  it  stand  till  it  becomes  about  blood-warm,  then  add  a  pint 
of  good,  lively,  fresh  yeast,  and  stir  it  well,  and  then  let  it  stand  in  a 
place  where  it  wil/  kosp  at  the  tempeiBture  of  about  70°  Fah.,  till  it 


i2Q  DIETETICS. 


uecomes  perfectly  light."    This  yeast  will  keep  from  one  to  two  weeks, 
if  corked  tight  in  a  clean  jug,  arA  placed  in  a  cool  cellar. 

Yeast  rakes,  which  may  be  kept  for  weeks  or  months,  are  made  by 
Btirring  good  light  yeast  into  Indian  meal,  until  a  fine  dough  is  formed, 
which  is  to  be  made  into  thin  cakes  and  perfectly  dried.  It  is  best 
when  dried  by  exposure  to  a  warm  dry  cun-ent  of  air,  or  what  is  called 
a  drying  w'ind.  Sunlight  or  fire  seems  to  impair  it^  properties.  Some 
persons  add  a  little  rye -meal  to  make  the  Indian  more  adhesive.  These 
cakes,  which  are  commonly  called  hard  yeast,  require  to  be  kept  in  a 
cool  and  dry  atmosphere.  One  of  these  cakes,  an  inch  thick,  tvv-o 
inches  wide,  and  three  inches  long,  is  sufl[icient  for  four  quarts  of  flour 
or  meal.  They  are  soaked  in  milk  or  water  until  completely  dissolved, 
and  then  employed  like  other  j'east. 

Hard  flour  yeast,  or  rubs,  is  prefeiTed  by  some  to  the  former  prep- 
ai*ation.  It  is  made  by  mixing  the  yeast  with  wheat-meal  or  flour  so 
that  it  will  be  formed  into  hard  lumps;  it  is  then  dried  in  a  warm  place, 
without  exposure  to  the  sun.  The  finer  particles  are  for  immediate 
use,  and  the  larger  lumps  may  be  put  into  a  bag,  and  hung  in  a  dry, 
cool  place.  In  using  these  "rubs,"  about  a  pint  are  necessary  for  six 
quarts  of  flour.  It  is  usual  to  let  them  soak  from  noon  till  night,  on 
the  day  preceding  that  for  wetting  up  the  bread. 

Some  persons  may  desire  to  know  hov\^  to  make  yeast  without  ye^t, 
in  other  words,  how  to  procure  the  original  ferment.  It  may  be  ob- 
tained by  subjecting  any  kind  of  meal  or  flour  to  fermentation. 
Wheaten  flour  or  meal  is  generally  employed.  Mix  the  meal  or  flour 
with  water  or  milk  into  a  batter  or  dough,  and  let  the  preparation  stand 
exposed  to  a  temperature  of  about  summer  heat — 60^  to  70°  Fah., 
until  it  "raises"  or  ferments ;  it  will  then  communicate  the  fermenting 
property  to  any  other  material  capable  of  undergoing  a  similar  process. 
The  ferment  can  be  created  more  rapidly  by  the  addition  of  mashed 
potatoes  and  molasses. 

Potato  yeast  is  a  favorite  with  some  domestic  bread-makers,  and  it  is 
certain  that  excellent  bread  can  be  made  with  it.  It  will  not  keep  as 
long  {IS  the  hop  yeast,  but  it  has  the  advantages  of  rising  quicker,  and 
of  not  imparting  the  shai-p,  harsh  taste  to  bread  that  the  former  does, 
when  not  carefully  managed.  Miss  Beechcr  (Domestic  Receipt  Book) 
gives  a  good  recipe,  with  the  exception  of  the  dist'llery  yeast,  which  I 
have  substituted  by  baker's  yeast.  I  have  also  omitted  the  salt,  which 
iippears  to  be  a  kind  of  fixture  in  every  preparation  or  thing  mentioned 
in  her  book :  "  Mash  h:df  a  dozen  peeled  boiled  potatoes,  and  mix  in  a 
hanJful  of  wheaten  flour  [or  meal],  and  after  putting  it  through  a 


HYDROPATHIC    COOKERY.  427 

colander,  add  liot  water  till  it  is  a  batter.     When  blood-warm,  put  in  a 
tea-cup  of  baker's  yeast.     When  raised,  keep  it  corked  tight." 

Milk  yeast,  or  risings,  is  made  by  mixing  two  table-spoonfuls  of 
flour  or  meal  with  a  quart  of  new  milk,  and  keeping  the  preparation  at 
about  or  a  little  below  blood-heat  for  an  hour  or  two.  It  requires 
nearly  twice  as  much  of  this  as  of  the  ordinary  hop  yeast  for  a  loaf  of 
bread.  For  those  w^io  are  fond  of  milk,  this  yeast  makes  an  agreeable 
bread,  to  be  eaten  the  next  day  after  being  made.  In  warm  weather 
it  soon  spoils. 

All  bread-makers  ought  to  be  thoroughly  acquainted  with  the  theory 
of  fermentation;  although  many  persons  acquire,  by  practice  and  ob- 
servation, the  tact  of  managing  the  fermenting  process  very  well,  a 
knowledge  of  its  theory  would  enable  all  to  succeed  more  uniformly, 
as  well  as  qualify  them  to  detect  the  errors  and  correct  the  mistakes 
of  others.     Panary  fermentation,  or,  which  is  the  same  thing,  vinous 
fermentation,  is  the  decomposition  of  the  sugar  or  saccharine  matter 
of  the  grain,  and  the  recombination  of  its  elements  so  as  to  produce 
carbonic  acid  gas  and  alcohol.     The  alcohol  is  mostly  dissipated  by  the 
heat  of  the  oven,  the  remainder  evaporating  subsequently,  and  the 
carbonic  acid  gas,  being  retained  by  the  tenacious  gluten,  puffs  up  or 
raises  the  dough.     If  the  yeast  is  not  intimately  mixed  with  every 
I)article  of  the  meal  or  flour  by  thorough  kneading,  the  fermentation 
%vill  be  unequal,  and  some  portions  of  the  bread  will  be  compact  and 
heavy,  while  others  are  marked  with  open  cavities.     If  the  dough  is 
weH  kneaded,  yet  not  allowed  to  raise  sufficiently,  it  will  be  heavy, 
raw,  and  clammy;   if  fermentation  is  allowed  to  proceed  too  far,  the 
starch  and  mucilage  are,  to  some  extent,  desti'oyed,  and  the  acetous 
fermentation  commences,  w^hich  develops  vinegar,  rendering  the  bread 
disagreeable  and  sour ;  and  if  the  fermentation  is  allowed  to  proceed 
still  further,  the  gluten  is  more  or  less  decomposed,  literally  rotted, 
and  the  putrefactive  stage  of  fermentation  exists ;   the  bread  is  then 
exceedingly  dry,  harsh,  and  as  unpalatable  as  a  dirty  chip.     It  will  be 
seen,  therefore,  that  the  management  of  yeast  bread  requires  the  most 
careful  attention,  and  affords  room  for  the  exercise  of  no  small  degi*ee 
of  judgment.     It  is  a  common  error  to  regard  bread  as  not  over-fer- 
mented unless  it  is  sensibly  acid  to  the  taste.     Fermentation  may  be 
carried  so  far  as  to  destroy  the  richness  and  sweetness  of  the  loaf,  and 
yet  arrested  by  the  heat  of  the  oven  at  a  point  just  short  of  developing 
any  appreciable  sourness.     It  is  here  that  the  majority  of  domestic 
bread-makers  fail.     If  it  does  not  feel  sticky  and  heavy,  on  the  one 
hand,  nor  taste  so«r,  m  the  other,  it  is  pronounced  good.    But  all  really 
good  bread  must,  in  addition  to  these  negative  qualities,  possess  th© 


i28  DIETETICS. 


positive  recommendation  of  being  in  every  way  delicious  to  the 
senses. 

VVliether  fermented  bread  is  made  of  fine  or  superfine  flour,  or  un- 
bolted meal,  it  requires  essentially  the  same  management.  Wheat- 
meal,  or  Graham  bread,  however,  requires,  on  account  of  the  swelling 
property  of  the  bran,  a  somewhat  softer  or  thinner  sponge  than  that 
of  wheaten  flour,  and  it  should  be  baked  one  half  longer ;  an  ordinary 
loaf  should  remain  in  a  brick  oven  about  one  hour  and  a  half.  Although, 
as  already  remarked,  wheat-meal  makes  the  best  fermented  bread,  j'et 
good  rye-meal,  or  this,  coarsely  ground,  and  mixed  with  Indian-meal, 
makes  a  very  good  article  of  bread. 

Raised  bread,  or  bread  made  light  by  means  of  acids  and  alkalies,  is 
used  to  some  extent  in  this  country  and  in  England.  It  has  been 
thought  by  some  that  this  method  of  bread-making  was  an  improve- 
ment on  the  fermenting  process ;  but  in  numerous  experiments  I  could 
never  succeed  as  well  with  acids  and  alkalies  as  with  yeast,  nor  do  I 
conceive  the  plan  to  be  as  healthful,  |)rovided  both  processes  are  man- 
aged in  the  best  possible  way.  It  is  true  that  a  part  of  the  sugar  is 
destroyed  by  fermentation,  and  it  is  true  that  if  the  acid  and  alkali 
usually  employed  exactly  neutralize  each  other  there  is  no  extraneous 
ingredient  formed  and  retained  in  the  bread  except  common  salt,  while 
all  the  natural  properties  of  the  grain  are  left  unchanged.  The  "  choice 
of  evils,"  then,  is  between  the  absence  of  sugar  in  one  case,  and  the 
presence  of  salt  in  the  other.     Which  is  the  greatest  evil .' 

For  making  the  best  unfermented  raised  bread  the  sesquicarbonate 
of  soda  and  hj'drochloric  acid  are  employed,  in  the  proportion  of  forty 
grains  of  alkali  to  fifty  drops  of  the  acid.  The  alkali  is  dissolved 
and  diffused  through  the  mass  of  dough,  and  then  the  acid  is  diluted 
and  worked  into  the  dough  as  rapidly  as  possible.  The  hydrochloric 
acid  combines  with  the  soda  of  the  sesquicarbonate,  forming  common 
Bait,  and  the  carbonic  acid  gas  is  set  free  to  puff  up  the  dough.  Those 
who  esteem  salt  an  alimentary  article,  will  reasonably  presume  that 
this  bread  is  better  than  fermented;  and  those  who  add  a  large  quantity 
of  salt  to  their  fermented  bread,  as  indeed  most  commercial  and  publiti 
bakei's  do,  will  have  an  additional  argument  in  favor  of  the  raised  as 
compared  with  the  fermented  bread.  Besides,  the  raised  bread  has 
the  actual  advantages  that  it  may  be  put  into  the  oven  as  soon  as 
mixed,  and  eaten  when  recently  from  the  oven  without  detriment, 
which  is  not  the  case  with  the  fermented,  although  most  persons  do 
eat  it  fresh  from  the  oven,  and  take  the  consequences.  But  I  do  not 
regard  salt  as  an  aliment;  in  fact  I  consider  breads  of  all  kinds  essen- 
tially deteriorated,  not  only  in  flavor  and  consistence,  but  in  physiologi' 


HYDROPATHIC    COOKERY.  429 

cal  properties,  by  the  admixture  of  salt  in  any  quantity.  It  is  the  very 
last  place  where  salt  should  be  used,  if  employed  at  all.  All  tlie  cereal 
grains,  wheat  especially,  contain  considerable  quantities,  comparatively, 
of  earthy  phosphates,  principally  phosphate  of  lime,  which  seem  to 
he  appropriate  for  the  sustenance  of  the  bony  structure;  but  any  ad- 
ditional and  unnecessary  admixture  of  saline  or  earthy  matters  in  those 
aliments  which  are  already  specially  furnished  with  saline  and  earthy 
materials,  must  be  the  very  worst  use  we  could  make  of  them.  If  salt 
must  be  taken,  let  it  be  with  those  articles  of  food  which  contain  the 
least,  instead  of  the  greatest  proportions  of  earthy  and  saline  matters, 
as  grapes,  apples,  cucumbers,  milk,  and  flesh-meats. 

There  are  a  few  general  rules  in  regard  to  bread-making  which 
may  be  conveniently  summed  up  in  this  place  :  1.  The  best  ovens  are 
constructed  of  an  arch  of  brick,  over  which  is  a  covering  of  ashes,  and 
over  this  a  covering  of  charcoal,  with  a  finishing  layer  of  bricks  over 
all.  This  arrangement  retains  the  heat  so  long  that  cakes,  apples,  and 
pies  can  be  baked  after  the  bread  is  taken  out,  and  custards  and  other 
light  articles  after  them.  2.  A  new  oven  should  be  heated  at  least 
half  of  the  day  previous  to  baking  in  it,  and  the  lid  kept  closed  after 
tlie  firo  is  out  until  heated  for  baking.  3.  The  fire  should  be  made 
nearly  on  the  back  side  of  the  oven.  4.  The  oven  must  be  heated  till 
all  tlie  bricks  look  red,  and  are  free  of  all  black  spots,  but  not  hot 
enough  to  burn  flour  quickly  when  sprinkled  on  the  bottom.  A  better 
test  is  the  thermometer.  5.  Bread  is  light  enough  for  the  oven  as  soon 
as  it  looks  porous  and  full  of  holes,  like  sponge ;  it  will  also  exhale  a  brisk, 
pungent,  but  not  in  the  least  degree  acid,  odor.  6.  When  bread  be- 
comes light  enough  before  the  oven  is  ready,  it  should  bo  kneaded  a 
little,  and  then  kept  in  a  cool  place.  7.  When  the  loaf  does  rise  too 
much,  the  best  corrective  is  to  knead  in  a  solution  of  bicarbonate  of 
soda,  about  a  tea-spoonful  for  every  three  quarts  of  flour.  8.  When 
taken  from  the  oven  bread  should  always  be  taken  out  of  the  pans  or 
tins  and  placed  endwise,  and  if  the  crust  is  very  thick  and  hard,  the 
loaf  should  be  wrapped  in  a  cloth  waning  out  of  cold  water.  9.  Iij 
making  the  sponge  for  fermented  bread,  the  water  or  milk  employed ' 
should  be  about  blood-warm.  10.  When  the  dough  has  been  properly 
kneaded,  it  should  be  covered  with  a  napkin  or  light  woolen  blanket, 
and  kept  at  about  summer  heat,  say  60"  Fah.,  until  the  dough  becomes 
light.  11.  In  very  warm  weather  the  sponge  should  not  stand  over 
night,  unless  kept  in  a  very  cool  place ;  even  then  better  bread  can  be 
made  by  mixing  the  sponge  in  the  morning,  and  baking  in  the  after- 
noon. 12.  All  bread-makers  should  remember  that  the  process  of 
fermentation  is  arrested  at  a  temperature  below  50°  Fah.,  that  it  pro- 


430  DIE  T  E 1  i  C  3. 


ceeds  slowly  at  50*',  moderately  ai  60",  rapidly  at  70°,  and  very  rapidly 
at  SO''. 

6.  Boiled  and  Roasted  Grains  and  Seeds. — Good  clean  ivlieat, 
boiled  in  pure  soft  watei,  and  eaten  with  a  little  sugar,  syrup,  cream, 
or  milk,  is  an  excellent  dish  as  part  of  a  dietetic  course.  It  requires 
boiling  nearly  all  day  to  become  entirely  soft,  hence  the  cracked  wheat 
is  much  more  convenient.  Those  who  would  hare  a  tasting  apprecia- 
tion of  the  vast  difference  in  the  gustatory  properties  of  different  sam- 
ples of  the  same  article,  should  eat,  without  any  seasoning  whatever, 
boiled  wheat  which  has  been  raised  on  a  new,  fresh,  virgin  soil,  and 
that  raised  on  an  old,  worn-out,  badly-tilled  and  viciousl^'-manured 
farm.    The  contrast  might  remind  one  of  pine-apples  and  pine  shavings. 

Hye,  barley,  and  corn  are  equally  wholesome,  prepared  in  the  same 
way,  but  not  as  pleasant.  It  is  difficult  t«.  remove  the  skins  of  corn, 
even  by  a  long  process  of  boiling,  without  the  use  of  ashes,  or  some 
other  alkali. 

Rice  is  a  good  food  when  well  boiled,  but  is  too  nutritious  to  eat 
alone.  Those  who  employ  it  freely  require  a  good  proportion  of  pota- 
toes, or  other  vegetables  or  fruits,  with  it.  When  cooking,  it  should 
never  be  stirred  so  as  to  break  up  or  mash  the  kernels.  A  very  pleas- 
ant but  rather  rich  dish  is  made  by  boiling  the  rice  in  water  until  soft, 
then  stirring  in  a  little  milk,  and  simmering  them  together  about  fifteen 
minutes.  Boiled  rice  is  often  used  as  a  vegetable  with  the  ordinary 
dinner,  and  as  a  dessert  after  dinner.  For  both  purposes  it  is  too  nu- 
tritive, unless  the  dinner  is  extremely  simple  and  abstemious. 

Boiled  jj>eas  and  beans  are  perfectly  wholesome  at  all  stages  of  their 
growth.  Very  young  peas  want  cooking  but  very  little.  Beans  are 
liable  to  produce  more  or  less  flatulence,  except  in  stomachs  long 
accustomed  to  a  very  plain  vegetable  diet.  They  are  more  tough  and 
indigestible  when  boiled  in  salted  w^ater,  as  the  salt  hardens  the  outside 
membrane  or  skin.  If  salt  is  employed,  it  should  be  added  as  they  are 
eaten.  There  are  no  vegetables  that  the  taste  which  has  been  trained 
to  the  love  of  salt,  so  dislikes  without  it  as  rice  and  beans ;  hence  most 
cook-books  direct  that  those  articles  have  plenty  of  salt  cooked  through 
them.  I  know  individuals,  however,  who  have  so  overcome  the  desire 
for  this  condiment  that  they  like  even  rice  and  beans  better  without  it 
than  with  it.  The  small  white  bean  is  an  excellent  vegetable  f»T  win- 
ter use.  It  may  be  simply  boiled  in  water,  and  seasoned  with  a  little 
Bait  and  milk,  or  aflerward  baked. 

Boiled  green  corn  is  usually  put  down  as  bad  food  by  medical  and 
dietetical  writers.     I  can  discover  no  reason  for  its  condemnation.     I 


HYDROPATHIC    COOKERY.  431 

have  employed  it  freely  for  years  at  a  table  for  invalids,  among  whom  tvere 
always  a  greater  or  less  number  of  dyspeptics,  and  I  have  never  Keen 
any  evil  result  from  it.  On  the  contrary,  I  regard  it,  when  tender  and 
milky,  as  excellent.  1  suspect  the  mischief  imputed  to  it  is  due  to  the 
butter  and  salt  with  which  it  is  usually  eaten.  It  is  also  generally 
cooked  in  salted  water,  which  has  a  peculiar  effect  in  rendering  it  \vdrd 
and  indigestible,  much  more  so  than  is  the  case  with  peas  or  beans.  It 
is  incomparably  better  when  boiled  in  pure  water,  and  eaten  with  salt 
added  to  it,  than  when  cooked  in  salt.  The  sweet  corn  is  the  best  for 
boiling  when  green. 

Succotash,  v/hich  is  a  mixed  disL  of  boilec  green  corn  and  boiled 
stringed  beans,  is  a  delicious  and  wholesome  food,  when  seasoned  with 
a  little  miik  or  sweet  c)*eam,  with  but  very  little  if  any  salt. 

Roasted  green  corn  is  not  particularly  unwholesome,  though  not  as 
good  as  boiled.  Parched  corn  is  a  favorite  dish  and  principal  food  with 
some  semi-barbarous  nations,  and  in  some  parts  of  South  America.  It 
is  perfectly  w^iolesome.  Roasted  wJieat,  rice,  buckwheat,  oats,  barley, 
and  chestnuts  are  wholesome,  but  the  process  of  cooking  all  of  them, 
except  the  latter,  is  too  inconvenient  to  deserve  much  consideration. 
Rice,  when  torrefied,  is  considered  more  constipating  than  when  boiled, 
and  has  hence  been  prescribed  in  cases 'of  diarrhea.  Those  who  must 
have  some  substitute  for  tea,  coffee,  cocoa,  and  chocolate,  besides  water 
and  milk,  will  find  a  pleasant  beverage  in  the  infusion  of  the  roasted 
seeds  of  wheat,  oats,  or  barley — equal,  in  fact,  to  the  famous  "  crust 
coffee,"  made  by  steeping  toasted  bits  of  bread-crust  in  hot  water. 

c.  Mushes. — Wheat,  rye,  and  corn  are  the  only  gi-ains  nmch  em- 
ployed in  the  prepaiation  of  mushes;  oatmeal  is  occasionally  used. 
They  are  all  made  by  boiling  in  pure,  soft  water,  though  in  a  very 
few  dishes  more  or  less  milk  is  ised.  WJieaten  grits,  or  cracked  loheat, 
ranks  at  the  head  of  the  list  of  mushes.  As  usually  put  up  at  the 
mills,  wheaten  grits  require  to  be  boiled  five  or  six  hours.  If  the 
grain  is  broken  up  finer,  it  may  be  cooked  in  a  much  less  time.  My 
own  plan  for  several  years  has  btien  to  procure  the  common  grits, 
made  from  the  best  Ohio  or  Western  wheat,  and  run  them  through  a 
hand-mill,  or  large  coffee-mill,  whenever  they  are  wanted  for  cooking. 
This  secures  the  full  flavor  and  freshness  of  the  grain,  and  grinds  the 
grits  fine  enough  to  be  well  cooked  in  an  hour  and  a  half.  The  most 
convenient  method  of  boiling  them  is  by  means  of  a  tin  or  iron  vessel 
surrounded  by  hot  water,  and  contained  within  another  vessel  which 
•■.omes  in  contact  with  the  fire.  This  obviates  the  necessity  of  constan*-ly 
stirring  to  prevent  them  from  burning  on  the  vessel.     They  may  be 


432  DIETETICS. 


managed  very  well  in  an  iron  pot  with  legs,  so  that  the  vessel  can 
Btand  on  the  i"ange  or  stove  without  coming  in  direct  contact  with  the 
fire.  Milk,  or  a  moderate  quantity  of  molasses  or  sugar,  are  the  only 
admissible  seasonings  for  all  kinds  of  mushes. 

Hominy  is  one  of  the  best  mushes.  In  this  mai-ket  it  is  prepared 
from  the  Southern  or  white  corn.  The  fine-gi*ained  hominy  is  usually 
boiled  about  an  hour;  it  may  be  very  well  cooked  in  half  an  hour  by 
boiling  a  few  minutes,  and  then  steaming  it,  without  stirring,  over  as 
hot  a  fire  as  can  be  borne  without  burning.  The  coarse  hominy,  or 
samp,  requires  boiling  five  or  six  hours.  It  should  be  washed  several 
times,  and  the  water  poured  through  a  sieve,  to  separate  the  hulls. 
Two  quarts  of  water  to  one  of  hominy  are  necessary. 

Rye-meal  makes  an  excellent  mush,  and  is  particulai'Iy  useful  in 
cases  of  habitual  constipation ;  to  those  unaccustomed  to  the  grain,  its 
effect  on  the  bowels  is  decidedly  laxative.  It  is  made  precisely  like 
cracked-wheat  mush. 

Indian  meal,  if  coarse-gi'ound,  makes  a  good  mush  known  as  hasty 
pudding.  White  and  yellow  meal  are  equally  agreeable  to  most 
persons  in  this  dish.  It  should  be  stirred  rather  stiflf,  and  cooked  about 
fifteen  minutes. 

Oatmeal  mush  is  a  favorite  with  some  pei"sons,  and  it  makes  a  pleas- 
ant change  for  all.  It  is  cooked  precisely  like  Indian  meal  mush.  In 
Scotland  it  is  called  stirabout. 

Graham  flour,  or  wheat-meal,  is  sometimes  cooked  in  the  form  of 
mush ;  it  may  do  for  a  change,  but  is  not  as  good  as  the  coarser  prep- 
arations of  wheat.  For  infants  and  young  children  it  is  much  better 
than  the  fiirina  which  is  so  extensively  used. 

Farina  is  occasionally  made  into  mush,  but  I  consider  it  too  nutri- 
tious and  concentrated  to  be  employed  in  this  way  as  a  leading  ai'ticle 
of  food,  or  as  a  principal  part  of  a  single  meal. 

d.  Gruels  and  Soups. — Gruels  are  merely  thin  mushes ;  they  are 
usually  prescribed  to  invalids  laboring  under  fevers  and  acute  inflamma- 
tions, or  for  the  purpose  of  promoting  the  action  of  the  bowels.  For 
the  latter  purpose  coarse  Indian  meal,  Graham  flour,  or  cracJced  tvheat 
gi'uel  are  the  best.  A  couple  of  spoonfuls  of  flour  or  meal  ai'e  suflicient 
for  a  quart  of  water.  It  need  boil  only  for  a  few  minutes.  Rice  is 
sometimes  made  into  a  thin  mush  or  thick  gruel,  for  the  table.  It 
helps  to  make  up  a  variety. 

But  few  vegetable  soujis  are  desirable.  Split  peas,  soaked  over 
night,  and  then  boiled  until  completely  diffused  i-n  the  water,  make 
one  of  the  best  dishes  of  this  group.     A  pound  of  peas  is  sufficient  for 


HYDROPATHIC    COOKERY.  433 

two  quarts  of  water.  Garden  beans,  and  common  field  peas,  and  the 
marrow  fats,  either  gi*een  or  dried,  may  be  made  into  tolerable  soups. 
Cook-books  generally  recommend  saleratus  to  be  put  into  all  vegetable 
soups,  and  indeed  into  nearly  every  vegetable  prepaicition  that  can  be 
named,  on  the  idle  supposition  that  there  is  something  terrible  in 
the  shape  of  an  acid  in  every  thing  vegetable,  which  requires  to  be 
neutralized.  It  is  a  pernicious  custom ;  it  is  giving  the  stomach  an 
actual  poison  to  counteract  an  imaginary  one. 

e.  Puddings. — The  majority  of  puddings  found  at  ordinary  hotels, 
Doarding-houses,  and  refectories,  are  vile  compounds.  Plain  puddings 
are  generally  farinaceous  mushes,  in  which  sugar  and  milk  are  cooked. 
The  addition  of  eggs  renders  all  puddings  indigestible  for  weak  stom- 
achs, and  unhealthful  for  all.  The  best  kinds  of  plain  puddings  are  not 
so  objectionable  in  themselves  as  a  part  of  some  of  the  meals,  as  they 
are  liable  to  be  swallowed  hot,  unmasticated,  and  at  the  end  of  a  full 
meal  of  other  things.  The  very  best  puddings  are  made  of  cracked 
wheat,  rye-meal,  hominy,  rice,  stale  brown  bread,  and  Indian  meal. 
Potato  and  apple  puddings  are  very  good,  and  several  other  kinds  are 
perfectly  admissible. 

Crackcd-ivheat  pudding  is  made  by  boiling  the  gi-its  perfectly  soft  in 
water,  adding  a  due  quantit}^  of  clean  brown  sugar,  or  good  New  Orleans 
molasses,  and  milk,  and  baking  in  a  moderate  heat. 

Rije-meal,  hominy,  rice,  and  Indian  meal  puddings  may  be  prepared 
in  precisely  the  same  manner.  Hominy  and  Indian  require  a  hotter 
oven  than  the  other  articles. 

Bread  pudding  may  be  made  by  soaking  pieces  of  stale  but  sweet 
bread  in  milk  until  soft,  then  sweetening  and  baking  it.  A  very  good 
method  is  to  cut  a  hole  in  a  loaf  of  bread,  add  as  much  new  milk  as  it 
will  soak  up  through  the  opening,  tie  it  up  in  a  cloth,  and  boil  it  an 
hour. 

Potato  pudding  may  be  made  of  Irish  or  Carolina  potatoes.  Mix 
into  a  stiff  paste  two  parts  of  boiled  and  mashed  potatoes,  and  one  part 
of  wheat-meal ;  tie  it  in  a  wet  cloth  dusted  with  flour,  and  boil  it  two 
iiours. 

Apple  pudding  is  made  in  various  ways.  One  good  method  is  to 
alternate  a  layer  of  prepared  apples  with  a  layer  of  wheat-meal  dough, 
until  a  tin  pudding-boiler  is  filled,  then  boil  three  hours.  Layers  of 
soft-boiled  rice,  in  lieu  of  the  wheaten  dough,  make  another  kind  of 
apple  pudding. 

Rice  and  apple  pudding  is  prepared  by  boiling  half  a  pound  of  rice 
in  a  pint  and  a  half  of  milk,  till  it  is  soft ;  then  fill  the  pudding-dish 
1—37 


184  DIETETICS. 


half  full  of  apples  pared  and  cored ;  sweeten  with  molasses  or  orovrn 
sugar;  put  the  rice  over  the  fruit  as  a  crust,  and  bake. 

Cracker  pudding,  of  Graham  or  wheat-meal  crackers,  is  made  iQ  the 
same  manner  as  bread  pudding. 

Tapioca  pudding  is  made  by  pouring  a  pint  of  boiled  milk  on  half 
that  quantity  of  tapioca ;  let  it  stand  half  an  hour,  then  add  another 
pint  of  milk,  sweeten,  and  bake.  Sago  pudding  is  made  in  the  same 
way.  These  are  very  bland,  and  not  very  nuti-itive,  and  their  principal 
value  is  to  fill  the  stomach  and  satisfy  the  appetite  when  but  littJo 
nutrition  is  desirable  or  practicable. 

Corn  starch  pudding  is  prepared  by  mixing  the  starch  with  a  sufficient 
quantity  of  milk  to  give  it  the  due  consistence,  then  sweetened  and 
baked.  It  is  rather  indifferent  tis  an  article  of  diet,  and  when  made 
with  eggs  decidedly  bad. 

Sweet  apple  pudding  is  made  by  putting  a  dozen  good  ripe  sweet 
apples,  cut  into  pieces,  into  a  quart  of  milk,  with  a  pint  of  Indian  meal, 
and  baking  about  three  hom-s.  If  lht»  apples  are  not  very  sweet,  a 
little  molasses  may  be  added. 

Snoiv-  hall  pudding  is  made  by  paring  and  coring  large  apples,  and 
inclosing  them  in  cloths  spread  over  with  boiled  rice ;  they  are  then 
boiled  an  hour.  They  should  be  dipped  in  cold  water  before  being 
turned  out  of  the  cloths.     They  may  be  eaten  with  syrup  or  sugar. 

Cottage  pudding  is  one  of  the  best  preparations  of  which  eggs  form 
a  part :  Mix  two  pounds  of  pared,  boiled,  and  mashed  potatoes  with 
one  pint  of  milk,  three  eggs,  and  two  ounces  of  sugar,  and  bake  thi'ee 
quarters  of  an  ^lour. 

Custard  puQvaug  is  a  preparation  in  which  eggs  are  much  more 
wholesome  than  they  ai'c  in  other  puddings,  particularly  tlie  farina- 
ceous kind  :  Mix  four  eggs,  well  beaten,  with  a  quart  of  good  milk,  and 
three  table-spoonfuls  of  clean  brown  sugar;  bake  in  custai'd  cups,  or  a 
common  pudding-dish  about  half  an  hour. 

Apple  custard  is  another  dish  preferable  to  farinaceous  puddings 
which  contain  eggs :  Pare  and  core  half  a  dozen  good  ripe,  mealy, 
tart  apples ;  boil  them  in  a  small  quantity  of  water  till  moderately  soft ; 
put  them  into  the  pudding-dish,  and  sugar  them  over ;  then  add  eight 
eggs  which  have  been  beat  up  with  three  table-spoonfuls  of  sugar,  and 
mixed  with  three  pints  of  milk,  and  bake  half  an  hour. 

Macaroni^  vermicelli,  and  arrow-root  are  sometimes  made  into  pud- 
dings ;  but  there  are  so  many  better  articles  they  are  not  worth  the 
tFOublo. 

f.  Pastry. —  "All  pastry  is  an  abomination,"  says  Pari«,  with  whom 


HYDROPATHIC    COOKERY.  435 


the  majority  of  dietetical  writers  coincide.  The  expression  is  not  too 
sti-ong  in  reference  to  pies,  as  they  usually  come  to  our  tables  from  the 
bakeries.  Nevertheless  pies  may  be  made  very  good  and  wholesome, 
even  much  better  than  the  majority  of  plain  puddings.  Pies,  as  they 
should  be  made,  are  but  little  different  fi-om  bread  and  fruit,  with  an 
extra  quantity  of  sugar.  The  crust  of  a  baker's  pie  is  better  adapted 
to  kill  a  hyena  than  to  nourish  a  human  stomach ;  and  the  crust  of 
ordinary  home-made  or  domestic  pies  is  too  full  of  meat-drippings, 
liog's  lard,  or  butter,  to  be  otherwise  than  pernicious  to  the  stom- 
ach. But  pie-crust  can  be  made  in  a  healthful  manner.  I  know 
the  majority  of  appetites  will  consider  it  harsh,  rough,  and  tough,  and 
many  will  turn  away  from  it  in  disdain,  because  they  cannot  swallow 
it  without  masticating.  But  the  fault  is  with  the  wrongly-educated 
appetite,  not  with  the  healthful  article.  It  seems  a  sad  pity  that  our 
fashionable  eaters,  w^ho  are  so  violently  opposed  to  chewing  their  own 
victuals,  can  not  employ  servants  to  perform  this  necessary  duty  for 
them,  or  invent  some  labor-saving  masticating  machine  ! 

Excellent  pie-crust  can  be  made  of  wheat-meal,  modified  or  short- 
ened with  good  mealy  potatoes  and  fresh  sweet  cream.  Rich  new 
milk  answers  very  well  in  the  place  of  the  cream,  and  if  the  fastidious 
appetite  insists  on  having  the  crust  a  little  smoother,  the  coarsest  part 
of  the  bran  may  be  sifted  out.  In  the  absence  of  cream,  the  crust 
may  be  raised  or  made  light  with  sour  milk  and  super-carbonate  of  soda, 
an  alkali  much  less  objectionable  than  saleratus,  and  the  only  one  that 
ought  to  be  employed  in  cooking.  Indian  meal  may  be  used  in  lieu  of 
wheat-meal  in  forming  the  crust;  equal  parts  of  each  may  be  employed 

Nearly  all  the  mild,  sub-acid,  and  sweet  fruits  may  be  made  intc 
pies;  many  kinds  of  pumpkins  and  squashes  make  delicious  pies;  some 
roots  and  leaves,  as  potfitoes  and  sorrels,  make  very  good  and  whole- 
some pies.  A  few  specimens  of  the  best  kinds  wiU  answer  the  pur- 
poses of  this  work : 

Apple  pie  may  be  made  of  green  apples  cut  into  thin  slices,  or  of 
dried  apples  stewed,  or  of  the  fruit  which  has  been  preserved  in  its 
own  inspissated  juice.  Moderately  tart  and  very  juicy  apples  make 
the  best  apple  pie.  Brown  sugar  or  molasses  is  the  best  sweetening 
for  all  kinds  of  pastry. 

Pears  and  peaches^  when  thoroughly  ripe,  make  excellent  pies, 
managed  the  same  way  as  apples. 

Currants,  when  very  young,  or  when  perfectly  ripe,  are  not  objec- 
tionable. Gooseberries  and  cranberries  are  too  acid,  in  all  stages  of 
their  growth,  for  this  use,  although  I  do  not  apprehend  a  sound  stom- 
ach, well  ti-ained  to  a  vegetable  regimes^  would  experience  any  diffi- 


436  DIETETICS. 


culty  from  their  employment.  Indeed,  I  know  individuals  Tvho  can 
and  do  use  them  without  any  apparent  disadvantage. 

Straivberries,  red  raspherries,  black  raspberries,  blackberries,  wkortle" 
berries,  black  cherries,  and  red  cherries,  all  in  their  season,  when  fully 
ripe,  make  delicious  pies  and  tarts. 

Pumpkins  and  squashes  are  equally  delicious  and  healthful.  They 
are  to  be  boiled,  mashed,  strained,  mixed  with  milk  or  milk  and  water, 
moderately  sweetened,  and  baked  on  a  single  crust.  Of  pumpkins, 
the  West  India  is  the  best  our  mai'ket  affords  for  pie-making,  and 
among  the  best  squashes  for  this  purpose  are  the  cream  and  the 
pumpkin. 

Potato  pies  ai'e  not  as  inviting  as  the  preceding.  The  sweet  potato 
is  the  best.  It  is  cut  into  squares,  with  a  little  sliced  turnip,  covered 
with  milk  or  cream,  and  then  with  a  crust. 

I  have  heard  tomato  pies  well  spoken  of,  but  I  have  had  no  experi- 
ence in  their  making  or  tasting. 

Rhubarb  pie  is  made  by  stewing  the  cut  stalks  till  tender,  sti*aining, 
sweetening,  and  baking  on  an  under  crust.  In  the  usual  method  of 
pie-making,  eggs  are  added.  This  pie  is  rather  too  acid  for  weak 
stomachs. 

Meadow  sorrel,  stewed  and  sweetened,  is  much  less  acid,  and,  to 
my  taste,  more  pleasant  than  rhubarb,  when  made  into  pies  or  tarts. 

Custard  pie  is  one  of  the  best  ways  of  eating  eggs,  providing  tlie 
pie  is  made  of  nothing  but  eggs,  sugar,  and  milk,  and  a  crust  as  herein 
advocated. 

g.  Cakes. — But  veiy  few  kinds  of  cake  are  agreeable  or  desirable  to 
those  whose  appetites  are  under  the  guidance  of  a  reasonable  degi'ee 
of  reason ;  and  to  all  others  no  extent  of  variet}'  and  complication  can 
give  satisfaction.  The  following  list  comprises  the  best  preparations 
of  cake  I  am  acquainted  with : 

Wheat-meal  cakes,  made  of  fi'esh  Graham  flour,  good  brown  sugar, 
and  sweet  cream,  raised  with  sour  milk  and  super-carbonate  of  soda, 
and  well  baked,  is  a  much  superior  article,  as  far  as  health  is  concerned, 
to  either  of  several  hundreds,  the  recipes  of  which  are  found  in  com- 
mon cook-books.  Sweet  cream  makes  a  much  richer  and  sweeter 
cake  than  lard  or  butter.  If  the  cream  is  wioderately  sour,  its  acid 
will  be  sufficient  to  neutralize  the  soda  without  the  sour  milk.  A  very 
fair  article  can  be  made  without  the  cream.  This  kind  of  cake,  if  pre- 
fen-ed,  can  be  raised  with  yeast,  but  it  should  not,  in  such  case,  be 
eaten  till  the  next  day. 

FinefiouT  cake  can  be  managed  in  the  same  manner,  but  it  is  not  as 


HYDROPATHIC    COOKERY.  437 

good  as  the  coarse.  When  fine  flour  is  used,  molasses  is  better  than 
sugar  for  sweetening. 

Indian  meal  cake,  made  of  coarse  yellow  Indian  meal,  is  very  light 
aaid  tender  made  in  the  same  way.  It  is  very  good  without  the  cream. 
It  should  be  sweetened  but  moderately.  Eggs  ai-e  almost  always  put 
in  all  kinds  of  Indian  cake,  but  I  think  it  is  as  pleasant  without  them, 
and  it  is  certainly  more  healthful. 

Biscuits  of  wheat-meal  or  fine  flour,  or  of  wheat  and  Indian,  or  rye 
and  Indian,  may  be  made  by  the  first-mentioned  process,  omitting  the 
sugar. 

Good  gingerbread,  "with  the  part  ol' ginger  omitted,"  and  also  with- 
out alum  and  potash,  can  be  made  with  rye  flour.  New  Orleans  mo- 
lasses, and  sweet  cream,  raised  with  yeast,  or  with  sour  milk  and  super- 
carbonate  of  soda,  and  baked  in  small,  thin  cakes. 

Griddle-cakes  are  made  of  buckwheat  flour,  fine  flour  and  Indian 
meal,  wheat-meal,  wheat  and  Indian  meals,  wheat-meal  and  rice,  or 
of  rye-meal  alone,  or  with  either  of  the  other  meals.  They  may  be 
raised  with  yeast,  or  ^vith  sour  milk  and  super-carbonate  of  soda;  the 
latter  is  the  best  method,  beciiuse  all  feriuont^^d  food  is  objectionable 
-"vhen  eaten  immediately  after  cooking.  They  are  wet  up  with  milk 
or  water,  or  both,  according  to  taste,  and  they  may  be  baked  on  a 
soapstone  gi'iddle  without  a  particle  of  gi-ease.  Sugar,  molasses,  or 
milk,  is  their  proper  accompaniment  for  seasoning. 

Wheat-meal,  with  a  very  little  coarse  Indian,  and  three  paits  of  rye- 
meal  to  one  of  Indian,  make  the  very  best,  sw^eetest,  and  most  whole- 
some kinds  of  griddle-cakes.  Buckwheat  is  improved  by  the  addition 
of  a  small  quantity  of  Indian.  All  of  them,  however,  are  very  good 
alone.  Rice  griddle-cakes  are  prepared  by  mixing  soft-boiled  rice 
with  a  little  flour  or  wheat-meal.  Those  who  are  not  provided  with 
soapstone  gi-iddles  are  obliged  to  use  a  little  oil  of  some  kind  to  prevent 
the  batter  fi-om  adhering.  Olive  oil,  when  perfectly  sweet,  is  much 
better  than  lard  or  butter  for  this  purpose.  Good  olive  oil  may  also  be 
used  as  a  substitute  for  butter  in  oiling  bread,  cake,  and  pie  pans,  or  in 
shortening  bread  or  cakes  for  those  who  have  not  cream,  and  will  have 
shortening  of  some  kind. 

h.  Roots. — All  of  the  esculent  roots — potatoes,  beets,  carrots,  pai^sneps, 
turnips,  gi'ound-nuts,  artichokes,  comfrey,  etc.,  are  equally  healthful 
j>er  se,  but  of  different  degrees  of  nutritive  power,  and  of  very  differ- 
ent degi'ees  of  adaptability  to  weak  stomachs,  or  stomachs  accustomed 
to  the  ordinary  concentrated  or  mixed  diet.  The  potato,  ground-nut, 
comfrey,  and  artichoke,  are   calle.l    mealy  roots,  the   others  toatery. 


4^6  DIETETICS. 


The  potato  fai-  exceeda  all  the  rest  in  amount  of  uuti'itive  property, 
and  is  alone  capable  of  sustaining  the  prolonged  nuti'ition  of  the  human 
being. 

Boiling  is  the  best  method  of  cooking  potatoes;  roasting  in  the 
ashes  is  the  next  best  process,  and  baking,  the  next.  When  boiled, 
they  should  be  taken  out  of  the  water  as  soon  as  they  can  be  easily 
pierced  with  a  fork,  and  then  steamed  about  five  minutes.  Some  prefer 
steaming  instead  of  boiling ;  the  difference  is  very  ti-ifliug.  They  are 
always  richer  flavored  and  more  nuti'itious  wiien  cooked  with  their 
skins  on,  especially  in  the  fall  and  eai'ly  part  of  winter.  A  potato 
should  always  be  pared  very  thin.  Some  cooks  prepare  them  by 
washing  and  paring,  and  soaking  in  cold  water  over  night ;  others  put 
them,  pai-ed  or  not,  as  the  case  may  be,  into  boiling  water  at  first. 
The  former  is  the  best  method  for  new,  and  the  latter  for  old  potatoes. 

Cold  boiled  potatoes,  cut  into  slices,  and  slightly  browned  on  a  griddle, 
make  an  excellent  relish  as  a  part  of  the  breakfast,  and  are  not  to  be 
despised  as  a  whole  breakfast.  For  dyspeptics  who  have  craving  appe- 
tites, and  for  all  who  are  liable  to  eat  too  much  bread,  or  other  very 
nutritive  food,  potatoes  prepared  in  this  way  are  peculiarly  serviceable. 

Boiled  potatoes,  jammed  up  with  a  little  milk  or  sweet  cream,  and 
seasoned  with  a  very  little  salt,  make  as  rich  a  vegetable  dish  as  any 
dne  ought  to  crave.  When  cold,  they  may  be  warmed  up  in  milk,  as  a 
pait  of  either  meal. 

The  Carolina,  or  sweet  potatoes,  may  be  cooked  in  the  same  ways 
precisely  as  the  common  potato.  They  are  generally  preferred  when 
roasted  ;  they  are  delicious  either  baked  or  boiled.  All  the  other  mealy 
roots  may  be  cooked  in  the  same  manner  as  the  potatoes. 

The  watery  roots  are  of  essential  service  in  a  die taiy  system  of  which 
farinaceous  food  or  flesh-meat,  or  both,  constitute  the  leading  features. 
The  parsnep,  when  boiled,  is  among  the  most  digestible  and  nutritive 
of  this  division.  It  keeps  well  through  the  winter,  and  is  most  sweet, 
tender,  and  wholesome  in  the  latter  pait  of  winter  and  early  in  the 
spring,  the  very  time  when  most  needed,  on  account  of  the  abse-nce 
of  fresh  fruits  and  the  scarcity  of  green  vegetables.  A  rich  and 
excellent  dish  may  be  prepared  by  cutting  the  root  into  thin  slices, 
boiling  it  in  water  until  soft,  and  then  simmering  it  a  few  minutes  in 
milk.  The  beet  requires  boiling  a  long  time ;  it  should  always  be 
2ooked  until  perfectly  soft.  The  turnip  should  be  thoroughly  boiled, 
but  taken  from  the  water  as  soon  as  well  done.  The  caiTot  is  more 
nutr "ive  than  the  turnip,  but  less  so  than  the  pai*snip  or  beet ;  it  is  not 
usually  rel'«hed  as  well  witliout  seasonings  as  the  other  watery  roots. 
AH    )f  these  roots  may  be  roasted,  baked,  or  stewed  in  water  or  milk/ 


II  V  D  R  0  F  A  T  iJ  i  C    C  U  0  K  E  E  Y.  439 

Tiit/are  i  .ost  frequently  yrie^^  at  common  hotels  and  boarding-houses, 
but  (hat  is,  of  course,  the  worst  manner  of  cooking  them.  The  radish 
possesses  a  very  little  nutriment,  but  its  acrid  property  is  objectionable, 
and  as  there  are  so  many  better  things  to  eat,  it  is  hardly  worth  re- 
taining. 

In  selecting  the  watery  roots,  great  pains  should  be  taken  to  get  those 
which  are  tender,  brittle,  and  juicy.  All  the  tough,  dry,  fibrous  articles 
should  be  rejected. 

i.  Green  Vegetables. — Many  of  the  articles  known  as  "  greens,"  or 
"spinach,"  are  slightly  nutritive  and  perfectly  wholesome,  and,  like  the 
watery  roots,  tiiey  help  to  make  a  variety,  and  also  offset  the  too 
highly  nutritive  property  of  farinaceous  food,  and  the  too  stimulating 
property  of  animal  food.  Aspai'agus  is  one  of  the  blandest,  and  most 
delicious  and  n^atritive  of  the  class.  It  is  good  enough  for  any  one  to 
eat  with  no  preparation  but  simple  boiling.  The  weakest  and  most 
dyspeptic  stomachs  can  almost  always  use  it  with  comfort  and  satisfac- 
tion. Water-cress,  celery,  onions,  and  lettxice  are  generally  eaten  as 
salads.  The  first  three  are  too  acrid,  and  the  latter  is  too  narcotic. 
Boiled  onions  are  not  objectionable,  except  from  their  rank  and,  to 
many,  disagTeeable  odor.  Boiled  mustard  loaves,  potato  tops,  cabbages, 
cowslips,  spinach,  young  beet  plants,  and  a  variety  of  other  leaves,  leaf- 
stalks, buds,  shoots,  flowers,  are  perfectly  healthful  to  healthy  stomachs. 
When  cooked  in  butter,  or  boiled  with  salted  meat,  or  mixed  with  vin- 
egar, tliey  are  objectionable  only  on  account  of  their  accompaniments. 
Lemon  juice  makes  as  pleasant  seasoning  as  vinegar,  and  this  or  some 
other  organic  acid  is  all  the  condiment  that  can  be  admitted  with  a 
consistent  regard  to  physiological  truth. 

Whenever  greens  or  vegetables  are  employed,  they  should  be  per- 
fectly fresh,  not  dry,  wilted,  nor  long  kept. 

J.  Fruits. — As  a  general  rule  all  sweet  and  sub-acid  fruits,  when 
full-grown  imd  perfectly  ripe,  are  most  wholesome,  if  eaten  without 
any  preparation  or  seasoning.  If,  however,  they  are  too  sour,  a  little 
sugar  may  be  added,  and  the  very  acid  fruits,  as  well  as  those  not  per- 
fectly ripe,  are  improved  by  stewing  and  sweetening.  I  have  never 
found  good  grapes  to  disagree  or  produce  even  temporary  inconveni- 
ence in  the  most  delicate  stomachs.  I  regard  them  as  always  prefer- 
able without  cooking.  Apples,  pears,  and  peaches  always  agree  with  all 
healthy  stomachs,  and  the  worst  dyspeptics  may  soon  acquire  the  habit 
of  eating  them,  not  only  with  apparent  impunity  but  with  absolute  ad- 
vantage, by  partaking  of  a  very  little  at  first,  and  gradually  increasing 


440  DIETETICS. 


the  quantity.  Baked  apples  stand  at  the  head  of  the  class  of  cooked  fruits. 
Apples,  peai-s,  and  peaches  may  be  made  into  an  elegant  dish  by  paring, 
boiling,  sweetening  with  molasses,  and  serving  them  whole.  This  is  an 
excellent  method  of  preparing  peaches  which  are  not  perfectly  ripe,  and 
but  few  sold  in  our  city  markets  are  so.  Pared,  and  cut  into  slices, 
and  sprinkled  with  sugar,  is  another  very  common  and  veiy  good  prep- 
aration. It  is  a  common  prejudice  that  there  is  something  unwhole- 
some or  pernicious  iu  peaches  winch  the  skin  tends  to  counteract  or 
correct,  hence  both  ought  to  be  eaten  together.  The  fact  I  believe  to 
be,  that  both  skin  and  pulp  are  perfectly  harmless.  Tomatoes,  when 
fully  ripe,  are  among  our  best  fruits,  and  are  relished  by  many  persons 
without  cooking.  An  excellent  dish  is  made  by  scalding  them  a  few 
minutes,  to  loosen  their  skins,  peeling,  and  then  stewing  them  sk)wly 
for  an  hour,  or  even  two  (as  they  are  improved  by  cooking  a  long  time), 
and  then  adding  pieces  of  toasted  bread. 

Water-melons  and  musk-melons  are  liable  to  })roduce  colic  and  flat- 
ulence in  very  weak  stomachs,  but  are  unobjectionable  as  a  pait  of 
the  dietary  system  of  those  whose  digestive  powers  are  not  greatly 
impaired.     The  variety  of  musk-melon  called  nutmeg  is  the  richest. 

It  is  the  general  fault  of  dried  fruits  that  the  poorer  qualities  ai'e  se- 
lected for  drying.  Those  w^ho  purchase  them  in  reference  to  their 
dietetic  character,  should  select  such  as  are  of  good,  rich  flavor,  and  not 
very  acid.  Dried  raspben-ies,  strawberries,  whortleberries,  and  black- 
berries, stewed  and  sweetened,  make  a  good  addition  to  dried  apples  and 
peaches.  Most  of  the  dried  plums  which  ai*e  sold  in  our  markets  are 
too  sour  for  pleasure  or  profit.  Dried  cherries  are  a  troublesome  article 
to  handle  on  account  of  the  stones,  but  they  are  among  the  most 
wholesome  articles.  French  prunes,  stewed  and  moderately  sweet- 
ened, are  excellent.  The  boiled  fig  is  a  good  and  very  nutritious 
fruit. 

Pumpkins  and  squashes  can  be  readily  dried  for  winter  use,  by  being 
cut  into  thin  slices,  and  exposed  to  the  sun,  or  placed  in  a  heated  oven. 
Peach  leather  and  tomato  leather,  are  prepared  by  squeezing  out  the 
pulp  of  the  fruits  when  very  ripe,  and  spreading  them  half  an  inch 
lliick  on  plates  or  shingles,  to  dry  until  quite  hard.  Ripe  tomatoes  are 
sometimes  cut  into  slices  without  peeling,  and  dried  in  an  oven.  Tomato 
figs  are  made  by  scalding  and  peeling  the  fruit,  then  boiling  it  in  one 
third  its  weight  of  sugar.  The  figs  are  then  flattened,  and  dried  in 
the  sun,  occasionally  turning  them  and  sprinkling  with  sugar. 

Currants  and  gooseberries  are  too  acil  for  the  majority  of  invalid 
stomachs.  They  raaj'  be  preserve.'  in  the  gi*een  state,  but  are  no* 
worth  the  ti   nble. 


DIETARIES.  441 


k.  Nuts. — These,  with  the  exception  of  the  boiled  chestnut,  perhaps, 
are  not  proper  food  for  invalids,  although,  as  previously  remarked,  they 
lU'e  adapted  to  the  digestive  organs  of  man,  and  other  frugivorous  ani- 
mals, in  a  state  of  nature.  The  butternut  and  walnut  ai'e  too  oily,  an 
objection  which  no  cookeiy  I  am  acquainted  v/ith  can  obviate.  The 
peanut  and  beechnut  are  less  oily,  but  so  long  as  the  world  is  full 
of  better  things  invalids  would  do  well  to  use  them. 

/.  Condiments. — In  relation  to  condiments  or  seasonings,  I  have 
named  milk,  sweet  cream,  sugar  in  some  form,  salt,  and  the  vegetable 
acids,  as  the  only  admissible  ones.  With  the  exception  of  salt,  they 
are  'all  more  or  less  nutritive,  and  are  really  different  forms  of  food. 
Although  the  most  perfect  nutrition  can  be  secured  without  the  aid 
of  any  of  them,  yet  their  moderate  employment  is  not  especially 
injurious,  but,  in  reference  to  the  imperfect  character  of  many  of  our 
fruits  and  vegetables,  sometimes  an  actual  advantage  ;  and  it  is  a  great 
step  in  advance  if  v/e  can  induce  the  highly  cultivated  and  grossly 
pampered  appetites  of  civilized  society  to  submit  to  the  simplicity 
here  enjoined.  The  great  misfortune  of  the  vast  majority  of  people, 
and  of  invalids  especially,  is  that  they  have  stimulated  away,  or  so  pal- 
sied the  organic  instincts  that  they  can  not  appreciate  the  intt^nsic 
properties  of  food.  Every  thing  is  flat,  insipid,  and  unsatisfactory,  save 
perhaps  the  best  kinds  of  fruit,  unless  strongly  charged  with  some 
exti'aneous  seasoning.  If  we  can  induce  them  to  abandon  all  cooked 
oils,  greasy  gravies,  strong  spices,  and  the  whole  list  of  enervating  bev- 
erages, we  can  cure  them  of  their  diseases,  and  when  they  are  restored 
to  such  a  degi'ee  of  health  and  vigor  as  their  remaining  constitutional 
vitality  admits  of,  they  may  take  as  many  progressive  steps  as  they 
please  in  simplifying  and  improving  their  whole  plan  of  diet.  There  is 
room  in  this  direction  for  the  exercise  of  the  best  talent  and  noblest 
energies  of  the  human  mind. 


CHAPTER  III. 

DIETARIES. 


General  Rules  for  Invalids. — Although  all  kinds  of  natural  food 
•i^ree  equally  well  \^ith  all  persons  in  a  pure  state  of  nature,  excepting 
.')  fiii-  as  the  mera  influence  it  habit  is  conoerned.  we  have  now  X.9 


442  DIETETICS. 


deal  almost  wholly  with  men  in  an  artificial  state.  In  a  gi'eat  variety 
of  alimentary  materials,  therefore,  all  of  which  are  intrinsically  whole- 
some, there  is  an  opportunity  for  the  exercise  of  consideraMe  skill  in  adapt- 
ing them  to  invalids,  and  so  managing  them  as  to  restore  the  deeply- 
injured  digestive  powers  and  broken-down  constitutions  to  comparative 
health  and  strength.  The  following  mles,  which  are  but  a  summaiy 
of  the  principles  indicated  in  various  parts  of  this  work,  may  serve  as 
a  kind  of  chart  to  those  who  are  not  thoroughly  familiar  with  all  the 
therapeutic  adaptations  of  diet. 

1.  The  general  errors  in  diet  are  too  gi'eat  concentralion,  improper 
combination,  excessive  quantity,  and  imperfect  quality  of  the  aliment- 
ary materials.  Each  of  these  errors  is  equally  important  to  guard 
against. 

2.  The  diet  may  be  equally  simple  and  wholesome  whether  the 
number  of  articles  employed  be  three  or  tlu'ee  hundred,  provided  but 
few  aiticles  are  eaten  at  a  single  meal. 

3.  Of  whatever  materials  the  diet  consists,  the  due  relations  of  nutri- 
ment and  bulk  must  be  maintained.  Thus  those  whose  food  is  princi- 
pally preparations  of  the  cereal  grains,  require  the  largest  proportion 
of  juicy  fruits  and  watery  vegetables;  those  who  eat  principally  animal 
food  and  potatoes,  require  a  less  proportion  of  the  less  nutritious  foods ; 
and  those  who  eat  potatoes  and  other  less  nutritive  roots  freely,  with 
little  bread  or  meat,  require  the  least  of  the  watery  vegetables  and 
fruits,  etc. 

4.  Chronic  diseases  of  the  digestive  organs  are  always  attended 
with  constipation,  diarrhea,  or  irregularity  of  action ;  in  ninety-nine 
cases  in  a  hundred  constipation  is  the  primaiy  morbid  condition.  All 
these  morbid  conditions  require  essentially  the  same  plan  of  diet,  but 
there  ai-e  two  diseased  states  not  uncommonly  met  with,  where  a  pecu- 
liar modification  of  the  general  plan  is  desirable,  if  not  necessary. 
One  is  an  inflamed,  abraded,  or  ulcerated  condition  of  the  mucous 
membrane  of  the  duodenum,  consequent  on  the  acrid,  coiToding  bile 
which  is  emptied  into  that  intestine  from  a  diseased  liver;  and  the 
other  is  the  same  condition  of  the  rectum,  or  lower  bowel,  consequent 
on  the  existence  of  hemorrhoids  or  piles.  In  these  cases  unbolted 
farinaceous  food,  brown  bread,  crackovi  wheat,  etc.,  often  irritates  and 
increases  the  pain  and  mucous  discharges,  and  as  local  quiet  is  import- 
ant for  the  healing  process,  a  diet  of  mealy  potatoes,  baked  apples,  or 
raw  gi-apes,  with  a  very  little  fiirinaceous  food,  which  may  be  farina, 
arrow-root,  tapioca,  or  even  wheat-meal,  will  aflford  the  patient  more 
quiet  and  fiicilitate  the  cure. 

5.  Invalids  whose  diso  '.ses  have  beer,  specially  produced  by  particu- 


DIETARIES.  448 


lar  articles  of  food,  or  a  particular  plan  of  diet,  will  almost  invariably  be 
inordinately  attached  to  those  articles  of  food,  or  that  plan  of  living. 
Thus  gout  is  often  produced  by  concentrated  farinaceous  food,  and  it 
is  very  rare  to  find  a  gouty  subject  who  has  not  a  sti'ong  repugnance 
to  all  other  kinds  of  farinaceous  food.  Those  patients,  too,  whose  dis- 
eases are  attended  with  an  inflammatory  diathesis  produced  by  the  ex- 
cessive use  of  flesh-meat,  will  almost  always  manifest  a  particular 
horror  toward  just  what  they  need — strict  vegetable  diet.  No  person 
is  more  wedded  to  or  more  passionately  fond  of  sti'ong  green  tea  and 
fine  tea  biscuits,  than  the  female  whose  stomach  is  contracted  to  half 
its  natural  size,  and  whose  whole  nervous  system  is  completely  shat- 
tered by  their  use ;  and  no  spoiled  child  is  more  crazy  after  candies 
and  sweet  cakes  than  one  rendered  feeble,  dull,  gaunt,  and  cachectic 
by  them.  These  facts  should  be  understood  by  both  pati^^nt  and  phy- 
sician ;  by  the  latter  that  he  may  prescribe  successfully  and  mteiligently, 
and  by  the  patient,  that  through  th«  tribulation  of  denying  a  morbid 
appetite,  he  may  work  out  a  salvation  from  its  consequences. 

6.  Invalids  who  have  lost  health  under  the  ordinary  way  of  living, 
should  select  a  moderate  variety  of  the  very  best  articles  of  farinaceous 
food,  and  the  mildest  fruits  and  vegetables,  and  persevere  in  their  use 
until  health  is  re-established,  gradually  proceeding  to  the  use  of  the 
coarser  articles,  or  those  fruits  and  vegetables  which  are  called  crude 
and  flatulent.  By  managing  carefully  in  this  way,  very  bad  dyspeptics 
will  in  due  time  be  able  to  partake  of  nearly  all  healthful  articles  with- 
out discomfort. 

7.  No  rule  can  be  given  for  weighing  or  measuring  the  quantity  of 
food  for  invalids,  as  it  vai'ies  with  age,  exercise,  temperament,  and 
pathological  condition;  a  correct  piactice  is  to  eat  sufficient  to  satisfj 
all  demands  of  actual  hunger,  but  not  to  the  extent  of  producing  a  sense 
of  oppression  in  the  brain  and  muscular  system.  If  the  appetite  be 
not  excessively  morbid,  the  intelligent  observer  will  soon  find,  in  the 
sense  of  hunger  in  the  stomach  on  the  one  hand,  and  the  feeling  of 
weariness,  fullness,  oppression,  and  dullness  in  both  body  and  mind  on 
the  other,  where  the  golden  mean  of  practice  lies.  But  in  extremely 
morbid  states  of  the  digestive  organs,  attended  with  a  craving  sensation, 
instead  of  natural  appetite,  the  best  practice  is  to  appoition  out  such 
quantity  as  the  judgment  approves  in  view  of  all  the  circumstances  of 
the  patient,  and  adhere  to  it  until  a  good  degree  of  natural  appetite  is 
restored. 

8.  Above  all  things  let  the  patient  not  become  a  monomaniac  on  the 
Bubject  of  diet.  It  is  infinitely  less  injurious  to  eat  too  much,  or  too 
little,  or  something  not  strictly  physiological,  than  to  be  always  worrying 


444  DIETETICS. 


for  fear  some  error  has  been  or  will  be  committed.  The  mind  must 
not  be  continually  directed  to  the  stomach,  and  on  the  watch  for  some 
new  or  old  feelii>g  or  symptoms,  to  be  modified,  mitigated,  or  aggra- 
vated after  every  meal.  The  judgment  should  be  convinced  that  the 
general  plan  is  right,  and  that  Nature  has  reserved  to  herself  the  ability 
to  coirect  slight  deviations. 

Therapeutic  Divisioys  of  Diet. — The  "old  school"  works  on 
diet  and  regimen  give  us  eight  technical  divisions  of  diet,  for  medicinal 
l>urposes.  As  truth  can  always  be  seen  to  better  advantage  when  con- 
trasted with  its  opposite,  it  may  be  useful  to  mention  briefly  the  systen? 
we  pronounce  erroneous. 

1.  FulL  Common,  or  Meat  Diet. — This  consists  of  plain  animal  aad 
vegetable  foods,  according  to  the  patient's  appetite ;  and  generally  in 
indolent  diseases,  as  scrofula,  chorea,  epilepsy,  etc.,  and  during  the 
convalescent  stage  after  fevers,  beer,  wine,  or  ai'dents  spirit  is  recom- 
mended with  it. 

2.  Animal  Diet. — An  exclusive  diet  of  animal  food  is  recommended 
only  in  the  disease  called  diabetis.  Pereira  tells  us  that  when  patients 
are  limited  to  animal  food,  a  considerable  variety  is  necessary  to  prevent 
him  from  loathing  one  kind  frequently  repeated,  and  for  this  variety 
Dr.  Pereira  names:  ^^ Butcher^ s  meat,  bacon,  poultry,  game,  fish,  shell 
fish,  cheese,  eggs,  sausages,  and  brawn ;  and  for  common  drink,  to  go 
with  it,  water,  beef-tea,  or  mutton-broth.''''  This  is  sufficiently  strong, 
in  all  conscience,  for  any  sick  person,  but  we  have  not  a  particle  of 
evidence  in  medical  books  tliat  a  single  diabetic  patient  ever  got  well 
upon  it. 

3.  Vegetable  Diet. — Although  a  vegetable  diet  is  named  among  the 
varieties  appropriate  in  certain  cases  of  disease,  an  exclusively  vegetable 
diet  does  not  appear  to  be  recognized  as  orthodox  in  the  allopathic 
materia  medica.  Pereira  disposes  of  it  in  the  fo]lo^ving  summary  and 
contemptuous  manner:  "The  exclusive  employment  of  vegetable  food, 
in  conjunction  with  the  use  of  distilled  water,  has  been  recommendec 
by  Dr.  Lambc,  as  a  remedy  for  cancer,  scrofula,  consumption,  asthma, 
and  other  chronic  dise,^ses ;  but  he  has,  I  suspect,  gained  few,  if  any 
proselytes  to  his  opinions  and  practice." 

4.  Spare,  or  Abstemious  Diet. — This  means,  in  allopathic  parlance 
a  mixed  animal  and  vegetable  diet,  with  the  use  of  fish  instead  of 
butcher's  meat,  becau&e  the  former  »s  supposed  to  be  less  stimulating 


DIETARIES.  446 


and  less  nuti'itious  than  the  latter.     It  is  principally  recommended  in 
the  gouty  and  apoplectic  diatheses,  plethora,  etc. 

5.  Fever  Diet. — This  is  also  called  spoon,  slop,  or  thin  diet.  It  con- 
sists of  teas,  toast-water,  bai'ley- water,  and  acidulous  drinks,  ad  libitum, 
with  light  saccharine  and  amylaceous  preparations. 

6.  Loiv  Diet. — This  does  not  differ  much  in  object  from  the  former, 
although  a  different  set  of  preparations  are  named  as  constituting  it,  as 
gi'uel,  broth,  milk,  bread  or  biscuit,  and  light  farinaceous  puddings.  It 
is  prescribed  in  cases  of  accident,  injuries,  surgical  operations,  and 
acute  inflammations,  with  the  object  in  view  of  depleting  the  system, 
or  effecting  a  change  in  the  blood  similar  to  that  produced  by  bleeding. 

7.  Milk  Diet. — This  includes  the  free  use  of  cowl's  milk,  and  a 
moderate  eraployn' ^nt  of  light  farinaceous  substances,  as  brecid,  arrow- 
root, tapioca,  sago,  and  even  rice,  batter  or  bread  puddings.  It  is  ad- 
vised mostly  in  consumption,  and  other  pulmonary  diseases,  and  after 
severe  bleedings  or  hemorrhages,  and  sometimes  for  the  strumous 
habit  of  children. 

8.  Dry  Diet. — The  object  of  a  dry  diet  is  to  lessen  the  volume  of 
blood,  in  cases  of  aneurism,  valvular  disease  of  the  heart;  it  has  also 
been  recommended  in  diuresis  and  diabetis.  It  consists  of  the  ordinary 
articles  of  a  mixed  diet,  excluding  fruits  and  watery  vegetables,  and 
taken  with  little  or  no  drink. 

As  being  more  philosophical,  as  well  as  hygienic,  I  propose  the  fol- 
lowing technical  divisions  of  hydropathic  diet,  some  one  of  which  will 
meet  the  necessities  of  all  classes  of  invalids,  as  well  as  all  classes  of 
well  folks : 

1.  Full  Mixed  Diet. — Bread,  mush,  butter,  cream,  milk,  potatoes, 
with  some  kind  of  fruit,  for  breakfast  and  supper ;  for  dinner,  bread, 
vegetables,  fruits,  plain  pudding  or  pastry,  with  flesh,  fish,  fowl,  or 
eggs.  This  is  calculated  for  persons  in  health,  and  for  that  class  of  in- 
valids v/ho  have  no  special  or  disproportionate  disease  or  derangement 
of  the  digestive  organs. 

2.  Full  Vegetable  Diet. — Precisely  the  same  as  the  preceding, 
omitting  the  flesh,  fish,  fowl,  and  eggs.  Milk,  cream,  and  butter  are 
not  included  in  the  term  animal  food,  whenever  the  term  occurs  with- 
out  being  defined  in  this  work.  This  diet  is  to  be  preferred  in  all  dis- 
eases attended  with  the  inflammatory  diathesis   or  gi-eat  irritability  of 


UG  DIETETICS 


the  nervous  system ;  in  gout  and  rheumatism,  in  incipient  pulmonary 
diseases,  in  scrofula,  scurvy,  neuralgia,  in  most  of  the  cachexies,  and  in 
ueai-ly  all  of  the  ordinary  female  complaints. 

5.  Strict  Diet. — Bread,  mush,  milk,  sweet  cream,  potatoes,  and  good 
grapes  or  apples,  or  the  equivalent  to  this  set  of  articles  for  each  meai. 
the  quantity  to  be  as  exactly  proportioned  as  possible  to  the  nutritive 
demands  of  the  bodily  structures.  This  is  adapted  to  nearly  all  chronic 
diseases  attended  with  neither  corpulency  nor  emaciation,  but  with  a 
decided  yet  not  extreme  dyspeptic  condition  of  the  digestive  organs. 
It  is  admirably  calculated  for  that  common  and  prevalent  condition  of 
body  known  as  "liver  complaint,"  and  foravariety  of  nervous,  rheumatic, 
and  neuralgic  affections  which  have  been  preceded  by,  and  are  con- 
nected with,  a  long-standing  derangement  of  the  biliary  secretion;  it  is 
peculi.arly  appropriate,  too,  in  almost  all  forms  oi  skin  diseases.  In 
chronic  catarrhal  affections,  and  severe  cases  of  bronchitis,  laryngitis, 
and  ulcerations  of  the  throat,  it  is  indispensable. 

4.  Abstemious  Diet. — This  is  the  same  as  a  sti'ict  diet,  with  the 
exception  that  the  quantity  of  food  should  be  rather  below  the  point  of 
complete  nutrition.  It  is  one  of  the  hydropathic  methods  of  depletion, 
and  is  the  very  "hunger-cure"  itself.  The  especial  object  of  abste- 
mious diet  is  to  favor  absorption  and  depuration.  It  is  heflce  adapted 
to  glandular  enlai'gements,  and  protracted  cases  of  chill  fever,  fever  and 
ague,  and  what  is  called  "dumb  ague,"  all  of  which  are  usually  attended 
with  enlarged  livers  and  spleens.  In  malignant  tumors,  phagedenic 
and  deep-seated  ulcers,  and  foul  skin  diseases,  it  ought  to  be  rigidly 
enforced,  as  long  as  the  general  strength  will  permit,  or  as  long  as  the 
patient  can  keep  about,  unless  the  disease  sooner  yields.  It  is  also 
often  indispensable  in  some  cases  of  mucous  dyspepsia,  attended  with 
great  intolerance  of  food  and  extreme  tenderness  in  the  epigastric  re- 
gion. In  blind,  or  bleeding  piles,  when  they  are  inflamed  and  irritable, 
and  the  bowels  disposed  to  griping  and  diarrhea,  it  is  highly  advanta- 
geous ;  and  in  nearly  all  forms  of  female  complaints,  attended  with 
great  local  relaxation,  prolapsus,  or  other  dispkicement,  it  is  absolutely 
necessary  to  a  perfect  cure. 

5.  Dry  Diet. — The  object  here  is  lo  promote  healthy  and  correct 
morbid  secretions.  When  the  saliva  is  imperfect,  the  gastric  juice 
deficient  or  depraved,  the  bile  acrid  and  irritating,  the  gums  tender 
and  spong5%  etc.,  very  solid  food,  which  secures  thorough  mastication, 
distends  the  stomach  gradually,  and  thus  pvjjnotes  the  most  perfect 


DIETARIES.  i47 

digestion,  is  an  almost  indispensable  means  of  cure.  It  is  seldom  that  it 
requires  to  be  continued  long,  although  no  harm  could  result  from  con- 
tinuing it  a  lifetime,  because  it  is,  or  should  be,  composed  of  a  set  of 
articles  capable  of  sustaining  perfect  and  prolonged  nuti'ition.  Crusts  of 
bread,  roast  potatoes,  Graham  crackers,  and  uncooked  apples,  make  a 
good  arrangement  of  dry  diet.  Man}''  other  selections  can  be  made 
equally  as  good.  Dyspeptics,  \^  ho  are  h'oubled  with  excessive  flatulency, 
acrid  eructations,  water-brash,  sick  headacne,  etc.,  are  benefited  by 
this  diet. 

6.  Watery  Diet. — The  object  of  this  kind  of  diet  is  to  satisfy  the 
appetite  and  stomach,  as  far  as  may  be,  while  the  necessary  amount  of 
nutrient  material  is  supplied,  and  at  the  same  time  wash  out  and  deterge 
fi'om  the  body,  drugs,  minerals,  alkaline  or  saline  accumulations,  and 
other  impurities.  It  is  in  some  cases  a  substitute  for,  and  in  many  an 
improvement  upon  the  practice  of  copious  water-drinking.  Due  pro- 
portions of  milk,  grapes,  parsneps,  and  potatoes,  are  an  example  of  a 
watery  diet.  It  is  adapted  to  gravel,  calculous  concretions,  biliary  ob- 
structions attended  with  gall-stones,  those  forms  of  gout  and  rheumatism 
in  which  chalky  deposits  are  formed  in  and  around  the  joints,  the  dis- 
ease caWed  fragilitas  ossium,  or  brittleness  of  the  bony  structure,  from 
excess  of  earthy  particles  and  deficiency  of  animal  matter.  It  is  also 
advantageous  in  plethora  and  obesity,  and  may  be  resorted  to  in  other 
cases  wherein  free  water-drinking  is  advisable,  but  when  pure  soft 
water  can  not  be  procured. 

7.  Fever  Diet. — This  term  is  almost  a  misnomer.  Strictly  speaking 
fever  and  food  are  antagonistic  ideas.  No  simple  fever,  if  well  man- 
aged, requires  dieting  in  any  way,  save  the  negative  one  of  starvation, 
until  its  violence  is  abated,  and  then  the  diet  would  more  properly  be 
called  convalescent.  It  is,  however,  often  desirable  to  satisfy  the  stom- 
ach or  act  upon  the  bowels,  for  which  purpose  the  Indian  or  wheat- 
meal  gi'uel  may  be  administered.  Toast-water,  barley-water,  lemon- 
ade, etc.,  are  no  better  than  pure  water,  as  fever  beverages ;  yet  they 
are  harmless,  and  very  often  gi'atifying  to  the  patient  or  friends. 

Diet  for  Public  Institutions. — A  glance  at  the  established 
dietary  systems  of  a  variety  of  public  institutions  will  enable  the  reader 
to  see  more  clearly,  by  the  contrast,  the  merits  or  demerits  of  the 
proposed  innovations.  For  this  purpose  I  have  made  such  selections 
as  will  present  a  fair  exhibit!  n  oi  the  leading  ideas  of  the  civilized 
world  on  this  subject. 


^8 


diete:  ics. 


Diet  of  the  London  Hospital 


Per  day 
Breakfast 

Dinner 

Supper 


Common  Diet. 


12  oz.  bread.  "j 

I  pint  porter,  men.  I 

A  pint  do.,  women. 

Gruel. 

8  oz.  beef,  with  pota- 
toes, thrice  a  week.    [^ 

8  oz.  mutton,  with  po- 
tatoes, twice  a  week. 

8  oz.  potatoes,  and 
soup,  with  vegeta- 
bles, twice  a  week. 

1  pint  broth. 


Middle  Diet. 


The  same,  ex- 
cept that  4  oz. 
of  meat  are 
given  instead 
of  8  oz. 


L-w  Wet. 


8  oz.  bread. 
Gruel. 

Broth. 

Gruei  or  broth. 


Milk  Diet. 


12  oz.  bread. 
Gruel. 

1  pint  milk.  ] 

1  pint  milk. 


Diet  at  St.  Bartliolomeiv' s  Hospital. 

Common  Diet,              >         Broth  Diet. 

1 

Fever  Diet. 

Milk  Diet. 

r  Milk  porridge. 

Milk  porridge. 

Milk  porridge. 

12  oz.  bread. 

12  oz.  bread. 

12  oz.  bread. 

6    oz.    mutton     or 

1    pint    milk,   with 

2  pints  milk,   with 

beef. 

Milk  porridge. 

tapioca,       arrow- 

tapioca,      arrow 

1  pint   broth,   with 

12  oz.  bread. 

root,    sago,    rice. 

root,      sago,      or 

Daily 

<*      pt-as  or  potatoes, 

2  pints  broth. 

as    may    be    pre- 

rice,  as    may    be 

lour  times  a  week. 

1  pint  beer. 

scribed. 

prescribed. 

2  pints  beer,  men. 

1  oz.  butter. 

Barley-water. 

Barley-water. 

1  pint  do.,  women. 

1  oz.  butter. 

1  oz.  butter  tv.-ice  a 

Bread  pudding  three 

week. 

times      a      week 
when  ordered. 

In  addition  to  the  heer,  in  the  foregoing  tables,  which  English  phy- 
Bicians,  as  well  as  English  legislators  and  people,  seem  to  regard  as 
"bread  in  another  form,"  wine,  spirit,  porter,  etc.,  are  permitted  as 
extras,  whenever  prescribed  by  the  medical  officers. 

Diet  at  Gw/s  Hosjntal. 


Daily 


14  oz.  bread. 
1^  oz.  butter. 
1    quart    table 

beer. 
8      oz.      meat, 

when  dress'd. 


Middle  Diet. 


12  oz.  bread, 
li  oz.  butter. 
1     pint     table 

beer. 
4      oz.      meat, 

when  dress'd, 

and  A  a  pint 

broth" 


12  oz.  bread. 
1  oz.  butter. 
Tea  and  sugar. 


Milk  Diet. 


12  OZ.  bread. 

1  oz.  butter. 

2  pints  milk. 


Fever  Diet. 


6  oz.  bread. 
1  oz.  butter. 
Tea  and  sugar. 


Half  a  pound  of  beef  (for  beef  tea),  or  arrow- 
root or  sago,  when  ordered.  For  each  diet, 
gruel  or  barley-water,  as  required. 


The  bread  mentioned  in  all  of  these  tables  is  undoubtedly  common 
baker's  bread ;  nothing  is  said  of  its  character  in  the  reports.  Under 
the  head  of  dry  diet,  at  St.  Thomas's  Hospital  (England),  we  find :  14 
oz.  bread  daily;  2  pints  of  beer!  aa-i  water  gi-uel  for  breakfast;  4  oz. 


DIETARIES.  449 

of  butter  four  times  a  week,  for  dinners :  and  rice  pudding  and  4  oz. 
of  butter  for  dinner  the  other  three  days  of  the  week.  No  supper  is 
allowed. 

Aiiiong  the  dietaries  of  Westminster  Hospital  (England),  we  find 
there  is  a  special  diet  for  the  incurables,  consisting  of  the  daily  rations 
of  I  lb.  bread,  h  lb.  meat,  h  ^^.  potatoes,  i  pint  milk,  and  one  pint  of 
porter  ! 

At  St.  George's  Hospital  (England),  under  the  head  of  Extra  Diet, 
2  pints  of  heer  am  allowed  to  each  man,  and  1  ^  pints  to  each  woman  ! 

Among  the  dietetic  curiosities  of  Middlesex  Hospital  (England),  is  u 
Cancer  Diet,  consisting  of  12  oz.  bread,  5  lb.  meat,  ^  lb.  potatoes,  and 
1  pint  milk  daily. 

Diet  at  London  Lying-in  Hosp-^.  ial. 

Breakfast. — Tea,  and  bread  and  butter,  ad  libitum. 

Dinner. — Broth  or  gruel,  until  the  third  day,  after  which  boiled  mutton  and  broth 
Tea. — As  breakl'ast. 

Supper. — Gruel,  after  the  ninth  day,  then  .bread  and  cheese  and  heer.    Should  the  pati(;nt 
be  delicate,  she  is  allowed  wine,  tish,  light  puddings,  or  any  thing  she  may  fancy. 

Diet  ai  Bethlehem  Insane  Hospital. 

Breakfast  . . .  Gruel. 

Dinner Every  day Table  beer. 

Sunday n 

Tuesday \8  oz.  cooked  meat,  8  oz.  bread,  vegetables. 

Friday ) 

Monday  5  •'^^^^^'^  batter  pudding,  4  oz.  bread,  1  oz.  cheese,  or  i  oz. 

<      butter. 

f  Pea  soup,  with  legs  and  shins  of  beef,  8  oz.  bread.    In  thf 
Wednesday ...  V      summer  months,  baked  rice  pudding,  4  oz.  bread,  1  oz 

'      cheese,  or  ^  oz.  butter. 
Thursday  5  ^°^^^^  ^''^^^  puddings,  4  oz.  bread,  1  oz.  cheese,  or  ^  os. 

I      batter. 

Saturday Rice  milk,  8  oz.  bread,  2  oz.  cheese,  or  1  oz.  butter. 

Supper 8  oz.  bread,  2  oz.  cheese,  or  1  oz.  butter  ;  table  beer. 

f  Mutton  broth,   beef-tea,  puddings,  fish,  meat,  eggs,  wine, 

Extras For  the  Sick  ..  .^      strong  beer,  etc.,  or  whatever  may  be  ordered  by  tha 

'-     medical  ofticer. 

.  8  oz.  roast  beef,  8  oz.  bread.   (Mem.  If  it  fall  on  a  meat  day, 
Christmas  Day. )      the  patients  have  a  meat  dinner  on  the  following  day.) 

(      A  mince  pie,  6d. 
New  Yearns  Day. .  Plum  puddings,  in  addition  to  the  ordinary  dinner. 
Good  Friday ....  A  bun.  Id. 

Easter  Monday .  .8  oz.  roast  veal,  8  oz.  bread,  vegetables. 
Whit  Monday  ...  8  oz.  roast  veal,  8  oz.  bread,  vegetables. 
During  the  summer,  about  the  month  of  August,  6  oz.  bread,  bacon,  beans, 
8  oz.  bread,  1  oz.  butter.     Fruit,  consisting  of  currants  and  gooseberries. 
I"  the  ixoflth  of  October,  apple  pies  in  addition  to  the  ordinary  dinner. 

Tne  ordinal    diet   at  the   Edinburgh  Hospital  (Scotland),  is,  for 


450 


DIETETICS. 


hreakfast  and  supper — 1  mutchin  of  porridge,  3  gills  of  milk  or  beer. 
or  5\  oz.  of  fine  bread,  iiilk  or  beer!  For  dinner,  on  Sundays  and 
Thursdays — 1  choppin  of  broth,  8  oz-  of  butcher's  meat  boiled  in  the 
broth,  or  beef-steak,  and  5i  oz.  of  bread.  On  Monday,  Thursday, 
and  Saturday,  a  choppin  of  broth  made  of  beef  and  bones,  barley, 
gi'oats,  potatoes,  and  vegetables,  and  5h  oz.  of  bread.  On  Tuesdays 
and  Fridays,  potato  soup,  with  beef  and  veal,  or  bones,  and  5*  oz.  of 
bread. 

At  the  Royal  Hospital,  Phoenix  Park  (Ireland),  the  breakfast  and 
5?/j;>/?er  are,  ordinarily— 1  pint  of  oatmeal  or  rice  gruel ;  dinner — J  lb. 
of  meat,  12  oz.  of  bread,  and  1  lb.  of  potatoes.  A  full  diet  consists  of 
I  lb.  of  meat,  1  lb.  of  bread,  h  lb.  of  potatoes,  and  1  quart  of  beer.' 

The  dietaries  for  the  prisons  in  England  and  Wales  differ  principally 
from  those  of  the  hospitals  in  being  more  plain  and  simple.  The  pris- 
oners who  are  obliged  to  work  are  actually  fed  more  healthfidly  than 
in  the  hospitals,  where  the  physicians  are  endeavoring  to  cure.  In 
the  prisons  the  beer  is  omitted ;  there  is  a  less  proportion  of  animal 
food,  and  the  suet  puddings,  mince  pies,  old  cheese,  etc.,  are,  fortu- 
nately for  the  inmates,  left  out. 

In  the  English  dietary  system  for  paupers,  the  beer  is  also  omitted, 
except  when  ordered  by  the  physician.  The  following  table  is  a  fair 
specimen  of  the  pauper  diet  of  that  nation : 


Dietary  for  Abie-Bodied 

Paupers. 

Breakfast 

Dinner. 

Supper. 

Bread. 

GrueL 

c  ^  » 
—  O 

Soup 

Bread. 

•3  « 

.J -3 
1.  .-i    33 

oil 

Bread. 

Clieeae; 

Sunday     )  ,, 

Frkl.y^    S"°'^''' 

Monday     }Afen 

Thursday  >  IVomen 

Wednesday  \  ^Jj'"' 

•'   }  Women .... 

^  .      1      C  Men ....       ... 

oz. 

8 
6 

8 
6 
8 
6 
8 
6 

pints. 
H 

^ 

OZ 

6 
5 

pints. 
2 

^ 

oz. 

6 
5 

oz. 

12 
10 

oz. 

12 
10 

oz. 

6 
5 

6 
5 
6 
5 
6 
5 

OS. 

2 

2 

1> 

i^^^rA^y\womea. :::::. 

In  the  above  table,  vegetables  are  not  included  in  the  weight  speci- 
fied. Old  peoi)le  of  sixty  and  upward  are  sometimes  allowed  1  oz.  of 
tea,  5  oz.  of  butter,  and  7  oz.  of  sugar  per  week,  in  lieu  of  the  gi-uel, 
fur  breakfast.  Chik'rcn  above  nine  are  allowed  the  same  quantities  as 
ivomen. 

The  iietary  system  of  the  public  institutions  of  the  United  States 


DIETARIES.  461 


does  not  differ  very  materially  from  those  adopted  by  the  similar  insti- 
tutions of  Great  Britain.  Generally  tea  and  coffee  take  the  place  of 
beer  and  porter,  and  a  gi'eater  proportion  and  variety  of  animal  food 
and  condiments  are  allowed. 

At  the  New  York  Hospital  the  dietary  is :  For  dinner,  on  Tuesdays^ 
Wednesdays,  Thursdays,  and  Saturdays — Beef  soup,  with  beef  and 
potatoes,  and  bread.  On  the  alternate  days — Mutton  soup,  with  mut- 
ton and  bread.  On  Mondays — Boiled  rice,  with  one  gill  of  molasses, 
is  served  ordinarily.  For  breakfast  and  snj^per — Black  tea  and  bread  ; 
1  oz.  of  tea  to  every  six,  and  a  pint  of  milk  to  every  eight  patients. 
Special  diet,  as  eggs,  oysters,  chickens,  crackers,  porter,  wine,  coffee, 
etc.,  is  directed  by  the  attending  physician. 

Diet  of  the  New  York  City  Prison. 

Dinner Monday Mush  and  molasses. 

Tuesday Beef,  with  soup  and  bread. 

Wednesday  ....Mush  and  molasses. 

Thursday Fresh  boiled  beef,  with  soup  and  bread 

Friday Mush  and  molasses. 

Saturday Fresh  beef,  with  soup  and  bread. 

Sunday Mush  and  molasses, 

Breakfast . . .  Coflee,  with  molasses  boiled  in  it,  and  bread. 

The  following  dietary  table  of  the  New  York  Protestant  Half-Orphan 
4sylum,  furnishes  a  fair  specimen  of  the  diet  provided  for  children  in 
i)ur  public  institutions : 

Dinner Monday Bean  soup,  with  bread. 

Tuesday Mutton  soup,  with  vegetables  (potatoes,  turnips,  carrots), 

and  bread. 
Wednesday  ....  Mutton,  hashed  with  potatoes  and  rice ;   clam  soup,  with 
rice,  during  the  summer  months,  with  potatoes  and  rice, 
or  balls  of  flour  boiled. 

Thursday Beef  soup,  with  vegetables  and  bread. 

Friday Beef,  hashed  with  potatoes  and  rice,  and  bread. 

Saturday Cold  corned  beef  and  bread;  except  during  the  summer 

months,  when  crackers  and  cheese  are  substituted   for 

salt  meat,  which  was  found  to  produce  bowel  complaint 

breakfast  . .  .Bread  and  milk  for  the  smaller  children  ;  bread,  with  molasses,  or  sugar,  or 

honey,  for  the  larger  ones. 
Supper Plain  bread,  except  on  Sunday  evening,  when  gingerbread  is  allowed. 

At  the  Pennsylvania  Hospital  (Philadelphia),  for  breakfast— Tea, 
coffee,  or  chocolate,  with  sugar  or  molasses,  and  milk,  and  common 
baker's  bread,  are  allowed  at  discretion.  For  dinner — Soup  always ; 
meat  of  two  kinuo     s.^...  .-f  -  >nf^rq1Kr.  pork  frequently;  vege- 

tables.  according  to  the  season,  poLctLO,^.b  ...xways.  For  supper — Tea 
4nd  bread ;  no  butter  allowed,  unless  prescribed. 


452  DIETETICS. 


The  dietary  of  the  Blockley  Ahus-house  (Philadelphia)  is  verj''  similar 
to  that  of  the  New  York  City  Prison. 

The  dietary  tables  of  the  Baltimore,  Providence,  and  Albany  Alms- 
houses do  not  differ  greatly  from  that  of  the  Bellevue  Alms-house  in 
this  city.  The  following  is  the  general  diet  of  the  paupers  at  the 
Baltimore  Alms-house,  which  may  serve  as  a  sample  of  the  w^hole  : 

Breakfast . . .  Bread,  and  rye  coffee  sweetened  with  molasspa 

Supper Bread,  and  tea  sweetened  with  sugar 

Dinner Monday Beef  and  soup. 

Tuesday Mush  and  molasses. 

Wednesday . . .  i 

Thursday  ....j^^^^^'^^o^P- 

Friday Herring,  mush  and  mulasses,  or  hominy. 

Saturday Beef  and  soup. 

Sunday Pork  and  vegetables. 

The  amount  of  animal  food  allowed  each  pauper  is  8  oz.  of  beef,  or  .5  oz.  of  povk  ■ 
each  laborer  is  allowed  20  oz.  of  bread  per  day  ;  and  aU  others  over  one  year  old,  16  oz. 
of  bread  daily. 

At  the  Manhattanville  Lunatic  Asylum  the  diet  approaches  more 
nearly  to  that  of  an  ordinary  hotel  or  boarding-house.  All  the  mate- 
rials are  said  to  be  of  first  quality,  and  all  the  articles  are  allowed  ad 
libitum.     The  following  is  the  table  : 

Breafe/osf ...  Meat,  hashed  with  potatoes,  or  cold,  with  bread  and  butter,  coffee,  milk, 

and  sugar. 
Dinner Monday ^Roast  meat,  beef,  mutton,  or  lamb,  with  vegetables,  rice, 

Tuesday 5     flour,  bread,  or  fruit  puddings. 

Wednesday , . .  j 

'^aturdav  \  ^°^P»  "^^^  "ce  or  Indian  mush  ;  pastry  on  Wednesday. 

Thursday Corned    beef,  ^vith   potatoes,   and  other  vegetables,   and 

puddings. 

iTiday Boiled  fish  (either  fresh  or  salted  cod,  fresh  halibut,  shad, 

mackerel,  etc.,  in  their  season). 

Sunday Cold  meat,  warm  vegetables,  pastry,  and  cheese. 

Supper Bread  and  butter,  tea  or  milk ;  molasses  gingerbread  on  Wednesday ;  sugar 

cakes  and  cheese  on  Sunday  evening. 

The  intelligent  physiologist  cannot  fail  to  notice  several  grave  and 
important  errors  in  the  existing  dietaries  of  all  our  public  institutions. 
In  some  of  them  tea  or  coffee  is  allowed  on  some  days,  and  refused  on 
others.  It  would  be  an  improvement  either  to  refuse  it  wholly,  or 
allow  it  daily ;  for  all  articles  which  strong'ly  stimulate  the  blood-vessels, 
or  excite  the  nervous  system,  if  administered  one  day,  and  withheld 
the  next.,  l.eep  the  whole  organism  in  a  constant  '.-i-ate  of  perturbation ; 
one  day  partially  exhi!«'" •*"<^''    :  -  '     '  ..<..<-.  .^uoirally  depressed. 

Another  error  is  in  allowiog  iuu  sunu  aiet,  as  meat  and  bread,  one  day, 
and  the  next  reshi**mting  the  diet  tc  slop  food,  as  soup  ani  mush,  or 


DI3TARii:S.  453 


mush  and  molasses,  or  both.  The  solid  and  nuti-itive  !naterials,  in 
whatever  forms  presented,  should  be  nearly  equal  on  each  day.  An- 
other sad  defect  is  the  meager  supply  of  fruits  and  vegetables.  In 
most  instances  they  seem  to  be  regarded  as  mere  indulgences,  whereas 
they  ought  to  be  considered  and  provided  as  a  substantial  part  of  the 
food  itself.  Again,  when  cakes,  pastiy,  and  puddings  are  allowed,  they 
are  among  the  most  unhealthfui  and  indigestible  preparations.  Such  an 
unphysiological,  irregular,  and  disorderly  plan  of  feeding  the  inmates 
of  prisons,  asylums,  or  pauper-houses,  must  be  exceedingly  detrimental 
as  regards  the  character,  health,  and  well-being  of  the  individuals  sub- 
jected to  their  punishments  or  charities,  and  as  regards  the  discipline, 
order  and  economy  in  which  the  public  are  more  especially  inter- 
ested. 

Every  dictate  of  true  humanity  demands,  and  every  consideration 
of  enlightened  public  policy  requires,  that  all  persons,  be  they  wicked, 
poor,  or  homeless,  be  furnished  with  such  food  as  will  be  alike  con- 
ducive to  healthy  bodies  and  sound  minds.  Society  has  a  right  to  study 
economy,  but  not  to  the  extent  of  depriving  a  fellow-creature,  under 
the  name  of  authority  or  alms-giving,  of  the  materials  of  a  pure  and 
perfect  nutrition ;  but  the  expense  of  a  perfectly  wholesome  dietary 
system  would  not  exceed  those  in  general  use. 

There  are  so  many  goo9  things  to  eat  in  the  world,  and  so  many 
ways  of  preparing  them,  as  taste,  convenience,  fancy,  or  economy  may 
dictate,  that  our  difficulty  consists  not  in  finding  sufficient  materials, 
but  in  raaking^judicious  selections. 

The  following  tables  are  presented,  not  as  being  any  better  than  a 
hundred  others  which  could  be  constructed,  but  as  landmarks  to  guide 
those  who  are  not  familiar  with  all  the  details  of  a  dietary  system 
founded  on  physiological  principles. 

General  Dieii^-ry  for  a  Water-  Cure  in  Winter 

Standing  Articles  for  the  Table.  -  Brown  bread,  white  bread,  cold 
cracked-wheat,  hard  biscuits  or  Graham  crackers,  water,  milk» 
sugar,  molasses  or  syrup,  salt. 

Monday. . Breakfast .  Cracked- wheat  mush,  baked  2JOtatoes,  green 

apples  stewed. 

Dinner Beef-steak,  boiled  potatoes,  pea-soup,  apples. 

Dessert — Rice  pudding. 
Supper. . .  .Indian  cake,  stewed  prunes. 

Tuesday Breakfast .  Rye  and  Indian  gi-iddle-cakes,  baked  potatoe», 

dried  apples  stewed. 


464 


DIETETICS. 


Tuesday Dinner 


Wednesday. 


Thursday 


Friday , 


Saturday 


Sunday 


Supper 

.  Breakfast 

Dinner  . . 

Supper. . . 
.Breakfast 

Dinner  . . 

Supper 

.Breakfast 

Dinner  . . 

Supper. . , 
.Breakfast 

Dinner  . . 

Supper. . . 
.Breakfast 

Dinner  . . 


Supper. 


.Mutton  chops,  mashed  potatoes,  boiled  pars- 

neps,  baked  tart  apples.    Dessert — I'ump- 

kin  pie. 
.Indian  mush,  dried  peaches  stewed. 
.  Rice   gruel,  cold    potatoes  browned,   green 

apples  stewed. 
.Corned  beef,  potatoes,  cabbage,  apples.   Des 

sert — Ind:s.n  pudding. 
.Milk  toast,  boiled  apples  sweetened. 
.Wheat-meal   griddle-cakes,  baked   potatoes, 

green  apple  sauce. 
.Boiled  mutton,  potatoes,  white  beans,  stewed 

cranberries.     Dessert — Apple  pie. 
.Dry  toast,  dried  whortleberries  stewed. 
.Water  biscuits,  boiled  potatoes,  dried  peaches 

stewed. 
.Boiled  halibut,  sweet  potatoes,  beets,  baked 

apples.     Dessert — Custai'd. 
.  .Stewed  figs,  hominy. 

.Rye-meal  mush,  cold  sweet  potatoes  brown- 
ed, green  apple  sauce. 
.Roast  beef,  potatoes,  turnips,  dried  currants 

stewed.  Dessert — Tapioca  pudding. 
.Wheat-meal  sweet  cake,  baked  apples. 
.Buckwheat  griddle- cakes,  dried  apples  and 

raspberries. 
.Roast  beef,  potatoes,  Lima  beans,  baked  tart 

apples.      Dessert — Bread   pudding,  dried 

squash  pie. 
.Oatmeal    mush,    dried    apples   and    prunes 

stewed. 


General  Dietary  for  a  Water- Cure  in  Summer. 

Standing  Articles  — As  in  the  preceding  table. 

Monday Breakfast  .Indian  cake,  young  cunauts  stewed. 

Dinner Roast    lamb     potatoes,    asparagus,    grapes 

Dessert—  Tapioca  pudding. 

Supper .Oatmeal  mush,  strawberries, 

Tuesday  . Breakfast  .Rye-meal  mush,  red  cherries. 

Dinner Beef-steak,  potatoes,  green  peas,  stewed  to 

matot.'^.     Dessert — Strawberry  pies. 
Supper, , .  -pry  toast,  whortleben-ies. 


DIETARIES.  455 


Wednesday.. -Brea^^asi .  Cracked-wheat  mush,  red  raspberries. 

Dinner Mutton  chops,  potatoes,  beets,  string  beans. 

uncooked  tomatoes.     Dessert — Rice  pud- 
amg. 

Supper Water  biscuits,  boiled  peaches. 

Thursday Breakfast .  Rice  gruel,  black  raspberries. 

Dinner Corned  beef,  potatoes,  spinach,  gieen  corra, 

tomatoes.     Dessert — Raspberry  pie. 

Supper Milk  toast,  boiled  pears. 

Friday Breakfast .  Rye-meal  cakes,  black  cherries. 

Dinner. Boiled  cod,  potatoes,  succotash,  baked  apples. 

Dessert — Custarc  puddii.g. 

Supper Hominy,  blackberries. 

Saturday  ....  Breakfast  .  Boiled  rice,  peaches. 

Dinner Beef  hash,  potatoes,  squash,  gi'een  peas,  to- 
matoes stewed.     Dessert — Whortleberry 
pie. 
Supper Wheat-meal  water  biscuits,  stewed    black- 
berries. 

Sunday Breakfast .  Oatmeal  cakes,  stewed  gi'een  apples. 

Dinner Boiled  eggs  or  chicken,  potatoes,  succotash, 

musk-melons.     Dessert — Blanc-mange. 
Supper Wheat-meal  sweet  cake,  baked  sweet  apples. 

I  need  not  say  that  in  the  above  tables  the  dry  and  watery  foods,  and 
the  proportions  of  nutriment  and  bulk,  are  so  arranged  that  the  dietary 
for  either  day  of  the  week  would  do  as  well  for  two  or  three,  or  even 
all  the  days  of  the  week. 

There  are  many  cases  of  indigestion,  attended  with  exti'eme  derange- 
ment of  the  digestive  powers,  and  also  various  chronic  inflammations, 
complicated  with  great  torpor  of  all  the  depurating  organs,  for  which 
a  more  strict  diet  i  indispensable.  I  propose,  therefore,  the  following 
plan,  which  is  substantially  that  which  I  have  prescribed  for  several 
years. 

Particular  Dietary  for  Dyspeptics. 

Breakfast Brown  bread,  apples,  grapes,  peaches,  or  pears,  or  other 

very  ripe  uncooked  fruit,  if  sweet  or  subacid.  Drink 
— Water,  or  a  very  little  milk. 

Dinner Baked  or  boiled  mealy  potatoes,  baked  apples,  or  grapes, 

with  brown  bread;  Dessert — Cold  cracked-wheat 
mush,  or  oatmeal,  oi    plain  boilec    rice,  with  a  little 


46b  DIETEriCS. 


sweetened  milk,  or  brown  sugar,  for  seasoning ;  as* 
paragus,  or  green  peas,  in  their  season.  Drink—  A 
very  little  water. 

Supper Brown  bread  toasted,  or  Graham  crackers,  baked  sweet 

apples.  No  drink,  and  the  whole  supper  very  light. 
Baked  or  boiled  mealy  potatoes  may  be  substituted  for 
the  bread  or  crackers. 

Those  who  reject  animal  food,  either  from  principle  or  interest,  will 
find  so  much  of  the  dietaiy  for  Water-Cure  establishments,  as  conve- 
nience admits  or  occasion  requires,  suitable  for  them,  omitting  the  flesh 
part.  To  show,  however,  the  amplitude  of  our  resources  for  eatables, 
without  the  shedding  of  blood,  let  us  look  at  the  subject  in  a  tabular 
form : 

Dietary  for  a  Vegetarian  Hotel. 

Standing  Articles. — Brown  bread,  white  bread,  rye  and  Indian 
bread,  butter,  pot  cheese  oi-  fresh  curd,  sweoi.  cream,  milk,  water, 
lemon  juice,  sugar,  synip  or  molasses,  or  honey. 

Monday Breakfast .  Wheat  and  Indian  griddle-cakes,  rice  gruel, 

baked  potatoes,  stewed  green  apples. 
Dinner. . .  .Mashed    boiled    potatoes,    parsneps,  squash, 
gi*een  corn,  apples,  grapes.   Desseit — Rice 
pudding,  custard  pie. 
Supper ...  .Milk   toast,  cracked-wheat   mush,  potatoes, 
baked  apples,  stewed  figs,  blanc-mauge. 
Tuesday  . .    .  Breakfast .  Corn-meal    cake,    boiled    potatoes,   stewed 

peaches,  stewed  currants. 
Dinner. . .  .Potatoes,  white  beans  boiled,  beets,  tomatoes, 
musk-melons.    Dessert — Tapioca  pudding, 
pumpkin  pie. 

Supper Dry  toast,  plain  sweet  cake,  hominy,  potatoes, 

whortleberries,  stewed  apples. 
Wednesday .  .Breakfast .  Rice  griddle-cakes,  wheaten  grits,  cold  boiled 

potatoes  browned. 

Dinner. Sweet  potatoes,  asparagus,  cabbage,  gi^een 

peas,  tomatoes,  green  pears,  baked  apples. 
Dessert — Custard  pudding,  apple  pie. 

Supper Cracker  toast,  Indian  mush,  potatoes,  stewed 

prunes,  stewed  dried  peaches. 

Thursday Breakfast  .  Graham    flour    hoe-cake,    baked    potatoes 

strawberries,  apples. 


DIETARIES  467 


Thursday Dinner Mashed    potatoes,    baked   carrots,   spinach, 

baked  white  beans,  sweet  oranges,  baked 
apples,  grapes.  Dessert — Indian  pudding, 
tomato  pie. 

Supper Oatmeal  mush,  brown  biscuits,  potatoes,  cus 

tard,  boiled  apples,  peaches,  or  pears. 

Fnday. ^rea t/<Z5^ .  Buckwheat  griddle-cakes,    baked    potatoes, 

stewed  apples,  grapes,  cherries. 

Dinner Common   potatoes,    sweet    potatoes,    gi-een 

corn,  string  beans,  baked  apples,  stewed 
tomatoes.  Dessert — Cracked-wheat  pud- 
ding, whortleberry  pie. 

Supper Rice  gruel,  dry  toast,  potatoes,  boiled  peaches 

or  pears. 

Saturday Breakfast .  Wheat-meal  water  biscuits,  baked  potatoes, 

oranges,  figs,  bananas,  or  grapes. 

Dinner Potatoes,  pea-soup,  parsneps,  boiled  cabbage, 

baked  sweet  apples.  Dessert — Boiled  rice, 
dried  apple  and  green  currant  pie. 

Supper Oatmeal  cake,  cracker  toast,  potatoes,  stewed 

apples. 
Sunday .  Breakfast .  Rye-meal  griddle-cakes^  farina  mush,  pota- 
toes, bc:!ed  peaches,  pears,  or  apples. 

Dinner Sweet  potatoes,  common  potatoes,  turnips, 

asparagus,  stewed  tomatoes,  baked  apples. 
Dessert — Blanc-mange,  pumpkin  or  squash 
pie. 

Supper Plain  biscuits  or  buns,  cold  hominy,  potatoes, 

green  apples  stewed. 

The  dietary  for  a  private  family  only  requh'es  a  little  simplification 
in  the  matter  of  vai'iety ;  there  is  as  much  room  for  improvement  in 
this  direction  as  any  one  is  disposed  to  occupy.  Those  who  see  fit  to 
drop  off  the  superfluities  or  seasonings — salt,  butter,  cream,  etc. — ^will 
experience,  in  due  time,  a  permanent  physiological  advantage,  amply 
compensating  them  for  the  temporary  privation  of  accustomed  indul- 
gences. But  let  me  in  this  place  urge  what  I  have  before  insisted 
upon,  and  what  is  of  vastly  more  importance  to  invalids,  and  even  to 
well  persons,  than  most  people  can  be  made  to  understand,  that  all 
seasonings  or  condiments,  and  especially  butter  and  salt,  are  incompar- 
ably less  injurious  when  added  to  the  article  of  food  after  it  is  cooked, 
than  when  cooked  into  it  The  sweetness,  digestibility,  and  healthful' 
1—39 


458  DIETETICS. 


ness  of  most  of  our  ordinary  vegetables,  I  repeat,  are  always  very 
materially  impaired  by  cooking  them  in  salted  and  gi'easy  water.  This 
is  one  of  the  great  errors  of  most  Water-Cure  establishments,  which 
easily  can  be  and  ought  to  be  corrected.  Let  those  whose  appetites 
or  whose  judgments  ai'e  determined  in  the  employment  of  these  things, 
put  them  on^  not  cook  them  in,  theh-  vegetable  dishes  or  farinaceous 
preparations. 

The  following  catalogue  of  green  fruits  and  vegetables  as  found  in 
the  New  York  mai'kets,  exhibits  our  ample  resources  for  these  articles 
during  each  month  of  the  year.  The  list  is  a  selection  of  the  bes^ 
articles  in  their  seasons,  rather  than  an  enumeration  of  the  whole  : 

January. — Common  potatoes,  sweet  potatoes,  beets,  cabbages,  -svhite 
turnips,  yellow  turnips,  preserved  greeL  peas,  preserved  green  Lima 
beans,  pumpkins,  apples,  grapes. 

February. — Common  potatoes,  sweet  potatoes,  parsneps,  beets,  cab- 
bages, white  turnips,  yellow  turnips,  preserved  gi-een  peas,  preserved 
Lima  beans,  apples,  gi*apes. 

March. — Common  potatoes,  sweet  potatoes,  parsneps,  beets,  cab- 
bages, white  turnips,  yellow  turnips,  preserved  gi-een  peas,  preserved 
green  Lima  beans,  apples,  grapes. 

April. — Common  potatoes,  parsneps,  beets,  carrots,  cabbages,  white 
turnips,  yellow  turnips,  preserved  Lima  beans,  spinach,  apples,  grapes. 

May. — Common  potatoes,  parsneps,  beets,  carrots,  cabbages,  aspara- 
gus, spinach,  apples,  currants,  sti'awberries. 

June. — Common  potatoes,  parsneps,  cabbages,  asparagus,  spinach 
of  various  kinds,  strawberries,  currants,  peas,  string  beans,  cherries, 
gooseberries,  apples. 

July. — Common  wotatoes,  sweet  potatoes,  peas,  beans,  young  corn, 
beets,  squashes,  suawberries,  cuiTants,  gooseberries,  whortleberries, 
chen'ies,  raspberries,  tomatoes,  apples,  peaches,  apricots,  water-melons, 
musk-melons. 

August. — Common  potatoes,  sweet  potatoes,  peas,  beans,  young 
corn,  squashes,  currants,  raspberries,  whortleben-ies,  blackberries,  to- 
matoes, apples,  peaches,  pears,  apricots,  water-melons,  musk-melons, 
plums,  grapes. 

September. — Common  potatoes,  sweet  potatoes,  beans,  young  corn, 
cabbages,  beets,  turnips,  'omatoes,  blackberries,  ipples,  peaches,  pears, 
water-melons,  musk-melons,  plums,  grapes,  pun.pkins. 

October. — Common  potatoes,  sweet  potatoes,  beets,  turnips,  cabbages, 
squashes,  pumpkins,  apples,  pears,  plums,  grapes. 

November. — Commou  potatoes,  sweet  potatoes,  beets,  turnips,  pump 
kins,  squashes,  cabbages,  apples,  pears,  plums,  grapes. 


DIETARIES.  459 


December. — Common  potatoes,  sweet  potatoes,  beets,  tm'nips,  pre- 
served green  peas,  preserved  Lima  beans,  squashes,  pumpkins,  apples, 
grapes. 

I  cannot,  perhaps,  better  conclude  the  dietetic  department  of  this 
work,  than  by  quoting  the  testimony  of  two  eminent  medical  scholars 
and  accurate  observers,  in  favor  of  vegetable  diet  both  as  a  curative  and 
preventive  of  disease.  The  first-named  author  practiced  in  his  person 
and  prescribed  to  his  patients  what  he  preached;  the  latter  did  neither. 

Dr.  William  Lambe  (Water  and  Vegetable  Diet  in  Consumption, 
Scrofula,  Cancer,  Asthma,  etc.)  remarks:  "It  seems,  moreover,  highly 
probable  that  the  inherent  power  of  the  living  body  of  restoring  itself 
under  accident  or  wounds,  is  strongest  in  those  who  use  mostly  a 
vegetable  regimen,  and  who  are  very  sparing  in  the  use  of  fermented 
liquors.  This  has  been  observed  among  the  Eastern  nations.  Sir 
George  Staunton  says  on  this  subject:  'It  is,  however,  to  be  remarked 
that  the  Chinese  recover  from  all  kinds  of  accidents  more  rapidly,  and 
with  fewer  symptoms  of  any  kind  of  danger,  than  most  people  in 
Europe.  The  constant  and  quick  recovery  from  considerable  and 
alarming  wounds  has  been  observed  likewise  to  take  place  among  the 
natives  of  Hindostan.  The  European  surgeons  have  been  surprised 
at  the  easy  cure  of  sepoys  in  the  English  service,  from  accidents  ac- 
counted exti'emely  formidable.'  "  This  felicity  the  relator  attributes  to 
the  causes  which  I  have  mentioned.  I  have  received  the  same  accounts 
from  other  quarters. 

These  facts  are  enough  to  nduce  a  suspicion  that  our  diseases  are 
much  exasperated  by  our  manner  of  living,  and  the  full  diet  of  animal 
food  to  which  we  are  habituated.  One  would  be  apt  to  imagine,  from 
the  common  practice  of  most  of  our  physicians,  and  still  more  of  our 
medico-chirurgeons,  that  excess  and  intemperance  were  the  regular 
methods  of  curing  diseases.  They  have  been  laboring,  during  almost 
the  whole  of  my  medical  life,  to  prove  to  the  public  that  the  doctrines 
of  abstemiousness,  inculcated  by  several  of  our  predecessors,  are  a 
mere  prejudice  and  error.  Li  almost  all  chronic  diseases,  to  forbid  the 
use  of  vegetables  is  a  part  of  the  established  routine.  If  there  be  a 
little  heart-burn  or  flatulency,  all  vegetables  are  instantly  proscribed. 
Infants,  even,  are  loaded  with  made  dishes,  and  their  breaths  smell  of 
wine  and  strong  liquors.  Nay,  to  such  an  extent  are  these  abomina- 
tions carried,  that  when  their  stomachs  revolt  against  these  unnatural 
compounds,  with  instinctive  horror,  and  the  importunities  of  nature 
cannot  be  wholly  resisted,  a  little  fruit  is  held  out  to  them  as  a  sort  of 
premium,  and  as  a  reward  for  foroiEg  down  the  nauseous  farrago  which 
they  loathe. 


400  DIETETICS. 


The  English  surgeon,  John  A.  Forsyth,  somewhat  celebrated  as  uu 
author  on  medical  and  dietetical  subjects,  and  aveiy  accurate  historical 
writer,  observes,  in  allusion  to  the  connection  between  the  vegetarian 
food  and  the  health  of  the  early  inhabitants  of  the  earth  (Dictionary 
of  Diet):  *'The  decays  of  nature,  in  the  expiring  periods  of  life,  were 
the  only  infirmities  to  which  men  were  then  liable  ;  and  though  their 
limbs  sometimes  failed  to  perform  their  office,  thoir  health  and  appetite 
continued  with  them  till  life  was  no  more.  In  this  rude,  but  natural 
Btate,  the  food  of  mankind  is  said  tf^  have  continued  upward  of  two  thou- 
sand years,  during  which  period  the  cook  and  the  physician  were  equally 
unknown.  It  is  not  easy  to  say  at  what  period  man  exchanged  vege- 
table for  animal  diet;  but  certain  it  is,  that  he  no  sooner  began  to  feed 
on  flesh,  fowl,  and  fish,  than  seasonings  of  some  kind  became  requisite, 
not  only  to  render  such  food  more  pleasing  and  palatable,  but  also  to 
help  digestion  and  prevent  putrefaction.  Of  these  seasonings,  salt  was 
probably  the  first  discovered ;  though  some  are  inclined  to  think  that 
savory  roots  and  herbs  were  first  in  use ;  spices,  however,  as  ginger, 
cinnamon,  pepper,  cloves,  and  nutmegs,  by  degi-ees  came  into  use,  and 
the  whole  art  of  cookery  gradually  improved,  till  it  reached  its  present 
climax  of  perfection.  Eating  of  animal  food  was  evidently  adopted  as 
necessary  to  guard  against  famine,  the  consequence  of  the  scai'city 
and  bad  condition  of  vegetable  productions.  We  find,  therefore,  that 
in  process  of  time,  and  to  aid  their  mutual  wants,  as  well  as  to  protect 
the  weak  against  the  strong,  the  industrious  from  the  indolent,  men, 
by  general  consent,  began  to  portion  out  to  each  other  a  certain  meas- 
ure of  land,  to  produce  them  their  supply  of  vegetables.  Reason  soon 
after  suggested  the  expedient  of  domesticating  certain  animals,  equally 
to  assist  them  in  their  labors  and  to  supply  them  with  food.  Hogs,  it 
is  said,  were  the  first  animals  of  the  domestic  kind  that  appeared  on 
their  tables,  as  then  they  held  it  to  bd  ung^^iteful  to  devour  the  beasti 
that  assisted  them  in  their  labors." 


GLOSSARY 


GLOSSARY 


In  the  following  vocabulary  will  be  found 
terms,  not  fully  explained  in  the  text : 

Abnormal,  irregular,  unnatural. 

Acetabulum,  saucer-like  cavity. 

Acute,  of  short  duration,  severe. 

Adipose,  fatty  ;  from  adeps,  fat. 

Adynamic,  relating  to  vital  debility. 

Asration,  arterialization  of  the  blood. 

Allopathy,  "  contraria  contrarius  curantur," 
or,  the  practice  of  counteracting  the 
symptoms. 

AntBSthesia,  deprivation  of  sensibility. 

Anastomosis,  communication  between  ves- 
sels. 

Anhamia,  bloodlessness,  with  debility. 

Anorexia,  absence  of  appetite. 

Antiphlogistic,  reducing,  cooling. 

Ant-irritant,  soothing,  sedative. 

Apparatus,  set  of  organs  or  instruments. 

Areolar  tissue,  cellular  substance. 

Arterial,  relating  to  arteries. 

Articular,  relating  to  joints. 

Asphyxia,  suspended  animation. 

Atheroma,  pulpous  encysted  tumor. 

Atony,  want  of  tone,  debility. 

Atrimatrics,^m.e(!iic&t\ou  with  foul  air. 

Basilir,  pertaining  to  the  base. 

Biceps,  a  two-headed  muscle. 

Bicuspids,  two-pointed  teeth. 

Bougie,  a  flexible  dilating  tube. 

Brachial,  belonging  to  the  arm. 

Bronchia,  branches  of  the  windpipe. 

Bursa  mucosa,  sacs  of  viscid  fluid. 

Calculi,  concretions  of  gravel,  stone,  etc. 

Capillary,  small,  minute,  hair-like. 

Cardiac,  relating  to  the  heart. 

Catamenial,  relating  to  the  menses. 

Cephalagia  headache  of  any  kind. 


a  definition  of  the  most  important  technioaf 

Cervical,  relating  to  the  neck. 

Cervix  uteri,  neck  of  the  uterus. 

Chronic,  of  long  and  uncertain  duration. 

Chylopoietic,  chyle-making  organs. 

Cicatrix — Cicatrization,  a  scar — scarring. 

Cineritious,  cortical,  ash-colored. 

Colliquative,  profuse,  exhausting  discharge* 

Commissures,  points  of  union  between  parts. 

Condyle,  an  articular  eminence  of  bone. 

Contractility,  the  vital  property  of  muscle. 

Convolutiojis,  undulating  windings. 

Corpuscules,  the  globules  of  various  fluida. 

Cortical,  exterior,  belonging  to  the  bark. 

Cuticle,  the  epidermis,  or  scarf  skin. 

Cutis  vera,  the  inner  or  true  skin. 

Demulcent,    gummy,    mucilaginous    medir 

cines. 
Dermoid,  pertaining  to  the  integument. 
Diaphoretic,  tending  to  produce  sweat 
Diluent,  tending  to  thin  the  fluids. 
Dispensatory,  book  of  medical  composition* 
Diuretic,  increasing  the  urinary  secretion. 
Dorsal,  pertaining  to  the  back. 
Dynamic,  in  biology,  the  vital  force. 
Eclectic,  selecting  from  all  sources. 
Effluvia,  impalpable  emanations. 
Elasticity,  property  of  areolar  tissue. 
Elingual,  destitute  of  a  tongue. 
Elixir  vita,  alcohol  and  aromatics. 
Emmenagogue,  promoting  menstruation. 
Emollient,  softening,  relaxing,  soottiing. 
Encephalic,  situate  within  the  head. 
Endemic,  prevailing  over  a  neighborhood 
Epidemic,  prevailing  over  a  country. 
Epidermis,  the  external  or  scarf-skin. 
Epigasf.-nc,  upon  or  near  the  stomach. 


GLOSSARY 


Epiploon,  the  caul  or  omentum. 

Epispaatic,  blietcring  the  skin. 

Episynthetic,  accumulative,  collective. 

Epithem,  soft  or  warm  applications. 

Eructation,  sonorous  ejection  of  wind. 
Escharotic,  producing  a  sore  or  ecar. 

Expiration,  breathing /rom  the  lungs. 

Facette,  small,  smooth  surface  of  bone. 

Facial,  belonging  to  the  face. 

Fasciculus,  a  small  bundle. 

Facet,  excrement  of  the  bowels 

Fauces,  the  throat,  pharynx. 

Feculent,  relating-  to  the  £bBcea. 

Fenestra,  window-like. 

Filament,  a  fine  thread,  fibril. 

Foramen — Foramina,  a  hole — apertures. 

fhssa — iz,  a  depression— cavities. 

Franum,  a  bridle  of  fibers 

F^imigations,  odorous  smokes  or  gases. 

Ganglia,  convolutions  of  nervous  cords. 

Gangrene,  death,  with  putrefaction. 

Gastric,  relating  to  the  stomach. 

Gastrodynia,  flatulent  colic. 

G astro-enteric,  relating  to  the  stomach  and 
bowels. 

Glenoid,  shallow  articular  cavity. 

Granulations,  flesh-shoots  of  ulcers. 

Granule,  a  small,  compact  particle. 

Grumous,  clotted  or  coagulated. 

Gymnastic,  relating  to  bodily  exercise. 

Hepatic,  pertaining  to  the  liver. 

Homaopathy,  "similia  similibus  curantur," 
the  doctrine  that  like  cures  similar. 

Humoral  patJiology,  the  doctrine  of  the  fluids 
being  the  primary  seat  of  disease. 

Hydropathy,  hygienic  medicine,  the  system 
of  treating  diseases  by  water,  light,  air, 
temperature,  exercise,  food,  etc. 

Hypiene,  preservation  of  health. 

Hypoglossal,  under  the  tongue. 

ldi,ipathic,  primary,  original. 

Idiosyncrasy,  functional  peculiarity. 

Jngesta,  lood,  drinks,  condiments,  etc. 

Inhalation,  breathing  into  the  lungs. 

Innominala,  nameless,  bones  of  the  pelvis. 

Inorganic,  without  distinct  organs. 

Inosculation,  connection,  communication. 

Inspiration,  receiving  air  in  the  lungs. 

Insujflation,  injecting  gases  or  vapors. 

Intumescence,  enlargement,  swelling. 

Irritability,  susceptibility  to  extenial  im- 
pressions;  the  ultimate  vital  propt.-ty. 

In-itant,  causing  painful  excitement 

Irritation,  preternatural  excitement. 
Lachrymal,  relating  to  the  tears. 


LameUar~-CR,  thin  plate  or  plates. 

Lamina — <e,  thin  part  or  parts  of  bone. 

Lentor,  viscid  or  sizy  matter. 

Lithontriptic,  solvent  for  the  stone. 

Lobe,  small,  round,  projecting  part. 

Lobule,  diminutive  of  lobe. 

Lumbar,  relating  to  the  loins. 

Malaria,  miasm,  noxious  gases. 

Malignant,  dangerous  or  putrescent. 

Mater,  mother,  membranes. 

Materia  Medica,  medical  material*. 

Meatus,  a  canal  or  passage. 

Medulla,  the  marrow  or  pith. 

Medullary,  relating  to  the  marrow. 

Membranous,  formed  of  membrane. 

Menstruum,  a  vehicle  or  solvent. 

Metastasis,  changing  the  seat  of  disease. 

Met-asyncrisis,  changing,  making  over. 

Metkodus  Medendi,  curative  method. 

Modus  operandi,  mode  of  operating. 

Moltcular,  relating  to  minute  portions. 

Mucous,  pertaining  to  mucus. 

Mucus,  animal  mucilage. 

Narcotic,  stupefying,  deadening. 

Nervine,  relating  to  articles  which  affect  pe- 
culiarly the  nervous  system,  either  ol 
an  exciting  or  soothing  nature. 

Neutral  salts,  salts  having  excess  of  neithei 
acid  nor  alkali. 

Neuralgia,  nerve-ache,  tic  dolereaux. 

Normal,  regular,  natural. 

Nosology,  classification  of  diseases. 

Nuclei — Nucleoli,  central  points,  or  primor 
dial  particles  of  matter. 

Ophthalmia,  inflammation  of  the  eye. 

Organic,  constituted  of  organs. 

Osseous,  relating  to  bono. 

Ova — Ovules,  germinal  particles,  eggs. 

Papilla,  nipple-like  eminences. 

Parenchyma,  substance  of  the  lungs. 

Parietal,  relating  to  a  side  or  wall. 

Pathogenetic,  disease-producing. 

Pathology,  doctrine  of  diseases. 

Petrous,  hard,  resembling  stone. 

Pharmaceutic,  relating  to  pharmacy. 

Pharmacopaia,  book  of  medical  formularii  t 

Pharmacy,  preparation  of  drug-medicine. 

PiJegmasia,  term  for  inflammation. 

Phlogistic,  active  inflammation.  \ 

Plastic,  that  which  serves  to  form. 

Plexus,  not-work  of  vessels  or  nerves 

Pneumatology,  in  medicine,  the  doctrine  of 
spiritual  substances. 

Pracordia,  near  the  heart,  or  about  the  e^ 
gastric  region. 


GLOSSARY 


Preternatural,  unnatural. 
Process,  in  anatomy  a  projection. 
Probang,  a  rod  of  whalebone,    s 
Prophylactic,  preventing  disease. 
Puerperal,  relating  to  childbirth. 
Radicles,  germs  of  the  roots. 
Regimen,  regulated  food,  drink,  etc. 
Refrigerant,  cooling,  reducing. 
Renal,  relating  to  the  kidneys. 
Respiration,  pertaining  to  breathing. 
Resolution,  removal  of  disease. 
Rubefacient,  inflaming  the  skin. 
Ruga,  membranous  folds  or  wrmkles. 
Sacral,  relating  to  the  os  sacrum. 
Sedative,  soothing,  anti-irritant. 
Hemi-animist,  half-living  and  half-dead. 
Sensation,  cognizance  of  an  impression. 
Sensibility,  feeling  of  an  impression. 
Serofibrous,  serous  and  fibrous. 
Scrorcs,  thin,  watery,  like  serum. 
Sialagogue,  exciting  the  salivary  flow. 
Sigmoid,  resembling  the  Greek  S  or  C. 
Speculum,  an  instrument  to  dilate  cavities, 

etc. 
Spermatozoa,  spermatic  animalcules. 
Stimulant,  exciting  the  circulation. 
'Spinous,  sharp  or  thorn-like. 
Sudorific,  producing  perspiration. 
Suppuration,  formation  of  pus. 
Sympathetic,  associated  in  functios,.  »ction, 

or  condition. 


Symptomatic,  secondarily  afi'ected. 
System,  assemblage  of  parts  or  organs. 
Temperament,  constitutional  peculiarity. 
Temporal,  relating  to  the  temple. 
Tenesmus,  frequent,  painful,  and  vain  at* 

tempts  to  eject  from  the  bowels. 
Therapeutics,  the  application  of  remediee. 
Tic  dolereaux,  nerve-ache,  neuralgia. 
Tissue,  a  distinct  struct-ure. 
Tone,  force,  power,  stamina. 
Tonic,  giving  strength,  corroborant. 
Tormina,  griping  pains  in  the  bowels. 
Traction,  gradual,  steady  pulling. 
Transpiration,  passage  of  fluid  outward. 
Tubercle,  a  tumor  within  an  organ. 
Tuberosity,  protuberance,  projection. 
Turge.scence,  swelling,  fullness. 
Vascular,  composed  of  vessels. 
Venisection,  bleeding  with  a  lancet. 
Venous,  appertaining  to  veins. 
Ventricular,  relating  to  small  cavities. 
Vermifuge,  a  remedy  against  worms. 
Vesicular,  consisting  of  vascular  cells. 
Vesicatory,  producing  blisters. 
Villous,  hair-like,  velvety. 
Vis  Medicatrix  Natura,  remedial  powef  cfl 

nature. 
Viscut — Viscera,  organ — organs. 
ViUdit^  i?»herent  principle  of  life. 
Vi$  vita,  vital  Ajree,  irrit»VtUty. 


THE 


HYDROPATHIC  ENCYCLOPEDIA: 


A   SYSTEM    OF 


HYDROPATHY  AND  HYGIENE. 


I.    OCTLIXE   OF   ANATOMY,  ILLUSTRATED. 

U.    PHYSIOLOGY   OF   THE   HUMAN   BODY, 
m.    HYGIENIC   AGENCIES  AND   THE    PRESERVATION    OF 

HEALTH, 
rv.   DIETETIC   AND   HYDROPATHIC   COOKERY. 


TI.    SPECIAL  PATHOLOGY  ^IT   PTfaO-THERAPEUTICS,  \ 

INCLUDING    IHB    NAXIT^E,    C4"8.ES,   SYMPTOMS,  { 

AND   TRSATtENT   OF  ALL  KNOW   T'SE^ASES.  '■■ 

VII.   APPLICAT^'^N   TO   SURGICAL  DISEASES  ^ 

VIII.    APPLICATION     cr     ir/Uitol-AfB\     TO     ISOHB-Ui-SB* 


V,    THEORY   AND   PRACITCE   OF   WATER-TREATMENT.       1  AND   THB  AURS^RT. 

DESIGNED   AS 

A  GUIDE  TO  FAMILIES   AND   STUDENTS, 

AND    A     TEXT-BOOK    FOR    P^YSICIA.^JS 

BY  R.  T.  TRALL,  M.D. 

fSFitj^  l^Tumerous  IBnflrabeti  KIlu»tvatton«. 

VOLUME   II. 

NEW    YORK:  i 

FOWLER       AND    WELLS,    PUBLISHERS,       ' 

NO.    308    BROADWAY. 

Boston:  i  ^.  (       PniLADELri-iA:  ' 

No.' 142  Washington  St.  f  18  5/.  •)  No.  231  Arch  Street.  ; 


Entered;  according  to  act  af  Congress,  in  the  yea."  1851,  oy 

FOWLERS  AND  Wf:LLS, 

In  Uie  Clerk's  Office  of  the  District  Court  of  the  United  States  for  the  Southern  Dl9tr*«t 

of  New  York. 


HYDROPATHIC     ENCYCLOPEDIA 


PART    V. 

THEORY    AND    PRACTICE. 


CHAPTER  I. 

PHILOSOPHY   OF   WATER-CURE. 

Relations  of  Water  to  the  Healthy  Organism. — Before 
we  can  clearly  comprehend  the  remedial  relations  of  pure  water  to 
the  morbid  conditions  of  the  body,  we  must  understand  its  physiological 
or  vital  relations  to  the  healthy  organism.  These  may  be  stated  most 
succinctly,  and  remembered  most  easily,  in  the  form  of  distinct  prop- 
ositions. 

1.  Water  constitutes  the  greater  proportion  of  the  entire  bulk  of  the 
body. 

2.  Water  composes  more  than  three  fourths  of  the  whole  mass  of 
blood ;  more  than  seven  eighths  of  the  substance  of  the  brain,  and 
more  than  nine  tenths  of  the  various  colorless  fluids  and  secretions. 

3.  Water  is  the  only  vehicle  by  which  nutrient  matters  are  conveyed 
to  the  blood,  and  through  the  blood  to  all  paits  of  the  system  for  its 
growth  and  replenishment. 

4.  Water  is  the  only  medium  through  which  waste  or  effete  parti 
cles,  or  extraneous  ingredients,  are  convej'ed  from  all  parts  of  the  sys 
tem  to  the  excretory  organs  to  be  expelled. 

5.  Water  is  the  only  solvent,  diluent,  and  detergent  in  existence,  for 
animal  and  vegetable  alimentary  and  excrementitious  matters. 

G.  Water  is  the  only  material  capable  of  circulating  in  all  the  tissues 
of  the  body,  and  penetrating  their  finest  vessels,  without  vital  irritat»c>ii 
or  mechanical  nijary. 

7    The  only  r^^-^^-bid  effe  ts  of  water  result  from  improper  tempeia- 


IHEORV    AND    PRACTICE. 


ture,  and  over-distension  of  the  hollow  viscera,  or  circulating  xt^ueia 
from  excess  of  quantity — eftecte  never  necessarily  unavoidable. 

Modus  Operandi  of  Water. — Contiary  to  the  teachings  of  the 
standard  medical  books  of  allopathic,  homeopathic,  and  eclectic  sciico.s, 
we  must  ever  bear  in  mind  that  disease  is  never  a  positu'e  entiti/,  but 
always  a  negative  quality ;  it  is  the  aljsence  of  health,  or  of  the  ^tate, 
circumstances,  and  actions  which  coubtitute  that  oalance  of  funccional 
duty  we  cnll  health.  By  refen-ing  to  the  raisuse  or  abuse  of  son.e  one 
or  more  of  the  li^'gienic  agencies,  we  find  the  cause  or  causes  oi  those 
deviations  from  the  normal  state,  which  constitute  the  abnormal  state, 
and  which  we  call  disease ;  and  now,  by  applying  the  above  propositions 
to  the  causes  which  jn-oduce  and  the  conditions  which  constitute  dis 
ease,  we  will  find  the  true  grounds  which  indicate  and  demonstrate 
water  to  be  a  remedy  of  general,  and  even  universal  application. 

In  a  general  sense,  diseases  are  produced  by  bad  air,  improper  light, 
impure  food  and  drink,  excessive  or  defective  alimentation,  indolence 
or  over-exertion,  unregulated  passions,  in  three  words — unphysiological 
voluntary  habits.  The  conditions  of  the  body  in  disease — the  proximati 
causes  against  which  all  remedial  effoi-ts  are  to  be  directed — are,  in 
general  terms,  impure  blood,  unhealthy  secretions,  obstructions  in  the 
minute  vascular  structures,  or  capillary  vessels,  excessive  action  in  some 
parts  or  organs,  with  deficient  action  in  others,  unequal  temperature, 
etc.,  in  other  words,  a  loss  of  balance  in  the  circulation  and  action  of 
the  various  parts  of  the  vital  machinery,  producing  great  discord  in  some 
portion  of  it,  and  more  or  less  disorder  in  all.  The  general  indications 
are,  therefore,  to  remove  obstructions,  wash  away  impurities,  supply 
healthful  nutriment,  regulate  temperature,  relax  intensive  and  intensify 
torpid  action,  etc. ;  and  what  like  water,  what  but  water,  with  its  concom- 
itants, air,  light,  food,  temperature,  etc.,  can  answer  to  these  indications? 

To  say  that  medicinal  diaigs  can  answer  these  indications  is  sheer 
nonsense.  They  may  respond  to  any  other  indications  almost  that  can 
be  named ;  but  these,  never.  They  may  change  the  issue,  they  may 
suppress  a  symptom,  remove  a  pain,  transfer  an  irritation,  excite  a 
new  vital  resistance,  produce  another  obstruction,  and  so  divide  the  or- 
ganic struggle  between  two  points,  ditninish  vital  powei",  or  increase 
vital  expenditure  ;  hut  none  of  these  impressions  or  effects  are  really 
remedial,  none  of  tliom  meet  the  indications:  and  if  physicians  in  gen- 
eral, and  '^^inkind  in  particular,  are  not  satisfied  with  the  experiments 
of  three  thousand  years,  which,  by  the  way,  have  destroyed  ten  times 
as  many  of  the  human  family  as  thev  have  saved,  let  them  by  all 
means  be  satisfied,  even  if  they  liave  to  go  on  ii  the  same  absurd. 


PHILOSOPHY    OF    WATER-CURE. 


blundering,  and  senseless,  though  veiy  learned  and  scientific  business, 
of  drugging  and  killing,  marring  and  scarring,  for  three  thousand  years 
longer. 

Water,  according  to  the  mode  of  application,  can  intensify  or  mod- 
erate any  function;  it  can  energize  or  abate  any  given  action;  it  can  be 
made  to  increase  or  diminish  temperature,  locally  or  generally,  to  any 
extent  desired;  hence,  though  not  a  universal  cure — for  diseases  are  not 
universally  curable — it  is  a  remedy  universally  applicable.  But  while 
water,  judiciously  managed,  may  be  doing  its  appropriate  work  in  alle- 
viating or  curing  disease,  other  causes  may  counteract,  retard,  or  en- 
tirely prevent  the  consummation  of  any  curative  process.  The  patient 
may  live  badly  in  other  respects  ;  something  in  his  eating,  or  drinking, 
or  sleeping,  or  exercising,  or  other  voluntary  habits,  may  be  wrong,  and 
constantly  re-supply  the  causes  of  disease  as  fast  or  faster  than  the 
best  remedial  use  of  water  can  remove  or  overcome  them;  therefore, 
though  water  is  put  prominently  foi'ward  in  the  hydropathic  systena 
ns  in  all  cases  the  great  panacea,  it  must  ever  be  recollected  that  it  is 
but  one  of  several  remedial  agencies  whose  influence  is  equally  to  be 
regarded  in  preserving  health  or  in  curing  diseases. 

To  illustrate  :  Of  fifty  or  a  hundred  invtilids  at  a  hydropathic  in- 
stitution, while  all  may  employ  water  in  the  way  of  bathing  in  the 
best  possible  manner,  one  half  of  them  will  pretty  certainly  hold  on  to 
some  unhealthful  habit  which  retards  or  prevents  the  cure,  or  renders 
it  imperfect.  One-  will  nibble  on  candies  or  fruits  between  meals ; 
some  in  the  cities  will  lunch  on  oysters  or  plum-pudding;  some  will 
eat  flesh  immoderately :  others  will  persist  in  the  use  of  butter  or 
greasy  meats  sufficiently  to  keep  them  constantly  bilious ;  others  will 
take  salt  enough  to  keep  the  whole  body  pickled,  as  it  were,  in  an 
acrid  brine;  others  will  eat  an  undue  proportion  of  fine  flour,  and  keep 
the  bowels  all  the  while  constipated ;  others  will  endeavor  to  make  up 
by  the  "  stimulus  of  distension"  foi-  the  lack  of  mustard,  vinegar,  and 
pepper ;  others  will  drink  tea  or  coffee,  chew  tobacco,  or  smoke  cigara 
occasionally;  and  yet  others  will  indulge  in  a  dose  or  two  of  drugs  now 
and  then,  stealthily,  of  course ;  and  so  on  to  the  end  of  the  chapter  of 
♦'  errors  in  Water-Cure. "  It  is  true  all  these  things  are  ruled  out  of 
the  establishments,  but  they  are,  notwithstanding,  very  frequently 
practiced  by  many  patients ;  and  what  is  particularly  vexatious,  ungrate- 
ful, and  perverse,  all  the  evil  consequences  of  their  bad  habit  are  usually 
imputed  to  the  Water-Cure ! 

It  may  be  said  that  the  physician  ought  to  manage  all  these  matters, 
and  make  all  patients  conform  in  all  respects  to  a  physiological  regimen. 
This   is   not  always   possible,  for  with   many  invalids   habit   is  much 


6  THEORY    AND    PRACTICE. 

sti'onger  than  reason,  and  with  some  dyspeptics  the  craving  of  the 
morbid  appetite  for  its  disease-producing  aliments,  and  conciinicnts. 
and  narcotics,  is  not  a  whit  more  governable  than  is  the  drunl^ard'a 
appetite  for  those  intoxicating  poisons  which  have  produced  his  insa- 
tiate craving.  Both  kinds  of  appetite  are  controlled,  and  finally  over- 
come by  a  few;  but  sad  experience  tells  the  story  that  the  majority 
are  conquered  and  destroyed  by  them. 

In  accounting  for  the  therapeutic  operation  of  particular  processes 
of  the  water-treatment,  we  must  never  forget  that  Nature  is  the  true 
physician.  The  restorative  power  is  inherent  in  the  living  oi'ganism. 
All  that  the  true  healing  art  can  do  is  to  supply  favorable  conditions, 
remove  extraneous  materials,  and  regulate  hygienic  influences,  and 
thus  place  the  system  as  fully  as  possible  under  organic  law. 

The  humoral  pathologists  impute  all  diseases  to  a  lentor,  or  morbific 
matter  in  the  blood ;  while  the  solidists  and  vitalists  contend  that  the 
action  of  the  solids — being  too  much  increased  or  diminished — is  the 
proximate  cause  of  all  diseases.  The  former  bleed,  leech,  scarify, 
blister,  sweat,  puke,  purge,  stimulate,  and  antiphlogisticate  ;  and  the 
latter  bleed,  leech,  scarify,  blister,  sweat,  puke,  purge,  stimulate,  and 
antiplilogisticate  too  !  Here  is  diversity  of  cause  producing  identity  of 
effect ;  a  postulate  not  dreamed  of  in  natural  philosophy. 

We  may  apply  water  to  the  ti'eatment  of  disease,  on  either  theory, 
much  more  rationally  than  the  allopath  can  his  drugs  and  depletives. 
Whichever  theory  we  adopt — and  both  are  correct  to  a  certain  extent — 
we  can  alter,  depurate,  change,  increase,  restrain,  or  modify  the  fluids 
and  actions  WMth  water  and  regimen,  as  well  as  with  lancets  and  drugs, 
and  with  none  of  their  necessary  evils  or  ever-present  dangers.  We 
can  even  get  minerals,  chemicals,  and  other  drug-medicines  out  of  the 
body  by  means  of  water-treatment,  whereas  the  ne  plus  ultra  of  drug 
medical  science  consists  in  getting  the  system  full  of  them,  and  then 
abandoning  it  to  its  fate,  and  "the  efforts  of  nature." 

It  is  no  uncommon  circumstance  for  patients  to  become  severely 
salivated  during  ^vater-treatment.  I  have  treated  several  cases  wherein 
patients  who  had  taken  no  mercury  for  several  years,  experienced  all 
the  symptoms  of  a  "mercurial  course,"  such  as  tender,  fleecy  gums, 
metallic  taste,  fetid  breath,  swelled  tongue,  and  copious  droolJing.  Orher 
mineral  poisons  also  produce  great  constitutional  or  local  disturbance 
during  the  process  by  which  they  are  expelled  from  the  body.  These 
drugs,  as  already  intimated,  all  the  other  drugs  in  creation  have  no 
power  to  remove  from  tlie  body.  They  may,  like  acids  and  alkalies, 
silence  each  other's  specific  action,  or  combine  to  produce  a  different 
action ;  but  they  do  not  and  cannot  drive  each  other  out  of  the  systemt 


PHILOSOPHY    OF    WATER-CURE. 


The  niiiriner  in  which  \Aater  purifies  the  body  from  mercury  and 
other  mineral  poisons,  alias  medicines,  aftbrds  an  explanation  of  itg 
mode  of  action  in  a  great  variety  of  morbid  conditions.  Referring  to 
the  laws  of  endosmose  and  exosinose,  as  explained  in  the  physiological 
part  of  this  work,  we  find  that  when  animal  membrares,  living  or 
dead,  and  whether  connected  to  or  separated  from  the  body,  have 
their  opposite  surfaces  in  contact  with  dissimilar  iluids,  an  interchange 
takes  place,  which  is  continued  until  the  constituents  of  both  fluids 
become  exactly  similar,  when  all  action  between  them  ceases.  Dr.  E. 
Johnson  (Domestic  Hydropathy)  has  constructed  the  following  dia- 
grams, which  very  well  illustrate  this  subject: 

In  fig.  162  a  is  a  glass  tube,  the  di- 
ameter of  whose  caliber  is  four  tenths 
of  an  inch.  Close  one  of  its  ends  ac- 
curately with  a  piece  of  bladder,  and 
fill,  the  tube  with  brine.  Now  take  a 
much  larger  tube  (6) — a  common  tum- 
bler will  do — and  fill  it  three  quarters 
full  with  pure  water.  Then  immerse 
the  bladder-end  of  the  small  tube  just 
under  the  surface  of  the  water  of  the 
larger  tube  or  tumbler,  giving  it  an  in- 
clination of  about  45".  In  a  short  time 
a  current  of  liquid  will  be  seen  rising 
from  the  bottom  of  the  water  in  the 
tumbler,  upward  along  its  side,  in  the 
direction  indicated  by  the  arrows, 
through  the  bladder,  and  up  along  one 
side  of  the  small  tube  to  the  surface  of 
the  brine ;  then  it  descends  along  the 


ENDOSMOSE    AND    EXOSMOSE. 

Other  side  of  the  small  tube,  in  the  direction  of  the  airows  on  that 
side,  down  through  the  brine,  and  through  the  bladder,  down  to  the 
bottom  of  the  water.  The  downward  current  is  a  current  of  brine 
descending  into  the  water  in  the  tumbler.  The  upward  current  is  a 
current  of  pure  water  ascending  into  the  tube  to  supply  the  place  of 
♦;he  lost  brine ;  and  this  current  will  continue  until  the  two  fluids  have 
become  similar,  that  is,  until  the  fluid  in  the  basin  has  become  as  salt 
as  that  contained  in  the  tube. 

"If  now  the  tumbler  be  emptied,  and  refilled  with  pure  water,  the 
current  will  be  re-established,  and  in  this  way  the  brine  in  the  tube 
may  be  completely  purified  of  its  salt. 

"  The  currents  will  be  seen  with  beautifu..  distinctness  if  some  very 


THSORV    AND    PRACTICE. 


Fi?.  163. 


END0S■v50^;E    A>'D    EXOSMOSE. 


fine  particles  of  indigo  be  suspended  in  both  fluids — that  in  the  tum- 
bler, and  that  in  the  t  nbe 

"  If  the  tube  a,  in  fig.  163,  which 
contains  the  brine,  have  a  caliber  whose 
diametei  is  four  fifths  of  an  inch,  and 
if  it  be  supported  vertically,  so  that  the 
bladder-end  be  immersed  just  below 
the  surface  of  the  water  in  the  tumbler 
(6),  two  currents  will  be  seen  to  ascend, 
in  the  direction  of  the  arrows,  through 
the  bladder,  one  on  either  side  of  the 
tube,  to  near  the  surface  of  the  brine. 
They  now  turn,  and  descend  together 
in  a  double  current  through  the  middle 
of  the  brine  in  the  tube,  down  through 
the  bladder  into  the  water,  where  they 
diverge,  turn  again,  and  again  ascend. 
The  double  current  descending  through 
the  middle  of  the  tube  is  a  cun*ent  of 
brine  coming  down  into  the  water  in 
the  tumbler.  The  two  separate  outer 
cuirents  a  jcending  from  near  the  bottom  of  the  water  in  the  tumbler, 
are  twr)  currents  of  water  going  up  through  the  bladder  into  the  tube, 
to  supply  the  place  of  the  brine  which  has  descended  into  the  water. 

''  Now  when  pure  water  is  held  in  couitact  with  the  external  surface 
of  the  skin  of  the  body,  by  means  of  the  wet  sheet,  or  any  other 
means,  |)rivisely  the  same  conditions  are  established  with  regard  to  the 
fluids  within  the  body,  that  is,  on  the  inside  of  the  skin,  and  the  water 
which  is  in  contact  with  its  outer  surface,  as  are  established  in  fig.  163, 
between  tlic  fluid  (brine)  contained  in  the  tube,  that  is,  on  the  inside 
of  the  bladder,  and  the  water  in  the  tumbler,  which  is  in  contact  with 
the  bladder's  outer  surface.  About  eighty  per  cent,  of  the  blood  is 
v/ater,  and  it  is  this  water  which  holds  in  solution  whatever  soluble 
substatices,  whether  poisonous  or  otherwise,  happen  to  be  present  in 
the  blood  ;  and  it  is  this  water,  holding  in  solution  fibrin,  albumen,  and 
the  varioiis  salts  proper  to  the  blood,  which  alone  circulates  in  those 
myriad-'r  of  millions  of  millions  of  cajiillary  vessels  which  are  too  small 
to  admit  the  red  paiticlos.  When  any  poisonous  matters  are  present 
in  the  blood,  it  is  in  this  water  of  the  blood  that  they  are  held  in  solu- 
tion, as  Ou^  salt  is  held  in  solution  in  the  water  of  the  brine. 

"  Xovy'  when  by  means  of  the  wet  sheet,  pure  water  is  held  in  con- 
tact with   the  outer  surface  of  the  si  in,  and  supposing  that  the  water 


PHILOSOPHY    OF    WATER-CURE. 


r>f  the  blood,  which  is  on  the  inside  of  it,  is  poise  ned,  say  with  bichloride 
of  mercury,  what  happens  is  this :  An  interchange  takes  place  between 
the  fluid  on  the  outside  (pure  water)  and  the  fluid  on  tlie  inside,  viz., 
the  water  of  the  blood  holding  bichloride  of  mercury  in  solution.  The 
mercury-and-water  passes  through  the  skin  into  the  Wciter  of  the  wet 
eheet,  while  the  pure  water  of  the  wet  sheet  passes  through  the  skin 
into  the  blood  to  supply  the  place  of  the  mercury-and-water.  As  in 
figures  162  and  163,  a  double  current  is  established  ;  a  current  of  pure 
water  into  the  body,  and  a  current  of  mercury-and-water  out  of  tho 
body ;  and  in  this  way,  by  frequently  renewing  the  external  contact 
of  pure  water  with  the  skin,  the  blood  is  pm-ified  of  whatever  poisonous 
or  otherwise  morbid  matters  it  may  happen  to  contain. 

"If  a  glass  tube  be  partially  filled  with  a  saturated  solution  of  salt 
(brine),  one  end  of  the  tube  having  been  first  carefully  tied  over  with 
bladder,  and  if  the  tube  be  suspended  in  the  air,  in  a  short  time  that 
side  of  the  bladder  which  is  exposed  to  the  air  becomes  covered  with 
salt.  The  brine  passes  through  the  bladder  from  the  inner  to  the 
outer  surfiice.  When  it  reaches  the  outer  surface  the  water  evaporates, 
leaving  the  salt  adhering  to  the  bladder. 

"  When  a  person  has  taken  the  nitrate  of  silver  for  a  considerable 
length  of  time,  it  is  well  known  that  the  skin  becomes  colored  i)€rma- 
nently  blue,  from  the  lodgment  of  oxide  of  silver  in  the  tissue  of  the 
skin,  ^he  nitrate  being  converted  into  a  simple  oxide. 

"It  would  seem  that  something  similar  happens  here  with  regard  to 
the  salt  of  silver  (nitrate  of  silver)  and  the  skin,  as  happens  with  regard 
to  the  salt  of  the  brine  and  the  bladder,  in  the  experiment  just  described 
above.  The  water  of  the  blood,  holding  the  nitrate  of  silver  in  solution, 
passes  through  the  under  layers  of  the  skin  until  it  reaches  the  rete 
mucosum,  which  lies  immediately  under  the  scar^-skin,  not  traveling 
along  tho  perspiratory  spiracles,  but  permeating  the  tissues.  Having 
L'eached  this  locality,  the  water  of  the  blood  evaporates,  while  the  sil- 
ver, unable  to  penetrate  the  dry  and  horny  cuticle,  is  left  fixed  in  the 
rete  mucosum." 

Similar  experiments  may  be  ti'ied,  with  similar  results,  with  any  of 
the  soluble  metaUic,  mineral,  or  earthy  salts,  as  of  arsenic,  iodine,  sul- 
pliate  of  potassa,  etc.  I  have  known  mercurial  ulcers  take  place  during 
water-treatment,  on  the  lower  exti-e-nities  of  patients  whose  bodies 
had,  years  previously,  been  thoroughly  mercurialized,  and  which  it 
was  impossible  to  heal  until  after  the  body  had  become  entirely  cleansed 
t'l"  the  mineral  by  several  months'  treatment. 

\V.\TKR-TREArMENT  AND  DrU     >rPF A.TMENT  CONTRASTED. The 


10  THEORY    ANt    PRACTICE 


above  flifts  mnply  demonstrate  tlie  s jperioritj'  as  well  as  the  more  ra- 
tional philosophy  of  the  water-treatment  over  the  drug  treatment  on 
the  humoral  theory,  ^ut  the  vitalists  have  much  to  say  about  "dynamic 
forces."  With  them  ever^  thing  goes  hy 'impression,  or  siimuli.  Dis- 
ease is  jn'oduced  by  morbid  impressions  on  the  brain,  or  nervous  system, 
which  impressions  are  conveyed  to  the  vfu-ious  organs  or  parts  of  the 
body  by  nervous  disti-ibution,  or  functional  sympathy;  and  remedies 
operate  by  electric,  magnetic,  stimulant,  alterant,  or  some  other  force- 
ful property  which  makes  impressions  on  the  nervous  centers,  and 
these  impressions  are  thence  radiated  through  the  system,  and  counter- 
act, overcome,  snbdue,  or  in  some  other  most  mysterious  and  utterly 
inexplicable  manner,  cure  disease,  or,  perchance,  by  some  unfortunate 
and  unaccountable  circumstance  or  aoMdent,  render  it  worse. 

But  there  is  something  of  matter-of-fact  in  this  theory,  as,  indeed, 
there  is  in  nearly  all  the  vagaries  which  have  ever  possessed  men's 
minds.  We  know  that  mental  impressions  do  disturb  or  modify,  arrest 
nr  energize  either  and  all  of  the  functions  of  the  body,  and  these  im- 
pressions may  be  morbid  or  sanatory ;  they  may  produce  disease  or 
remove  it.  But  on  this  principle  of  physiological  impressibility,  is  there 
not  a  better  way  of  exciting  counteracting  morbid  impressions  than  by 
drawing  ofl  the  vital  current,  or  poisoning  the  bod}  through  and 
through  with  pernicious  drugs?  Common  sense  replies  in  the  affirm- 
ative, and  all  rational  minds,  unbiased  by  a  miseducation,  would 
respond,  "there  must  be  a  better  way."  And  here  our  "universal 
panacea,"  pure  soft  water,  supplies  the  desideratum.  On  the  theory 
of  impressibility  it  is  just  what  is  desirable,  and  all  that  is  requisite,  if 
suitably  aided  by  the  other  hygienic  adjuvants.  All  the  impressions 
made  on  the  living  body  can  only  affect  its  functions  as  they  j)roduce 
or  an'est  action  or  motion,  which  action  or  motion  is  muscular  contrac 
tion.  Cold  water  and  ice  are  assuredly  the  most  powerful  constringing 
agents  that  can  be  applied  to  the  living  structures  without  destruction  or 
injury;  and  hot  water,  or  steam,  is  the  most  efficient  relaxant  that  can 
be  safely  employed.  For  producing  moderate  conti'action  or  relaxa- 
tion, we  have  all  degrees  of  temperaturt^  between  the  freezing  and 
the  boiling  points. 

The  remedial  effects  of  water,  thus  far  considered,  are  a  complete 
substitute  for  all  the  depletory  processes  of  the  regular  system,  as 
bleeding,  leeching,  antimonializing  and  refrigerating,  and  all  the 
classes  of  medicines  called  em.etics,  cathartics,  diaphoretics,  diuretics, 
alteratives,  tonics,  and  stimulants.  But  there  are  other  classes  which 
are  called  narcotics,  nervines,  and  sedatives,  to  which  opium,  camphor, 
etlier.  musk,  castor  hnnbane.  rats'^nne,  d  jgsbane,  wolfsbane,  and  divers 


PHILOSOPHY    OF    WATER-CURE.  11 

o.'"her  banes  belong,  which  at  first  view  seem  more  difficult  to  dispense 
with.  There  is  something  like  a  charm  in  the  idea  of  sending  down  the 
the  sick  person's  throat  a  dose  which  silences  his  pains  and  quiets  his 
distress  with  magical  celerity.  But  the  charm  is  at  once  dispelled 
when  we  look  to  ultimate  consequences.  The  very  pain  which  the 
potent  and  ill-advised  dose  of  the  doctor  has  subdued  is  generally  the 
warning  voice  of  the  organic  instincts  that  something  is  wrong,  or  the 
effort  of  the  organism  to  rid  itself  of  an  enemy.  When  the  organic 
instincts  proclaim  to  the  v/hole  domain  of  life,  through  the  medium  of 
the  brain,  that  an  enemy  is  present,  that  proclamation  is  felt,  not  heard, 
and  its  language  is  pain.  It  is  one  thing  to  silence  the  outcry  of 
nature  for  help,  but  it  is  quite  another  thing  to  relieve  her  by  dislodging 
the  enemy.  The  first  may  often  be  done  bj  narcotics  and  stimulants; 
the  second  can  be  accomplished  by  the  use  of  water.  In  fact,  water 
will  often  succeed  in  promptly  removing  pain  which  the  most  powerful 
narcotics  fail  to  mitigate.  There  may  be  inflammation,  obstruction, 
engorgement,  distension  or  contraction,  the  pain  of  which  all  the  opium 
that  can  be  taken  short  of  deathful  doses  will  not  alleviate,  and  yet 
water  of  some  temperature  and  in  some  form  of  application  will  relieve 
at  once. 

There  are  also  classes  of  medicines  called  acids,  alkalies,  anthelmin- 
tics, lithontrijytics,  demulcents,  etc.  How,  it  may  be  asked,  is  water 
to  substitute  them?  Simply  by  obviating  the  occasion  for  them.  A 
patient  has  a  sour  stomach,  and  the  doctor  gives  him  soda ;  another  is 
afflicted  with  worms,  and  the  doctor  administers  something  to  poison 
them  to  death ;  another  has  gravelly  concretions,  and  the  doctor  ad- 
vises chemical  solvents;  another  has  acrid  bile  which  corrodes  his 
throat,  and  the  doctor  prescribes  lubricating  mucilages,  and  so  on  to 
the  end  of  life.  But  who  cannot  perceive  that  all  this  practice,  as  a 
part  of  the  healing  art,  is  absurd  and  ridiculous  ?  Who  so  stupidly 
blind  as  not  to  see  that  it  is  a  mere  patch-work,  tinkering  at  effects 
without  removing  causes  ?  The  water-treatment  corrects  the  condition 
upon  which  the  existence  of  these  abnormal  symptoms  depend,  v/hen 
of  necessity  they  all  disappear. 

In  the  works  of  the  popular  system  we  read  much  about  "  acceler- 
ating the  change  of  matter."  in  order  to  renovate  the  tissues  and  rein- 
vigorate  the  functions.  To  do  this  it  is  recommended  to  bleed,  purge, 
and  mercurialize  the  patient  down,  and  then,  presto  !  wine,  tonics,  and 
"  senerous  diet,"  to  stimulate  him  up  again  as  fast  as  possible,  thus 
doing  and  undoing  interchangeabh^  Bathing,  with  appropriate  air  and 
exercise,  and  plain  simple  food,  will  effect  a  change  of  matter  incom 
parably  more  rapid,  nnd  without  the  destru-^tion  of  health ful  r.-'interiuls 


12  THEORY    AND    PRACTICE. 

or  the  iiijuiious  '•  dynamic  force"  of  alcoholic  poison.  If  there  is  sur- 
plus matter  about  or  withm  the  body,  water  will  wash  it  away,  and  if 
there  is  a  deficiency  of  organic  material,  pure  food  and  good  r.igestion 
are  the  natural  means  to  supply  it. 

Again,  the  water-treatment,  by  regarding  the  skin  as  the  leading 
depurating  function  of  the  ^^ody,  follows  out  the  indications  of  nature 
herself,  which  expels  the  gi-eatest  amount  of  morbific  agents,  whether 
miasms,  effete  organic  matters,  or  drugs  and  medicines,  from  the  body, 
through  the  cutaneous  channels.  Instead  of  wearing  out  the  alimen- 
tary cjinal,  where  but  a  small  quantity,  corapai'atively,  of  waste  or 
offensive  matter  is  ever  found,  with  horridly  }xtisonous  emetics  and 
bowel-sciaping  cathartics,  the  principal  detergent  process  is  directed 
to  the  skin,  where  naturally  five  or  six  times  the  amount  of  excremen- 
titious  matters  are  got  rid  of,  that  is,  thrown  off  by  the  bowels. 

There  is  a  principle  recognized  in  the  allopathic  school,  called 
counter-irritation  or  antagonism.  Indeed,  some  late  authors  have 
gone  so  far  as  to  consider  it  the  fundamental  principle  of  the  whole 
drug  and  depleting  system.  It  is  based  on  the  supposed  law  of  the 
animal  economy,  that  nature,  or  the  vital  powers,  cannot  maintain 
two  different  kinds  of  morbid  action  in  different  parts  of  the  body  at  the 
same  time.  Thus,  if  a  man  has  an  inflammation  of  the  stomach  and 
bowels,  and  you  produce  a  severer  inflammation  of  the  mouth  and  sali- 
vary glands  with  calomel.  t>.e  stronger  mercurial  excitement  will 
absorb,  as  it  were,  the  lesser  inflammatory  action;  the  latter  will  theu 
get  well,  after  which  the  doctor  may  cure  the  drug-disease  he  has 
produced — the  salivation — if  he  can.  Such  practice  has  no  claim  to  the 
title  of  healing  art ;  it  is  doing  an  iirepai-able  injury,  with  the  ulterior 
possibility  of  a  gi'eater  good.  Blisters,  issues,  escharotics,  and  the  end- 
less compounds  in  the  shape  of  irritating  ointments  and  stimulating 
jiniments  are  predicated  on  no  better  philosophy  than  that  of  removing 
one  evil  by  producing  another. 

But  admitting  the  fact  that  one  disease  does  antagonize,  or  neutralize, 
or  supercede  another,  the  usual  explanation  is,  I  think,  unsound. 
This  vaguely-conceived  *'law  of  the  animal  economy"  is  really  no  law 
at  al'.  It  is  the  resistance  that  the  vital  powers  make  to  morbific  agents, 
which  pathologists  have  misnamed  a  law  of  the  animal  economy.  Two 
diseased  actions,  or  diseases  in  two  different  parts  of  the  body,  or  ob- 
structing or  offending  materials  in  two  or  more  parts  or  organs,  wili 
manifest  different  phenomena  from  what  are  observed  when  one  part 
or  organ  only  is  affected,  because  vital  resistance  is  then  distributed  to 
several  pomts  insteat'  of  being  concentrated  at  one. 

If  a  person  if  laboring  un^-<»r  a  fever,  that  contiiotion  of  the  orgaa 


PHILOSOPHY    OF    WATER-CURE.  IS 

ism  which  we  denominate  the  febrile  paroxysm  is  the  manifestation  of 
the  vital  struggle  to  defend  the  organic  domain  against  some  morbific 
cause,  or  to  expel  some  injurious  matter.  If  the  vital  powei-s  are 
making  the  principal  effort  to  the  surface,  the  introduction  of  a  cathar- 
tic dose  of  epsom  salts  would  divert  some  part  of  this  vitid  effort  to  the 
bowels  to  meet,  defend  against,  and  expel  the  new  enemy  which  is 
committing  its  ravages  there,  and  thus  purgation  would  result,  while 
the  depurating  or  remedial  effect  to  the  skin  would  be  materially 
diminished.  The  seat  of  war  would  be  changed,  oi  the  battle-field 
divided,  but  so  jf\ir  from  being  "  a  friend  in  need,"  thf».  saline  purgation, 
by  drawing  off  and  WHSting  a  portion  of  vital  power,  would  only  prove 
a  *'  foe  indeed." 

The  water-treatment  does  not  operate  on  the  principle  of  antago- 
nism or  counter-irritation,  according  to  the  popular  theory,  for  it  does 
not  produce  a  train  of  morbid  actions  constituting  a  new  specific  disease  ; 
nor  does  it  put  foreign,  acrid,  irritating,  and  deleterious  ingredients  into 
the  blood,  to  produce  some  powerful  impression  at  a  dash,  and  then 
leave  the  vital  powers  to  war  against  and  waste  themselves  in  counter- 
acting or  removing  them  for  months  and  years  afterward.  It  has  been 
objected,  that  a  cold  bath  was  a  morbid  impression,  as  much  as  a  hot 
blister,  because  it  is  an  artificial  instead  of  a  natural  method  of  apply- 
ing water.  But  this  argument  is  short-sighted.  A  cold  hip-bath,  for 
example,  produces  exactly  the  same  vital  phenomenn.  action  and  re- 
action, that  our  bodies  are  subjected  to  every  day,  and  hour,  and  mo- 
ment of  our  lives,  differing  only  in  degree.  The  first  impression  of 
the  cold  water  causes  the  blood  to  recede  from  the  canillaries ;  but  the 
vital  powers  soon  meet  the  impression  by  an  increased  determination 
of  blood  to  the  part,  to  balance  the  temperature  of  the  body,  and  soon 
the  capillaries  become  distended  with  blood,  the  part  red,  turgid,  and 
in  a  warm  glow.  If  this  process  is  frequently  repeated,  the  general 
result  is  to  develop  the  superficial  or  capillary  circulation  of  the  part, 
and  to  that  extent  unload  the  vessels  elsewhere,  remove  internal  con- 
gestion, etc.  If  the  impression  is  too  strong  for  successful  vital  resist- 
ance, if  the  water  is  too  cold  for  the  ability  of  the  patient  to  react,  of 
course  the  opposite  efiect  results;  internal  congestion  is  increased,  and 
we  have  die  abuse  of  the  hygienic  or  remedial  agent. 

This  determination  to  the  surface  in  consequence  of  the  ijnpression 
of  cold  water,  cannot  be  called  a  morbid  action  in  any  sense.  If  we 
gc  out  of  a  comfortably  warm  room  into  a  very  cold  atmosphere,  out 
hands  and  face  may  at  first  become  pale,  cold,  the  vessels  contracted 
and  bloodless  ;  but  on  returning  to  the  room,  and  often  under  the  con- 
tinued  application   of  the   cold,   reaction  takes   place,   and  the}'  soon 


14  TIIEO.IV     AND    TRACTICE. 


opiiear  more  red  mid  turg'.d,  and  feel  warincr  than  before  their  expo- 
sure, fur  Ji  few  minutes,  and  then  return  to  their  usual  appearance  uno 
feeling.  So  the  sJijrht  disturbances  of  ihe  circulation  produced  byordi- 
cary  bathing  is  merely  an  intensified  co->»vaction  and  relaxation,  amount- 
ing to  temporarily  increased  action,  and  followed  by  the  same  harmony 
of  circulation  sis  existed  before.  Atmospheric  influences,  vicissitudes 
of  temperature,  vaiiations  of  exercise,  etc  when  not  extreme  or  vio- 
lent, produce  tomporaiy  disturbances  of  the  circulation,  which,  so  far 
from  being  morljid.  are  really  sanatoiy,  nay,  indispensable  to  full  health 
and  vigor.  Nature  allows  us  a  liberal  range  of  immunity  in  the 
employment  and  enjoyment  of  agencies  naturally  harmonious  with  our 
eti-uclures  and  functions. 

But  how  difterent  is  the  case  if  we  take  into  the  domain  of  life  a 
Bubstance  chemically  incompatible  with  its  structures,  or  an  agent  phys- 
iologically incompatible  with  its  functions.  Although  they  are  met 
with  the  same  vital  resistance  as  a  cold  bath,  or  a  hot  bath,  their 
temporary  impression  is  iiever  succeeded  by  absolute  equilibrium 
and  quietude.  They  leave  either  a  mark  or  a  void  in  their  track. 
When  chemically  incompatible,  as  are  all  the  metallic  and  mineral 
preparations,  they  act  upon,  corrode,  decompose,  and  destroy  some 
part  or  portion  of  some  constituent  of  some  solid  or  fluid,  of  some 
organ  or  structi  ve.  Familiar  and  melancholy  examples  of  chemical 
incompatibility  ai<^  found  in  the  ulcerations  of  the  mucous  membrane 
of  the  mouth,  throat,  stomach,  and  bowels,  produced  by  the  ordinary 
employment  of  saleratus  in  cooking,  and  the  rotting  of  the  teeth  and 
bones  in  consequence  of  a  mercurial  course.  When  they  are  physio- 
logically incompatible,  like  alcohol,  tobacco,  opium,  etc.,  they  exhaust, 
in-ecoverably,  some  portion  of  the  vitality  itself.  The  impressions  of 
drug-agents  of  all  kinds  are  constantly  destructive  or  exhausting  so  long 
as  they  are  kept  up ;  but  the  impressions  from  cold  bathing  may  be 
continued  during  a  whole  lifetime  without  injury. 

It  is  true  that,  in  water-treatment,  we  apply  cold  water  to  the  body 
when  hot,  hot  water  when  cold,  etc.,  not  to  antagonize  action,  but  to 
balance  action;  the  gi-and  general  indication  in  treating  all  diseases  hy- 
dropathically  being  to  equalize  the  temperature,  circulation,  and  action. 
The  principle  of  antagonism,  as  practiced  allopathically,  tends  to  silence 
the  cftorts  of  nature,  to  counteract  the  vital  powers,  to  suppress  the 
organic  instincts,  to  obstruct  the  vis  mcdicatrix  naturce,  to  embarrass 
the  cure,  and,  in  the  majority  of  ciises,  to  place  the  life  of  the 
patient  in  greater  jeopardy  than  it  would  be  with  no  medication 
whatever. 

The  true  philosophy  of  water-cure,  ir.  almost  every  essentia!    point 


PHILOSOPHY    OF    WATER-CURE.  15 

of  doctrine,  is  diameti  icaily  antagonistical  to  the  prevailing  theories  of 
the  allopatliic  schools. 

Some  of  the  honioopathists  have  lately  discovered  that  water  acta 
on  their  favorite  principle — similia  s'anilibus  curartur.  It  is  to  my 
mind  inconceivable  howw^ater  can  produce,  in  infinitesimal  or  any  other 
quantities,  any  other  c/?/na/?i/c  effects  than  such  as  are  referrible  to  tem- 
perature, bulk,  or  solvency.  Water  is  the  agent  which  homeopathy 
employs  to  dilute,  and  thus  "  enlarge  the  surface"  and  develop  the 
pathogenetic  property  of  its  remedies ;  but  how  it  is  to  be  reduced  to 
its  third  or  thirtieth  potency  by  dilution,  is  a  problem  which  may  be 
safely  laid  away  among  the  unaccountables. 

The  eclectics,  who  "  select  the  good  and  reject  the  bad"  of  all  sys- 
tems, claim  that  water  acts  like  a  hundred  other  drugs  which  are  in 
"  harmony  with  the  constitution."  They  pretend  to  eschew  all  poi- 
Bons,  and  use  nothing  but  the  "  innocent  remedies,"  which  are  best 
adapted  to  "aid  and  assist  nature;"  but,  unfortunately  for  their  fair 
pretension,  we  find  a  variety  of  vegetable  and  even  mineral  poisons 
among  the  everyday  prescriptions  of  their  writers  and  practitioners, 
as  preparations  of  opium,  and  preparations  of  iron. 

Rationale  of  Drug-Medication. — All  the  standard  works  on 
physiology  and  therapeutics  of  the  drug  schools  throw  not  a  solitary 
ray  of  light  on  the  modus  operandi  of  drug-medicines.  The  effects 
which  a  thousand  different  drugs  produce  upon  the  various  fiinetions 
of  the  human  body,  under  almost  all  conceivable  variations  of  conditions 
and  circumstances,  have  been  investigated  with  praiseworthy  industry, 
and  recorded  with  tedious  minuteness  and  extraordinary  precision. 
But  why,  how,,  and  wherefore  these  effects  are  thus  and  so,  we  are  as 
ignorant,  as  far  as  their  labors  are  concerned,  as  are  the  inhabitants  of 
the  moon,  who,  it  is  presumable,  do  not  have  access  to  their  books. 
Wliy  tartar  emetic  or  ipecac  produces  vomiting,  why  jalap  or  senna 
purges,  why  mercuiy  or  tobacco  salivates,  why  opium  or  cjitnip  produ- 
ces perspiration,  why  nitre  or  green  tea  produces  diuresis,  why  Spanish 
flies  or  boiling  water  raises  a  blister  on  the  skin,  why  calomel  or  pink 
operates  as  a  vermifuge,  why  aloes  or  iron  operates  as  an  emmena- 
gogue,  etc.,  etc.,  are  problems  as  deeply  in  the  dark  now  as  they  were 
before  the  light  of  medical  science  dawned  upon  the  world,  for  all  that 
appears  in  the  writings  of  the  standard  authors,  or  the  teachings  of 
living  professors. 

But,  fortunately  for  humanity,  the  principles  upon  which  this  ex- 
planation is  founded  are  abroad  in  the  world.     Surely  and  steadily  they  , 
are  working  their  way  into  the  vnrlerstandings  of  reading  and  thinkinji 


15  THEORY    AND    PRACTICE. 


oeople,  nnd  just  so  soon  as  they  are  generally  appreciated  will  the  drug 
pystcni  of  treating  diseases  be  among  the  things  that  were.  These 
principles  are  more  fully  developed  in  the  writings  of  Sylvester  Gra- 
ham than  in  those  of  any  other  author.  The  works  of  George  Combe 
contain  some  illustnitions  of  them.  The  writings  of  Dr.  Lambe,  Dr. 
Alcott,  Dr.  Jennings,  and  Rausse,  abound  in  teachings  predicated  on 
their  recognition,  Avhile  the  practice  of  Priessnitz  and  his  followers  is 
constantly  demonstrating  the  cori'ectness  of  the  explanation  which 
they  adbrd.  I  will  try  to  present  this  matter  clearly,  for  I  am  most 
undoubtingly  convinced  that  the  individual  who  fully  undei-stands  it 
will  be  exceedingly  loth  to  swallow  any  apothecary  drug,  whether  it 
go  by  the  name  of  drag-poison  or  drug-medicine  ;  and  he  who  has 
both  philanthropy  and  intelligence  will  be  as  un\^^Hing  to  administer 
those  foreign  agents  to  other  stomachs,  as  to  take  them  into  his  own. 

There  is  a  class  of  medicines  known  as  tonics,  or  sti-engthening 
medicines.  Books  on  materia  raedica  define  them  to  be  such  articles 
as  give  tone,  or  tonic  contractility  to  the  moving  fibres,  and  at  the  same 
time  augment  the  activity  of  the  digestive  function.  Now  among  the 
tonics  we  find  a  most  incongi'uous  set  of  materials,  as  quinine,  arsenic, 
boneset,  iron,  wormwood,  oak  bark,  quassia,  aloes,  rhubarb,  copper, 
zinc,  etc.  All  authors  agree  that  if  the  use  of  a  tonic  is  long  continued, 
the  effect  is  dehil'ity.  Here  is  a  paradox.  A  tonic  medicine  fii-st 
strenglhens,  and  then  dchilitates.  How  are  these  results  to  be  ac- 
counted for? 

When  a  drag-medicine  of  any  kind,  or  a  poison  of  any  kind,  is  taken 
into  the  stomach,  the  organic  instincts  recognize  the  presence  of  a 
something  which  is  neither  food  nor  drink ;  something  unnatural ; 
Bomething  which  has  no  constitutional  relation  to  any  want  or  duty  of 
any  part  or  organ,  hence  an  intrader,  an  enemy.  The  vital  powers 
feel  an  attack  upon  the  citadel  of  life,  and  prepare  to  act  defensively. 
The  lining  membrane  of  the  stomach  is  aroused  to  increased  action ; 
an  unusual  quantity  of  mucus  and  serum  is  secreted  to  protect  the 
coats  of  the  stomach  fi-om  the  poisonous  or  medicinal  agent ;  but  the 
stomach  does  not  suffer  alone;  the  alarm  is  communicated  to  other 
organs,  to  nil  parts  of  the  system ;  and  this  manifestation  of  increased 
vital  action,  this  disturbance  of  the  organism,  this  commotion  of  the 
body,  is  regarded  by  the  doctors  as  a  tonic  effect!  How  words 
deceive  ! 

If  but  a  few  of  these  "tonic"  impressions  are  r.ade  on  the  stomach, 
if  only  a  few  doses  are  taken,  the  vital  powers,  after  enduring  the 
siege,  and  defending  themselves  as  well  as  may  be,  subside  into  their 
accustomed  quiet,  nnd  tk?  exhaus*;'.on,  being  n:t  very  gi'eat,  is  p 


PHILOSOPUY    OF    WATER-CURE.  17 


specially  noticed.  But  if  these  tonic  impressions  are  kept  up  a  long 
time,  if  the  medicines  be  long  continued,  the  vital  expenditure  is  so 
great  that  the  doctors  onll  the  evidence  of  its  loss  debility ;  and  well 
they  may.  The  organic  instincts  are  finally  wearied  out,  they  become 
torpid,  and  refuse  longer  to  respond  to  the  impression ;  the  lash  ceases 
to  be  troublesome.  Now  it  is  that  the  doctor,  who  wishes  to  still  keep 
up  a  tonic  impression,  who  desires  to  strengthen  the  system  yet  a  little 
more,  brings  a  new  recruit  into  the  field.  He  adrainistei-s  another 
tonic  ;  no  matter  what,  if  it  be  a  different  one.  It  works  like  a  chai'm ! 
The  vital  powers,  though  jaded  and  half  palsied,  are  not  j-et  dead.  A 
new  eneny  will  startle  them  again;  an  unaccustomed  imj)ression  will 
again  arouse  them  to  resistance.  If  the  first  tonic  was  wormwood, 
the  second  may  be  arsenic,  or  vice  versa.  After  the  second  tonic  has 
spent  its  force,  or,  rather,  after  the  vital  powers  cease  to  resist,  a  third 
one  m;iy  be  brought  to  bear;  and  so  on,  as  long  as  the  patience  of  the 
patient  or  perseverance  of  the  practitioner  can  endure.  Thus  do  tonics 
continually  strengthen  the  patient,  and  leave  him  weaker  in  the  end. 

A  decisive  evidence  of  the  correctness  of  this  explanation  is  found  in 
the  fact,  that  every  drug  under  heaven  can  be  made  to  operate  as  a 
tonic.  Mercury,  lead,  antimony,  cod-liver  oil,  ipecac,  gamboge,  aqua 
fortis,  or  powdei'ed  glass — as  incongraous  a  medley  as  can  be  conceived 
— will  produce  tonic  etifects,  provided  the  dose  is  such  as  not  to  occasion 
any  decisive  evacuant  or  corrosive  operation,  by  which  the  article  is 
suddenly  evacuated,  or  the  structure  altered.  Cud-liver  oil  and  ipecac 
have  both  had  their  day  of  reputation  for.  improving  digestion,  or  fiit- 
tening  the  body.  Why?  Because  when  taken  into  the  stomach,  that 
organ  being  the  point  of  attack,  the  vital  powers  are  dispropoitionately 
directed  to  that  organ  in  defense ;  and  if  the  doses  are  frequently 
fepeated,  a  determination  of  nervous  or  vital  energy  is  established  to- 
ward the  digestive  function.  The  digestive  organs  may  thus  be  tem- 
porarily invigorated  at  the  expense  of  all  the  rest  of  the  body — a  dear- 
bought  method  of  promoting  digestion  and  fattening  the  body,  in  the  end. 

But  why  do  some  poisons  or  medicines  produce  vomiting,  others 
sweating,  others  purging,  etc.  Simply  because  they  are,  by  means 
of  those  violent  or  increased  efforts  of  the  excernent  functions,  got  rid 
C)f.  It  is  a  law  of  the  animal  economy,  that  all  injurious  agents  which 
gain  admission,  no  matter  how,  within  the  domain  of  vitality,  are  coun- 
teracted, neutralized,  or  expelled  in  such  manner  as  will  produce  the 
least  injury  or  disturbance  to  the  organism.  If  a  very  large  dose  of 
ipecac,  for  example,  is  swallowed,  so  large  as  to  pi-ove  immediately 
dangei'ous  to  life,  or  seriously  destructive  to  the  structural  or  functional 
integi'ity  of  the  stomach,  its  action  is  met  with  such  violence  of  resist- 


18  THEORY    AND    PIIA..TICE. 


ance  fts  to  produce  severe  spasmodic  contractions  of  the  muscular  fibres 
of  the  stoiiiMcli  and  the  nbdonVuial  muscles,  by  which  the  ordinary  i-er- 
istaltic  motion  of  the  alimentaiy  canal  is  reversed,  and  vomiting  results. 
If  the  dose  be  smaller,  a  pr^  fuse  watery  secretion  is  poured  out  upon 
it  from  the  mucous  and  lining  membrane  of  the  stomach  and  bowels. 
to  dilute  it,  and  render  its  presence  less  harmful,  while  it  is  conducted 
along  the  alimentary  canal  by  the  ordinary  peristaltic  motion,  and  ex- 
pelled from  the  bowels,  and  thus  we  have  a  cathartic  effect.  If  the 
dose  be  still  smaller,  it  is  laigely  diluted  with  serum,  taken  up  by  the 
absorbents,  carried  into  the  mass  of  blood,  and  finally  thrown  off  by  tho 
skin,  this  being  the  manner  in  w^hich  a  small  quantity  can  be  most 
easily  got  rid  of,  and  thus  we  have  a  diaphoretic  operation.  If  the 
dose  be  even  yet  smaller,  so  that  no  special  effort  of  the  organism  is 
made  to  throw  it  off  at  either  emunctory,  the  vital  powers  meet,  de- 
compose, and  destroy  it  in  the  stomach,  for  which  purpose  there  is  an 
increased  determination  of  blood  and  of  nervous  influence  directed  to 
the  part,  and  hence  we  have  its  tonic  effect.  Thus  may  a  single  article 
of  the  materia  medica  produce,  according  to  the  quantity  administered, 
the  various  and  seemingly  opposite  operative  effects  of  vomiting,  j^urg- 
ing,  sweating,  and  strengthening ;  while  each  effect  is  attended  with 
an  absolute  waste  of  vital  power. 

It  is  well  known,  too,  that  all  drugs  lose  a  degree  of  their  potency 
by  repetition ;  in  other  words,  the  vital  resistance  is  gi-adually  overcome 
or  worn  out,  so  that,  to  produce  the  same  operative  effect,  the  dose 
must  be  constantly  augmented.  Those  who  find  a  sufficient  stimulus 
in  one  glass  of  brandy  per  day,  frequently  find  ten  required  in  a  few 
years  to  produce  an  equal  excitement ;  those  who  commence  on  one 
cigar  daily,  generally  end  with  several ;  and  those  who  find  at  first  one 
patent  pill  sufficient  to  move  the  bowels,  not  uufrequently  find  twerfty 
or  thirty  an  inefficient  dose  after  the  vital  resistance  liis  been  pretty 
thoroughly  subdued. 

When  medical  books,  therefore,  tell  us  that  drugs  lose  their  reme- 
dial effects  by  long  continuance,  we  are  to  understand  that  vital  resist- 
ance is  subdued;  for  so  long  as  the  organic  instincts  act  a^a?r?s^  the 
remedy,  so  long  will  the  phenomena  of  resistance  occur,  which  med- 
ical reasoners,  starting  from  mistaken  premises,  call  medicinal.  It  may 
be  remedial,  and  is,  in  a  ceitain  sense — rendering  evil  for  evil. 

If  a  blistering  compjund,  which  acts  chemically  or  corrosively  upon 
the  structures,  is  placed  upon  the  skin,  serum  is  poured  out,  the  cuticle 
is  raised,  a  collection  of  water  is  formed  as  a  barrier  to  the  farther 
approach  of  the  adversary,  the  scarf-skin  is  sacrificed  to  save  the  tiue 
fikin,  and  the  red,  turgid,  inflamed  blood-vessels  show  the  violence  of 


PHILOSOPHY    OF    WATER-CURE.  i» 


this  defensive  struggle.  It  may  be  that  the  vital  energies  which  were 
struggling  against  the  cause  of  a  deeper-seated  pain  are  so  diverted  to 
the  new  point  of  attack — the  blistered  surfiice — that  the  prior  pain  is 
no  longer  felt.  The  doctor  calls  it  cured ;  it  may  be  cured,  and  yet 
its  cause  be  aggravated,  and  the  patient  only  the  worse  fo-r  the  cure. 

The  grand  distinctive  effects  of  homeopathic  and  allopathic  practice 
are  not  to  be  explained  on  the  principle  of  "■similia  similibus  caraniur^' 
nor  upon  the  principle  of  '■'■  coniraria  contrarius  curantur,^'  nor  upon 
both  principles  together,  but  upon  this  principle  of  vital  resistance  we 
are  considering.     Let  me  illustrate  this  point. 

Tea,  coffee,  catnip,  thoroughwort,  uva  ursi,  milkweed,  etc.,  aro 
medicinally  diaphoretic  and  diuretic ;  in  other  words,  the  vital  powers 
expel  them  through  the  skin  and  kidneys,  the  expulsive  effort  being 
denoted  by  diaphoresis  and  diuresis.  From  improper  food,  vitiated 
air,  impure  water,  or  suppressed  perspiration,  the  blood  may  be  loaded 
with  morbific  matters,  which  the  vital  powers  are  naturally  disposed  to 
expel  through  these  depurating  organs — the  skin  and  kidneys.  Now 
while  the  vital  powers  are  making  a  special  effort  to  get  rid  of  tho 
special  cause  of  disease — morbid  matter — let  us  see  what  happens  by 
the  special  introduction  of  a  medicinal  drug.  Precisely  this.  If  tho 
drug  be  so  small  in  dose  as  not  to  disturb  seriously  the  first  passages, 
and  provoke  vital  resistance  there — that  is,  if  it  be  homeopathic — it 
passes  on  into  the  circulation,  to  be  expelled  thi'ough  the  skin  and  kid- 
neys ;  thus,  by  adding  another  morbid  cause  to  the  existing  one,  both 
of  which  incite  the  vital  powers  to  expulsive  efforts  through  the  same 
channels,  the  determination  to  the  skin  and  kidneys  is  increased ;  tho 
remedy  does  actually  increase  the  remedial  efforts  of  nature,  for  the 
simple  reason  that  it  provides  a  greater  duty  for  nature  to  perform. 
When  the  morbid  matter  of  the  disease  and  the  morbid  matter  of  the 
drug  are  got  rid  of,  we  have  a  cure  on  the  homeopathic  principle. 

But  suppose  the  dose  to  be  allopathic,  that  is,  large  enough  to  pro- 
duce a  strong  impression  on  the  stomach  and  bowels,  and  excite  active 
resistance  in  the  first  passages.  Here  are  then  two  sets  of  vital  efforts 
at  work  in  different  directions,  at  variance  with  and  counteracting  each 
other;  one  to  the  skin,  to  expel  the  morbific  causes  of  the  disease,  and 
the  other  to  the  primary  nutritive  functions,  to  resist  the  morbid  matter 
of  the  medicine.  The  efforts  of  nature  being  thus  divided  and  dis^ 
tracted,  are  rendered  inefficient  for  either  duty;  but  if  the  impression 
of  the  drug  be  very  powerful,  it  may  produce  a  new  disease,  and  draw 
oft'  all  the  remedial  efforts  from  the  skin  and  kidneys  to  resist  its  action, 
and  then  we  have  a  cure  on  the  allopathic  principle.  The  disturb- 
ance of  the  skin  and  kidneys  is  silenced,  and  all  that  is  required  ia 


ZO  THEORY    AND    PRACTICE. 


to  recover,  if  possible,  from  the  factitious  malady — the  effect  of  the 
drug. 

We  can  more  readily  understand  how  vastly  superior  the  homeo- 
pathic practice  is,  in  ail  those  cases  of  disease,  as  the  simple  fevere  and 
exiinthv:.i^,  wherein  the  efforts  of  nature  are  du-ected  especially  to  the 
Bkin,  and  wherein  they  ai-e,  in  almost  all  cases,  when  left  to  themselves, 
equal  to  the  task  of  overcoming  the  difficulty.  The  infinitesimal  dose 
does  not.  to  any  appreciable  extent,  hinder  tiie  success  of  those  remedial 
powers  inherent  in  the  living  organism.  We  can  account  for  another 
problem,  too :  the  superiority  of  the  allopathic  practice  in  a  different 
cliiss  of  diseases,  in  obstructions  of  and  morbid  accumulations  in  the 
alimentary  canal,  where  the  strongest  impression  of  the  allopathic  dose 
can  be  made  in  the  line  of  direction  of  the  remedial  efforts  of  nature. 
In  the  case  of  n  simple  fever  the  allopathic  dose  would  interrupt  the 
natural  course  of  these  remedial  efforts ;  but  in  a  Cfise  of  constipalion 
from  retained  excrementitious  matters,  the  homeupathic  dose  would 
work  advers<^ly. 

I  am  far  from  denying   that,  under  certain   circumstances,  drug- 
medication,  either   homeopathically  or  allopathically,  may   do    much 
more  good  thnn  evil,  though  I  contend  that  such  is  not  the  general  rule ; 
but  I  insist  tliat  the  true  healing  art  contemplates  a  method  of  medi 
eating  diseases  on  an  entirely  different  basis ;  and  a  ti'ue  basis,  I  daijn 
is  furnished  by  the  philosophy  of  the  Water-Cure  system,  which  al 
jures  drugs,  and  depends  w^iolly  on  hygienic  influences. 

There  is  nothing  in  medical  experience  more  speciously  delusiv 
than  the  sti^mlating  practice  in  cases  of  extreme  prostmtion  aiu 
debility.  When  a  fever,  for  example,  "turns,"  or  completely  subsides, 
the  patient  is  weak  and  relaxed ;  and  if  he  has  beeu  severely  drugged, 
he  will  be  vc^v  weak.  The  doctors  of  all  schools,  except  the  hydro- 
pathic, are  always  afraid  the  patient  will  "sink,"  or  "run  down,"  unless 
kept  up  with  brandy,  wine,  quinine,  or  some  other  diffusible  stimulant 
or  tonic.  Hence,  no  sooner  is  a  fever  subdued  by  reducing  agents, 
than  it  is  produced  again  by  exciting  agents,  on  the  absurd  theory  of 
sustaining  the  uody  on  mere  stimulation  until  it  can  recover  its  balance, 
or  in  some  :"!\vsterious  way  acquire  a  faculty  of  existing  without  it. 
This  "fallacy  of  the  faculty"  has  been  the  death  of  no  small  number 
of  the  earth's  inhabitants. 

It  is  no  un'-ommon  circumstance  for  a  patient  to  be  dosed  with  a 
quart  of  bnmdy,  or  a  gallon  of  wine,  in  twenty-four  hours,  every 
swallow  occasioning  a  new  organic  resistance,  and  a  further  waste  of 
vital  power,  and  imperiling  the  patient's  life,  while  the  doctor  is  firmly 
impressed  with  the  belief  that  the  patient's  breath  i-emains  in  his  body 


PHILOSOPHY    OF    WATER-uURE.  21 

only  by  virtue  of  the  alcoholic  stimulant.  It  is  easy  to  account  for  this 
delusion.  When  the  fever  is  up,  the  physician  is  afraid  of  death  from 
its  violence  ;  but  he  knows  the  patient  will  not  die,  in  i^rdiuary  case?, 
until  the  cold  stage  of  the  paroxysm  becomes  permanent.  -When  the 
fever  is  down — that  is,  in  the  cold  stage — the  patient  is  pak^.-cool  or 
cold,  the  features  sunken,  and  the  pulse  low,  natural  coiisequences  of 
the  previous  febrile  excitement.  The  organism  now  requires  rest, 
quiet,  perhaps  nourishment.  But  the  doctor,  feiiring  this  depression 
will  end  in  death,  kindles  up  the  fever  again.  So  Icng  :is  the  system 
will  respond  to  stimuli,  so  long  us  the  vital  powers  will  manifestly  resist 
the  morbid  impression  of  the  stimulant,  the  body  is  not  absolutely 
death-struck,  and  the  doctor  has  the  satisfaction  of  kijcwing  that  the 
patient  is  not  now  dying.  But  this  evidence  of  his  existing  vitality  is 
the  expenditure  of  a  part  of  that  vitality,  hence,  although  the  stimulant 
causes  him  to  manifest  more  signs  of  life,  it  also  hastens  oi  endangers 
his  death,  for  the  simple  reason  that  it  causes  a  furthei  waste  of 
vitality. 

But  it  may  be  objected  that  our  theory  of  vital  resistance,  though 
applicable  to  those  agents  which  produce  evacuation,  or  increased  action 
of  the  circulating  system,  will  not  explain  the  phenomena  produced  by 
the  narcotics,  which  operate  in  a  very  different  mannei.  Let  us  see. 
Medical  books  tell  us  that  opium  in  small  doses  suppresses  all  secretions 
except  the  cutaneous,  which  it  promotes.  What  is  this  but  the  effort 
of  the  vital  powers,  all  concentrated,  as  it  were,  to  expel  it  through 
the  skin  ?  In  large  doses  opium  always  creates  nausea,  and  usually 
vomiting,  evincive  of  the  effort  of  the  vital  powers  to  expel  it  at  once 
from  the  stomach.  The  pure  narcotics,  as  henbane,  belladonna,  stra- 
monium, cicuta,  prussic  acid,  etc.,  are  really  evacuants  in  relation  to 
the  nervous  power.  Being  so  deadly  in  their  influence,  they  are  met 
with  an  energy  proportioned  to  their  potency  of  dose,  and  the  shock, 
as  it  were,  is  often  sufficient  to  destroy  the  organism  ir;  a  moment,  like 
that  from  a  Leyden  jar,  or  a  surcharged  electric  cloud.  In  very  small 
doses  the  pure  narcotics  are  thrown  off  more  or  less  by  all  the  excre- 
tory organs,  but  more  especially  the  skin. 

In  conclusion,  we  may  find  a  convincing  illustration  in  the  effects  of 
tlie  very  Sampson  of  the  allopathic  materia  medica — mercury.  Ko 
medical  books  pretend  to  explain  the  modus  operandi  of  this  drug,  but 
all  agree  that  it  promotes  all  the  secretions  of  the  body-  It  is  this  gen- 
eral effect  upon  all  the  secretions  which  causes  mercury  to  be  regarded 
as  a  universal  alterative,  and  administered,  too,  so  freeiy  and  so  fatally 
in  almost  all  the  diseases  incident  to  humanity.  But  how  and  ivhy  doesr 
mercury  promote  the  f.itiviiy  of  aJ!  the  secreting  organs?     Because 


22 


THEORY    AND    PRACTICE. 


its  operation  is,  although  veryslow  and  gradual,  is  chemically;  destructive 
to  some  of  the  constituents  of  all  »he  fluids  and  solids  of  the  body ; 
hence  it  is  every  where  met  with  active  vital  resistance,  either  to  expel 
it  at  the  natural  outlets,  or  involve  it  in  mucous,  so  as  to  neuti'aliz3  or 
lesson  its  ruinous  consequences  while  it  remains  in  the  system.  Its 
universally  remedial  operation  is  only  the  evidence  of  universal  war  in 
the  organism,  the  final  result  oi  which  must  inevitably  be  universal 
ruin,  to  a  gi-eater  or  less  extent,  of  the  vital  powers. 


Fig.  164. 


!:aif!l,;,i.M,, 


CHAPTER  II. 

WATER-CURE   PROCESSES. 

The  hydropathic  appliances  embrace  all  the  usual  methods  of  vapor, 
warm,  tepid,  cool,  and  cold  bathing,  besides  a  variety  of  processes 
which  have  had  their  origin  in  the  development  of  Water-Cure  as  a 
system. 

The  Wet-Sheet  Packing. 
— This  process,  the  lien  tuch  of 
the  Germans  (fig.  164),  is  admi- 
i-ably  calculated  to  answer  two 
general  indications,  which  are 
manifestly  leading  ones  in  a  long 
catalogue  of  maladies,  both  acute 
and  chronic,  viz.,  to  reduce  the 
heat  of  the  bodj*  and  the  force 
of  the  circulation,  and,  as  an  al- 
terative, to  correct  morbid  and 
restore  healthy  secretions.  It 
produces  also,  incidentally,  a 
powerfully  detergent  or  cleans- 
ing'efl'ect,  and  generally  exerts 
a  wonderfully  sedative  or  sooth- 
ing influence  on  the  whole  nervous  system.  The  first  disagi'eeable 
sensation  of  cold  is  usually  soon  followed  by  a  pleasurable  warmth  over 
the  whole  surface.  It  is  capable  of  superseding,  to  advantnge,  bleeding, 
antimony,  salts,  hydriodate  of  potassa  (iodide  of  potassium),  calomel, 
ond  opium,  and  a  hundred  other  more  or  less  injurious  agents- 


^WTfFi 


THE    WET-SHEET    PACKING. 


WATER-CURE    PROCESSES.  23 
^f 

In  fevers,  and  in  all  acute  inflammatory  disorders,  it  may  be  employed 
with  a  freedom  exactly  proportioned  to  the  degi'ee  of  morbid  heat  and 
force  of  the  pulse ;  that  is,  continued,  with  frequent  changes,  until  the 
temperature  and  circulation  are  reduced  to  the  natural  standard,  and 
the  skin  becomes  soft  and  perspirable.  Much  sweating  is  not  usually 
to  be  desired. 

In  nearly  the  whole  range  of  chronic  complaints,  there  is  one  prev- 
nlent  morbid  condition,  ever  varying  in  intensity,  yet  consisting  essen- 
tially in  a  deficiency  of  blood  in  the  superficial  and  capillary  vessek', 
find  an  accumulation  or  engorgement  in  the  large  internal  vessels,  with 
consequent  congestion  in  some  one  of  more  of  the  viscera.  To  reverse 
this  condition,  relieve  the  overburdened  internal  organs,  and  supply  the 
deficient  external  circulation,  the  wet-sheet  process,  aided  by  the  proper 
auxiliaries,  is  the  best  known  remedial  agent. 

Dr.  Gully  well  remarks  :  "  This  process  repeated  day  after  day,  and 
sometimes  twice  daily,  at  length  ^.re5  a  quantity  of  blood  in  the  blood- 
vessels of  the  entire  skin,  and  thereby  reduces  the  disproportionate 
quantity  which  was  congested  in  the  inner  skin,  or  mucous  mem- 
branes." 

If  any  one  doubts  the  purifying  efficacy  of  this  process,  he  can  have 
a  "demonstration  strong"  by  the  following  experiment:  Take  any  man 
in  apparently  fair  health,  who  is  not  accustomed  to  daily  bathing,  who 
lives  at  a  "first-class  hotel,"  where  they  fatten  their  own  chickens  and 
pigs  on  the  refuse  matter  of  the  kitchen,  takes  a  bottle  of  wine  at' 
dinner,  a  glass  of  brandy  and  water  occasionally,  and  smokes  from 
three  to  six  cigars  per  day.  Put  him  in  the  "pack"  and  let  him 
"  soak"  one  hour  or  two  ;  on  taking  him  out,  the  intolerable  stench  will 
convince  all  persons  who  may  be  present  that  his  blood  and  secretions 
were  exceedingly  befouled,  and  that  a  process  of  depuration  is  going 
on  rapidly. 

The  time  for  remaining  "  packed"  varies  greatly  in  different  cases. 
The  average  time  is  from  thirty  to  sixty  minutes,  though  in  some  few 
cases  fifteen  minutes  is  long  enough,  while  others  may  remain  envel- 
oped two  hours  to  advantage.  Persons  of  highly  nervous  tempei"a- 
ment,  and  rapid  though  feeble  pulse,  and  those  laboring  under  great 
deJjility  with  considerable  irritability,  should  remain  in  the  wet  sheet 
only  until  the  body  becomes  comfortably  warm.  Those  having  a  more 
torpid  circulation  and  phlegmatic  temperament,  unattended  with  much 
debility,  may  remain  a  much  longer  tiine. 

Much  of  the  comfort  or  disagi'eableness  of  the  process  depends  on 
the  skill  and  dexterity  of  the  attendant.  There  is  at  least  as  much 
Bcience  in  applying  wet  cloths  to  the  naked  body  as  in  rubbing  in  an 


24  THEORY    AN  DPRACnCE. 

ointment  or  putting  on  a  blister.  A  person  may  be  wi-appef3  up  so 
elowly,  loosely,  and  unevenly  by  an  awkward  hand,  as  to  find  the  whole 
affair  from  beginning  to  end  exceedinglj'  uncomfortable  ;  or  the  cloth- 
ing may  be  so  rapidly  and  nicely  adjusted,  as  to  give  the  patient  an 
liour  or  so  of  actual  enjoyment. 

Licht  cotton,  hair,  or  sea-grass  mattresses,  or  even  sti'aw,  for  those 
accustomed  to  very  hard  beds,  may  be  used  for  "packing."  On  one 
of  these  spread  from  three  to  five  large  thick  comfortables,  then  a 
l)iiir  of  soft  flannel  blankets,  and,  lastly,  the  wet  sheet  lightly  wrung 
out,  so  as  not  to  drip.  Two  pillows  placed  on  the  mattress  are  neces- 
sary for  the  head.  The  patient,  lying  down  flat  on  the  back,  is  quickly 
enveloped  in  the  sheet,  followed  by  the  blankets  and  comfortables.  A 
light  feather  bed  may  be  thrown  over  the  top,  in  which  case  two  com- 
fortables less  will  be  required.  If  the  feet  remain  cold,  bottles  of  hot 
water  should  be  placed  to  them.  Headache  is  prevented  or  removed 
by  the  application  of  cold  wet  cloths.  In  wrapping  up  the  patient, 
gi-eat  care  should  be  taken  to  turn  the  clothing  snugly  and  smoothly 
around  the  feet  and  neck.  For  very  delicate  persons,  the  sheet  should 
at  first  be  wnang  out  of  tepid,  or  even  warm  water.  On  coming  out 
of  the  "  pack,"  the  plunge,  douche,  rubbing  wet-sheet,  or  towel 
washing  may  be  employed,  as  either  is  speedily  indicated. 

Some  hydropathists  recommend  the  sheet  to  be  wrung  as  dry  as 
possible,  and  others  advise  it  to  be  used  quite  wet.  I  prefer  a  very 
wet  sheet  in  all  cases  wherein  the  patient  is  not  deficient  in  external 
heat.  When  the  skin  is  very  cold  and  torpid  I  would  advise  it  to  be 
J19  dry  as  the  attendant  can  conveniently  wring  it. 

Some  persons,  whose  pores  are  prettj^  eftectually  closed  up  with 
bilious  accumulations,  find  it  rather  difficult  to  get  entirely  warm  at 
first.  In  a  few  days,  however,  the  glow  comes  up  readily,  and  it 
ceases  to  be  dreaded.  Such  cases  are  benefited  by  a  good  deal  of 
friction  to  the  skin  over  the  wet,  and  then  the  dry  sheet. 

There  are  some  few  patients,  of  weak  vital  energies  and  extreme 
Fusceptibility,  who  very  soon  get  warm  in  the  wet  sheet,  and  inmie- 
diately  after  grow  chilly  again ;  and  in  some  cases,  if  they  remain  yet 
half  an  hour  longer,  a  comfortable  reaction  will  come  on  again.  Such 
persons  should  be  taken  out.  if  possible,  during  the  glow  upon  the  sur- 
face. If  it  so  hfippens  that  they  get  an  unpleasant  chill  after  coming 
out,  a  thorough  rubbing,  followed  by  fifteen  or  twenty  minutes  dry 
packing,  will  usually  obviate  all  injurious  consequences. 

Headache,  languor,  muscular  debility,  and  giddiness,  if  serious  and 
long  continued,  generally  indicate  that  the  envelop  has  been  continued  too 
long.     When  thej'  occur  repeatedly   the  time  should   be  shortened. 


W  AT  E  R  -  C  U  R  E    PROCESSES. 


A  linen  is  always  to  be  preferred   for  "  nackln<r,"  more  especially  in 
waini  weather. 

The  wet  sheet  is  not  a  sweatiug  process,  as  generally  supposed, 
although  frequently  a  moderate,  and  occasionally  a  copious  perspiration 
takes  place.  It  is  permanently  either  a  cooling  or  a  heating  process, 
according  to  the  degree  of  envelopment.  When  the  object  is  to  reduce 
fever  or  inflammation,  the  patient  should  be  lightly  covered,  and  the 
wet  sheet  frequently  renewed.  In  chronic  diseases,  when  the  inten- 
tion is  to  produce  reaction  and  develop  the  external  circulation,  an 
additional  quantity  of  bedding  secures  this  object.  As  a  cooling  pro- 
cess, it  may  always  with  safety  be  frequently  repeated,  until  the  force 
of  the  pulse  and  the  preternatural  heat  are  reduced  to  the  normal 
standard.  Under  its  judicious  employment  in  chronic  diseases,  the 
skin  gradually  becomes  softer,  velvety,  and  more  porous  and  delicate ; 
its  structure  more  firm,  and  its  functions  more  vigorous. 

The  Half-Pack  Sheet. — This  is  the  application  of  the  wet  sheet 
as  above  to  the  trunk  of  the  body  only.  It  is  milder,  yet  less  effica- 
cious, than  the  full  pack.  It  is  only  employed  on  feeble  persons,  who 
have  not  sufficient  vitality  for  the  whole  sheet,  or  as  a  preparatory 
taeasure  for  the  entire  envelopment. 


The    Douche. — The    prima)-y  i^'-  i;"'> 

(;bjcct  of  t!ie  douche  {doosli)  b;ith,  ■;!■■■: '■^i"r:l':t'"!^'\f'';!1^';i'"'i!!:^ 

(iir.  Kio,  is  to  arouse  the  activity  liL,, „.,„ 

01  the  absuroent  system,  and  th:s 
it  certainly  accomplishes  in  a  most 
powerful  and  effectual  manner. 
It  is  well  adapted  to  chronic  en- 
largements of  the  viscera,  tumors, 
swellings  and  stiffness  of  the  joinls, 
local  attacks  of  gout  and  rheuma- 
tism, obstinate  constipation,  the  in- 
cipient stage  of  tubercular  con- 
sumption, and  many  other  disor- 
ders. The  force  of  the  stream 
and  time  of  application  should  be 
carefully  adapted  to  the  sti'ength  of  the  patient.  Very  nervous  per- 
ms, and  those  subject  to  a  determination  to  the  brain,  must  resort  to 
i  with  extreme  caution.  Generally  the  stream  should  be  directed  to 
the  back  of  the  neck,  along  the  spine,  hips,  and  shoulders ;  in  chronic 
swellings  of  the  joints  the  stream  mn\  be  directed  to  the  aflected 
II— 3  ^        • 


THE    DOUCHE 


26  THEORY    AND    PRAOTICE. 


parts ;  in  cases  of  torpid  bowels  a  moderate  stream  may  be  applied  to 
the  external  abdominal  muscles.  No  sti-oiig  douche  should  ever  be 
taken  on  the  head,  nor  should  it  be  long  continued  on  any  one  spot 
about  the  spine  or  back  bone. 

Douches  may  be  so  constructed  as  to  produce  any  degi-ee  of  impres- 
sion, from  that  which  is  scarcely  appreciable,  to  one  as  powerftil  as  the 
muscular  system  can  endure,  according  to  the  size  of  the  stream,  its 
fall,  pressure,  etc.  They  may  be  verticah  oblique,  horizontal,  or  as- 
cendins-  Those  most  generally  muse  are  perpendicular  streams  from 
one  to  two  inches  in  diamete^'  Smaller  streams,  as  inch  and  half 
inch  are  better  in  some  cases  The  oblique  and  horizontal  streams 
ran  be  more  conveniently  applied  locally  when  indicated,  and  in  many 
cases,  fis  in  difficult  respiration,  it  is  advantageous  to  have  the  bodily 
position  erect  during  its  application.  The  ascending  douche  is  particu- 
larly valuable  in  piles,  prolapsus  of  the  uterus  or  bowels,  constipation 
from  debility,  etc.  The  sti-eam  should  not  be  forcible  enough  to  cause 
absolute  pain  nor  serious  inconvenience;  the  stream  may  be  half  an 
inch  to  an  inch. 

Warm  water  douches  have  been  employed  but  little  comparatively, 
but  I  think  they  are  destined  to  grow  in  favor.  In  many  cases  of 
rigidity  of  the  muscles,  painful  swellings,  chronic  inflammations  of  the 
joints,  in  neuralgic  affections  attended  with  exti'eme  nervous  irritabil- 
ity, and  in  spasmodic  and  bilious  colic  I  have  known  excellent  effects 
from  sti-eams  of  warm  water  applied  to  the  parts  affected.  They  are 
also  useful  in  obstinate  constipation,  retention  of  urine,  amenorrhea, 
etc.  As  the  object  of  a  warm  douche  is  to  relax  instead  of  contract- 
ing the  muscles  of  the  affected  part,  a  small  stream  long  continued  is 
the  best;  it  should  be  followed  by  the  cold  dash  for  a  moment. 

The  hose-bath  is  a  modification  of  the  douche ;  it  may  be  employed 
horizontally  or  obliquely  to  my  ])art  of  the  body,  the  force  being 
regulated  by  a  stop-cock. 

The  Rubbing  Wkt-Sheet. — This  bath  produces  a  strong  and 
general  determination  to  the  whole  surface.  The  sliock  is  generally 
rapidly  succeeded  by  vigorous  reaction,  which  is  further  promoted  and 
maintained  by  active  friction.  It  is  applicable  in  all  cases  wherein  a 
strong  diversion  from  the  internal  viscera,  o?  the  mucous  membrane 
of  the  alimentary-  canal,  to  the  skin,  is  required.  It  is  more  or  less 
serviceable  in  nearly  every  rondition  of  disease  wherein  the  patient 
has  sufficient  reactive  energy  to  prevent  a  permanent  chill.  In  the 
primary  stage  of  fevers,  in  the  eirly  stages  of  bowel  complaints,  colic, 
diarrhea,  dysentery,  cholera,  etc  ,  it  is  particularly  valuable.     In  these 


WATER-CURE    PROCESSES. 


2T 


cases  it  should  bo  applied  frequently  lor  a  few  minutes,  and  tlie  skin 
inibbed  energetically  and  perseveringly.     In  the  great  majority  of  skin 
diseases  it  is  among  the  best  resources  of  hydrotherapia.     It  is  one  of, 
the  best  kind  of  "  wash-downs"  to  foUow  the  pack. 

The  rubbing  wet-sheet  is  an  admirable  bath  for  the  ?odeutary  and 
studious;  for  exliaustion  consequent  on  severe  rpental  exertion;  for 
mental  disorders,  and  many  states  of  insanity  ;  for  nearly  all  spasraodie 
and  epileptic  conditions ;  foi  delirium  tremens ;  for  night  sweats- 
WHtchfulness,  nightmare,  etc. 

When  employed  drippingly  wet  {the  aHpping  sheet),  a  large  tub  or 
dripping  pan  is  necessary  for  the  patient  to  stand  in.  When  wrung 
so  as  not  to  drip  it  may  be  used  in  any  room  or  on  a  cavpcted  floor. 
The  sheet  is  thrown  suddenly  around  the  patient's  body,  which  it 
closely  envelops  from  the  neck  to  the  feet,  and  the  body  is  rubbed  by. 
the  hands  of  the  attendant  outside  the  sheet;  in  ordinaiy  cases  fivo 
minutes  are  sufficient.  Some  prefer  a  larger  sheet  thrown  over  the 
head  and  reaching  down  to  the  feet,  by  which  the  patient  can  himself 
exercise  by  rubbing  in  front  while  the  attendant  rubs  the  back  part  of 
the  body.  I  do  not  see  any  special  advantage  in  this  to  offset  its 
awkwardness.  The  patient  can  and  should  make  active  friction  over 
the  chest,  abdomen,  and  lower  extremities,  if  the  slieet  is  thrown 
around  the  neck,  leaving  the  head  out.  It  is  succeeded  by  the  dry 
rubbing  sheet,  or  rubbing  with  dry  towels. 


ilmilDi'Mrti,. 

v('",'  '.lit;!',. 


The  Hip  or  Sitz-Batii.— The  Fig.  166. 

sitting-bath  answers  the  several 
indications  of  tonic,  derivative,  and 
Eodativc.  It  is  invaluable  in  vv^eak- 
ness,  irregularity,  obstruction,  and  — x, 

torpor  of  the  lower  organs  of  the 
pelvis  and  abdomen.  Any  com- 
juon  wash-tub  will  answer  for  its 
administi'ation,  though  it  is  more 
convenient  to  have  vessels  made 
for  the  purpose,  the  bottom  raised 
;•,  few  inches  from  the  floor,  the 
lr,tck  side  raised  to  rest  against, 
l^he  water,  as  a  general  rule, 
should   cover  the  hips  and   lower  the  sitti^-g-bath. 

portion  of  the  abdomen.  It  may  be  of  any  temperature,  from  very 
warm  to  extreme  cold,  according  to  the  case ;  and  the  time  of  appli' 
cation  varies  from  five  to  thirty  minutes.     The  cool  and  cold  sitting 


28  THEOfvi'     iND    PRACTICE. 


baths  nre  far  the  most  fre(iuently  indicated,  and  the  usual  time  is  from 
ten  to  fifteen  minutes. 

In  the  cold  stage  of  fever,  the  warm  sitz-bath  very  much  mitigates 
the  severity  of  tlie  chills,  and  if  followed  by  the  cold-rubbing  wet 
sheet  when  the  hot  stage  of  the  paroxysm  supervenes,  will  often  break 
up  the  attack  in  a  few  hours.  In  acute  inflammations  of  the  hver, 
stomach,  l)oweis,  spleen,  and  kidneys,  hip-baths  should  be  used  very  fre- 
quently, conjoined  with  the  plentiful  use  of  tepid  or  cool  water  in 
injections.  Debility  of  the  external  muscles  of  the  abdomen,  caused 
l)V  the  excessive  use  of  tea  and  coffee,  or  crooked  positions  of  the 
body,  evinced  by  short  breath,  weakness  in  the  small  of  the  back,  and 
trembling  of  the  knees,  is  greatly  benefited  by  this  process,  used  as 
cold  as  can  \yell  be  borne.  A  *^lauket  is  usually  thrown  around  the 
patient  during  this  bath. 

The  best  tonic  effect  of  hip-baths  is  secured  by  having  them  of  short 
duration — five  to  fifteen  minutes — and  frequently  repeated. 

A  derivative  effect  is  obtained  by  longer  baths — fifteen  to  thirty 
minutes — and  at  gi-eater  intervals.  It  must  be  noticed,  however,  that 
the  effect  of  any  bath  is  determined  as  much  by  the  condition  of  the 
patient  as  the  length  of  the  bath.  Tonic  hip-baths  are  more  or  less 
derivative;  but  to  get  the  gi'eatest  derivative  effect,  the  bath  should  be 
continued  as  long  as  reaction  is  vigorous,  but  not  can-ied  to  the  extent 
of  producing  the  second  chill ;  if  so,  determination  may  take  place  to 
the  internal  organs  instead  of  derivation  fi'om  them.  Derivative  hip- 
baths sliould  not  be  carried  to  the  point  of  producing  paleness  or  livid- 
ness  of  the  lips,  general  shivering  of  the  whole  body,  nor  nausea  at 
the  stomach,  for  they  would  thus  endanger  congestion  of  the  brain  or 
lungs.  In  treating  affections  of  the  head  and  chest,  for  which  this 
bath  is  one  of  our  best  resources  ^Teat  caution  should  be  exercised  in 
managing  them  so  as  to  secure  a  derivative  without  producing  a  re- 
vulsive effect. 

Some  of  the  effects  of  sitting-baths,  isually  called  derivative,  are 
really  se(/a/ae ;  no  matter,  though,  so  long  as  they  work  curativel}'. 
In  a  general  fever,  for  example,  when  the  whole  body  is  preter- 
naturally  hot  and  turgid,  a  long-continued  bath  of  tbis  kind  operates  as 
a  refreshing  and  fever-assuaging  sedative. 

The  temperature  of  the  water,  and  its  quantity',  also  have  some 
mfluence  in  determining  whether  its  effects  shall  be  tonic,  derivative, 
sedative,  or  repellant.  The  rule  of  practice,  is  to  lessen  the  quantity 
of  water,  or  raise  its  temperature,  according  to  the  coldness,  torpor, 
and  debility  of  the  patient. 


WATER-CURE    PRO 'BESSES. 


29 


The  Shallow-Bath.— This.  Fi^.i67. 

as  usually  employed,  is  a  power- 
fully alterative,  mildly  derivative,  ^^  p; : 
and  moderately  sedative  bath.    It          :.  -     ■  ;~^' 
is  sometimes  used   cool,  seldom 
very   cold,    but   generally   tepid, 
from  65°  to   75".     The  common 
shnllow-bath   tub   may  be    used, 
but  a  circular  or  oval  tub,  raised 
about   twelve    inches    from    the 
floor,  is  more  convenient  for  the 
attendant.      In    private    families 
any  tub  large  enough  for  the  pa 
tient  to  sit  upright  will  answer.  ~         '"^       "" 
The  water  should  be  from  four             the  shallow-bath. 
to  six  inches  deep.     During  the  bath  the  abdomen  and  lower  part  of 
the  body  should  be  well  rubbed  by  the  patient  if  able ;  if  not,  by  an 
attendant;  while  the  head  is  sprinkled  and  the  back  and  chest  rubbed 
by  the  attendant,  who  sprinkles  those  parts,  or  dips  his  hands  occasion- 
}illy  in  water.     When  there  is  no  chilliness,  a  pail  of  cold  water  {the 
'pail  douche)  should  be  poured  on  the  chest  and  shoulders  to  complete 
the  process.     This  bath  may  be  employed  from  one  to  fifteen  minutes 
with  those  who  are  very  feeble  and  sensitive  to  cold,  and  from  fifteen 
to  thirty  minutes  with  others.     It  is  usually  followed  by  the  dry  rub 
sheet;  sometimes  also  by  the  hand  rubbing.     When  used  for  a  long- 
time, the  water  is  renewed  as  often  as  it  becomes  quite  warm. 

Many  nervous  and  delicate  invalids  will  find  this  the  best  bath  to  fol- 
low the  wet-sheet  pack.  It  is  also  one  of  the  best  leading  baths  in 
the  treatment  of  cutaneous  affections,  in  mineral  diseases,  in  mercurial 
affections  of  the  joints,  in  sick  headache  and  "rush  of  blood  to  the 
head,"  in  apoplectic,  epileptic,  paralytic,  and  hysterical  affections,  in 
'sun-stroke,"  intoxication,  delirium  tremens,  etc. 

In  some  instances  the  half-bath  has  been  continued  for  several  hours 
v/ith  decided  benefit.  When  there  is  uLiform  and  preternatural  heat 
of  the  surface,  in  any  of  the  above-named  diseases,  it  may  be  pro- 
tracted as  long  as  those  symptoms  can  hold  out,  with  perfect  safety ; 
but  in  all  other  cases  short  baths  often  repeated  are  preferable  to  very 
long  ones;  the  former  are  never  dangerous,  the  loiter  j)ossihly  may  be 


The  Half-Bath. — The  half  and  shallow-baths  are  often  spoken 
of  as  the  same.  Some  authors  make  a  distinction  by  calling  the  ord  ■ 
nnrv  shallow- bath  a  half-bath,  when  the  water  i&  about  one  foot  in 


at) 


THEORY    AND    PRACTICE. 


depth,  so  as  to  cover  t  e  lower  part  of  the  abdomen,  as  well  as  the 
lower  extremities.  This  is  in  efiect  iutermediat*  between  the  shallow- 
bath  and  full-bath,  or  plunge,  and  is  employed  when  the  reactive 
power  of  the  patient  admits  of  a  stronger  impression  than  the  former, 
yet  is  not  suffcient  for  the  shock  of  the  latter.  It  is  specially  adapted 
lo  those  cases  ^or  which  the  shallow-bath  is  indicated,  when  they  are 
complicated  wi.h  great  weakness  of  the  external  abdominal  muscles, 
deficient  action  of  the  kidneys,  obstructions  of  the  liver,  leucorrhea, 
menorrhagia,  etc.  In  relation  to  time  and  temperature,  it  is  to  be  reg- 
ulated by  the  same  rales  as  the  shallow-bath. 

Dr.  Johnson  (Domestic  Hydropathy )  says,  in  allusion  to  this  bath : 
"Place  me  under  the  most  unfavorable  circumstances,  viz.,  in  the 
heart  of  a  large  town,  let  me  have  my  fair  average  of  all  sorts  of  cases, 
new  and  old,  acute  and  chronic,  slight  and  severe,  and  give  me  the 
shallow-bath,  the  sitz,  and  the  wet-sheet,  and  no  other  bath  whatever, 
and  let  me  have  an  opportunity  of  frequently  seeing  my  patients — I 
would  undertake  to  cure  or  relieve  more  cases  than  are  now  cured  or 
relieved  by  the  ordinary  drug-treatment  in  the  proportion  of  two  to 
one."  I  think  the  doctor  is  safe  enough.  It  would  not  become  me  to 
speak  for  London  practice,  but  as  for  drug  practice  in  New  York,  I 
would  confidently  undertake  the  same  task  with  either  one  of  these  three 
baths,  or  with  a  pail  of  pure  soft  water  and  a  crash  towel,  without 
either  of  tlicm. 


mmi'z 


Tui  Plu.xge-Bath. — Immers- 
ing the  whole  body  up  to  the  neck 
quickly,  when  the  patient  has 
room  and  opportunity  to  exercise 
his  limbs  under  water,  is  all  that 
is  essential  to  the  full  benefit  of 
this  process.  It  is  generally  pre- 
ferred after  the  sweating  process, 
and  very  frequently  after  the  wet 
sheet,  by  those  who  are  able  to 
bear  the  exertion.  The  patient 
wears  the  wrapping-sheet  and 
blanket  (fig.  168)  to  the  bath,  hav- 
ing his  feet  sufficiently  released 
to  walk,  and  as  p.  useful  pre- 
caution, wcXs  the  head  and  chest,  and  then  plunge^  into  the  water, 
either  head-forem>ist  or  feet-foremost,  as  he  fancies.  The  shock  pro- 
duced is  much  ess  than  most  persons  a  ould  suspect,  while  the  reaction 


goi?;g  from  pack  to  plunge. 


WATER-CURE    PROCESSES.  31 

is  generally  rap'd,  equal,  and  extremely  agreeable.  It  may  be  advan- 
tageously employed  more  or  less  in  the  majority  of  all  chronic  diseases 
which  are  not  attended  with  strong  determination  to  the  brain,  great 
disturbance  of  the  circulation,  or  difficulty  of  respiration.  It  is  one  of 
the  most  pleasant  and  refreshing  morning  baths  taken  on  first  rising 
from  bed ;  and  by  all,  except  the  very  feeble,  it  may  ^  employed 
colder  than  any  other  bath  can  be,  with  equal  comfort. 

Invalids  with  lungs  so  tuberculated  as  to  prevent  a  full  inflation,  do 
not  bear  the  plunge  well,  nor  persons  laboring  under  organic  affections 
of  the  heart,  nor  those  laboring  under  dropsical  accumulations  of  the 
chest  or  abdomen  ;  in  these  cases  it  disturbs  the  circulation  and  respira- 
tion too  much.  But  with  all  invalids  or  other  persons  who  have  mod- 
erate vigor  and  a  pretty  well-balanced  circulation,  with  no  serious  local 
determinations  or  organic  lesions,  there  can  be  no  more  agreeable  or 
exhilarating  bath. 

A  plunge-bath  may  be  easily  constructed  wherever  there  is  a  run- 
ning stream.  A  square  plank  box,  four  or  five  feet  in  depth,  makes  a 
good  and  cheap  one  ;  its  dimensions  may  be  large  enough  for  a  swim- 
ming-bath to  advantage,  if  there  is  room. 

The  temperature  of  the  plunge  is  usually  from  55°  to  65^,  and  the 
time  for  i-emaining  in  the  bath  varies  from  a  very  few  seconds  to  two 
or  thre  ,'  minutes,  in  chronic  diseases;  in  high  fever  or  general  inflam- 
mation of  the  whole  system,  the  patient  may  remain  ten  or  fifteen 
minutes — at  all  events,  until  thoroughly  cooled. 

The  Foot-Bath. — Most  persons  are  aware  of  the  int>mate  con- 
nection between  the  whole  nervous  system  and  the  feet,  maniteste:il 
by  the  extraordinary  susceptibility  of  the  soles  of  the  feet  to  external 
impressions ;  and  such  persons  must  readily  appreciate  the  importance 
of  this  remedial  appliance.  The  potency  of  mustard,  onions,  garlic, 
vinegar,  ginger,  pepper,  and  other  pungents,  applied  to  the  feet,  in  a 
variety  of  aches,  pains,  cramps,  and  spasms,  has  long  been  celebrated 
among  physicians  and  nurses.  The  intelligent  hydropath  will  admit 
the  importance  of  the  principle — sympathy — upon  which  the  employ- 
ment of  those  articles  has  been  based,  while  he  will  produce  every 
desirable  result  of  them  all  with  simple  water.  As  a  derivative  in  af- 
fections of  the  head  and  chest,  it  is  often  used  in  connection  with  the 
sitz-bath,  with  which  it  may  be  advantageously  alternated.  To  prevent 
or  remedy  habitual  cold  feet,  it  is  absolutely  indispensable  in  a  hydro- 
pathic course.  Active  exercise,  in  this  case,  should  generally  precede 
aftd  follow  the  cold  foot-bath.  The  rules  given  for  the  regulation  of  the 
eitz-bath  will  apply  to  this.     Any  vessel  large  enough  to  admit  the  f£9t 


32 


THEORr    AND    PRACTICE. 


and  water  enough  to  cover  them  ankle  deep,  will  answer.     The  tim<» 
is  usually  from  ten  to  fifteen  minutes. 

Persons  of  very  feeble  circulation,  and  who  are  unable  to  take  much 
exercise,  should  use  shallow  foot-baths  for  about  five  minutes,  the 
water  being  not  more  than  one  or  two  inches  deep.  The  feet  or 
roes,  or  both,  should  be  kept  in  motion  during  the  bath.  Walking  foot- 
baths,  where  a  stream  of  cool  water  can  be  found  with  a  clean  bottom, 
is  a  most  efficient  remedy  for  habitual  :-old  feet,  and  one  of  the  best 
appliances  for  chronic  headache,  restlessness,  sleeplessness,  and  also 
one  of  the  most  excellent  and  efficient  strengthening  processes  for 
almost  all  forms  of  female  weaknesses  and  obstructions. 

The  warm  foot-bath  is  often  valuable  to  relieve  sudden  attacks  of 
Jieadache,  and  soothe  the  nervous  system  when  unusually  uTitated 
Many  delicate  invalids  who  are  habitually  liable  to  cold  feet,  will  find 
the  wet-sheet  pack  more  pleasant  and  agreeable  by  putting  the  feet  in 
warm  waiter  for  three  minutes  before  being  enveloped. 


Fig.  IPO.  The    Head-Bath.— The    com- 

mon method  of  bathing  the  head  is 
by  folds  of  wet  cloths,  or  a  sti'eam 
of  water  poured  over  the  head.    In 
;'  all  acute  diseases  about  the  head, 
'!j  attended  with  pain   and  increased 
-J  tempei'ature, those  processes  are  suf- 
:  ficient,  but  in  some  chronic  affec- 
tions a  powerful  derivative  or  sedative 
AYect  is  desired.     For  this  purpose 
ihe  patient  lies  extended  on  a  rug  or 
matti'ass  (tig.  169),  the  head  resting 
in  a  shallow  basin  or  bowl,  holding 
two  01-  tliree  inches  of  water,  the 
shoulders  being  supjX)rted  by  a  j)il- 
low.     It  may  bo  administered  from  fifteen  to  thirty  minutes. 

When  the  pouring  head-bath  is  employed  the  patient  lies  face  down- 
ward ;  the  head  is  held  by  the  attendant  and  projecting  over  the  side 
v^f  the  bed  :  the  bedding  being  protected  by  a  sheet  or  blanket  thrown 
aiound  the  patient's  neck  ;  a  tub  is  placed  under  the  head  to  catch  the 
water.  The  water  is  poured  from  a  pitcher  or  other  convenient  vessel 
moderately  but  steadily  for  several  minutes,  or  until  the  head  is  well 
cooled,  the  stream  being  jipplied  principally  'o  the  temples  and  back 
pnrt  of  the  head.  This  process  is  excellent  n  all  high  fevers,  and  in 
tJ\e  cailv  stages  "^^  colic  and  chojpja  morbus 


THi:    Hi-Au-iJAiH. 


WATER -on  RE    PROCESSES. 


33 


Fig.  170  represents  a  convenient  vessel  for  a  Fig.  170. 

head-bath.  Length  from  a  to  b,  11  inches; 
breadth  from  cto  d,8  inches  ;  depth,  3^  inches ; 
height  from  the  floor,  7  inches.  The  t  jttom  is 
concave. 

The  cold  cloths,  or  pouring  stream 
13  beneficially  employed  in  convulsions, 
delirium  tremens,  rheumatic  affections 
of  the  head,  transferred  gout,  epilepsy, 
apoplexy,  nose  bleed,  inflammation  of 
the  brain,  etc. 

In  chronic  diseases  of  th©^ eyes  and 
ears,  earache,  partial  or  complete  loss 
of  hearing  from  debility  of  the  auditory  nerves,  dimness  of  vision  from 
local  debility,  morbid  depositions  in  the  humors  or  structures  of  the 
eye,  chronic  catarrh,  etc.,  the  bathing  vessel  is  advantageous. 


VESSEL.    FOR    THE    HEAD-BATH 


The  Shower-Bath. — This  bath  is  greatly  misused  by  many  per- 
sons, and  is  genei"ally  sadly  mismanaged  by  allopathic  physicians. 
Cases  like  the  following  are  everyday  affairs  in  New  York :  A  patient 
has  been  under  drug-treatment  a  long  time  without  benefit ;  he  has 
been  entirely  unaccustomed  to  regular  bathing  in  any  manner,  and  has 
never  taken  a  cold  bath,  nor  has  the  doctor  even  hinted  at  any  sort  of 
a  bath  during  his  whole  course  of  medication.  But,  getting  discour- 
aged, the  patient  begins  to  annoy  his  medical  adviser  with  questions 
about  the  Water-Cure ;  the  latter  speaks  in  the  highest  terms  of  the 
remedial  uses  of  water  in  ilie  hands  of  competent  persons;  thicks  it  is 
a  very  good  remedy  indeed  in  many  cases,  but  in  this  particular  case 
it  p)rohahly  would  not  ansii^er ;  it  might  produce  congestion  !  Still  the 
patient  may,  if  disposed,  rry  it  and  see — that  is,  on  his  own  responsi- 
bility. He  may  try  a  shower-bath,  and  ascertain  thereby  how  the 
treatment  will  be  likely  to  operate.  Influenced  by  these  loose  innen- 
does,  and  without  any  precautions  or  regulations,  the  patient  takes 
two,  three,  or  half  a  dozen  shower-baths.  Each  one  gives  him  a  dis- 
agreeable chill,  perchance  a  violent  headache,  and  makes  him  fee 
decidedly  worse  in  every  sense.  He  goes  back  to  the  doctor,  whc 
shakes  his  head  porteutiously,  looks  "wondrous  v/ise  out  of  all  his 
eyes,"  and  exclaims,  "  I  was  afraid  it  wouldn't  work  well ;  cold  water 
is  a  very  powerful  agent;  very  dangerous  when  not  properly  managed.** 

Now  the  shower-bath  is  excellent  in  its  place,  but  in  almost  all  cases 
it  is  the  very  worst  bath  t3  commence  on  an  invalid  with.  Generally 
p;it':oiits  require   considerrMe  preparatory  ti'eatraent  before  they  can 


1 


34  THEORY    AND    PRACTICE. 

take  it  to  advantage.  Altliough  it  is  ni'^re  frequently  ^.tescribed  than 
any  other  bath  by  the  drug  doctor,  the  hydropath  ^YOuld  sooner  dis- 
pense with  it  entirely  than  with  any  other. 

The  shower-bath  can  be  employed  profitably  only  by  those  who 
have  a  good  degree  of  vital  heat,  and  a  rather  active  and  pretty  well 
balanced  circulation.  It  is  contra-indicated  in  very  nervous  and  ex- 
tremely susceptible  persons,  in  those  liable  to  nervous  headache,  pal- 
pitation of  the  heart,  great  determination  to  the  lungs,  or  severely 
constipated  bowels. 

Whether  it  should  ever  be  taken  on  the  head  is  a  controverted  pro- 
position. Many  persons,  to  my  certain  knowledge,  have  taken  it  freely 
on  the  head  as  well  as  all  over  the  body,  ai^a  daily  bath,  for  years,  not 
only  without  ai\',  unpleasant  symptom,  but  with  uniform  pleasure  and 
advantage.  But  I  have  known  many  invalids  with  whom  it  would  oc- 
casion more  or  less  headache  or  giddiness,  when  applied  to  the  head, 
and  none  whatever  when  only  taken  upon  the  rest  of  the  body.  The 
safest  geHeral  rule  is  to  direct  patients  to  incline  the  head  forward  so 
as  to  let  the  shock  fiUl  upon  the  neck,  spine,  and  shoulders.  It  may 
also  be  fip^ely  applied  to  the  chest  and  abdomen. 

Its  principal  advantage  is  in  affording  a  convenient  morning  bath; 
a  good  wash  down  after  the  wet  she^t,  when  no  other  bath  is  specially 
indicated,  and  also  after  the  hot  and  vapor  baths. 

In  the  stupor  of  drunkenness  a  smait  shower  of  cold  water  often 
restores  sensibility  very  promptly.  The  cold  shower  has  recently  been 
introduced   into  tlie  penal  transactions  of  our  criminal  code.     Refrac-  ;.. 

tory  culprits  ai-e  often  brought  to  prompt  obedience  by  its  terrors.   Tlie  f 

prisoners  are  said  to  dread  it  worse  than  the  old-fashioned,  barbarous  { 

methods  of  flagellation.  It  is  certainly  more  humane,  but  is  liable  to 
do  injury  to  those  who  are  extremelj'  susceptible,  with  a  tendency  to 
head  alTections. 

This  bath  has  long  enjoyed  considerable  repute  as  a  popular  remedy 
for  i.ckets  and  other  cachetic  affections  of  children.  It  is  raanaget 
so  injudiciously  in  home  practice  as  to  work  more  mischief  than  bene- 
fit, as  the  following  anecdote  will  illustrate  I  once  saw  what  was  in- 
tended for  a  shower-bath,  administered  in  this  fashion  :  a  good  mother 
became  anxious  about  her  little  boy,  who  was  about  a  year  and  a  half 
c-d ;  he  appeared  to  be  "poorly,"  without  having  any  particular  dis- 
ejise  for  which  a  name  could  be  found.  The  doctor  g>ive  it  oil,  rhu- 
barb, "a  touch  of  calomel,"  elixir  drops,  worm  seed,  and  strengthenmg 
things  in  abundance,  but  it  stayed  "poorly."  Some  kind  neighbor  ad- 
vise-i  showering,  and  the  mother  concluded  lo  try  it.  The  next  morn- 
uiff   wli'ch  happenec"  \    be  of  a  keev    blustering,  November  day,  the 


IVATER-CURE   PROCESSES. 


35 


mother,  at  early  sunrise,  drew  a  paijful  of  water  from  the  bottom  of  a 
deep  well,  stripped  the  child  naked,  placed  it  out-door  on  the  bare 
cold  grouno,  and  then  threw  the  pail-douche  over  it  at  a  single  dash  ! 
The  result  was  a  fiiver,  which  lasted  the  child  a  week.  The  child 
should  have  been  placed  in  a  tub  in-door,  and  the, water  poured  over 
it  gently. 


Fig.  171. 


The  Cataract-Baih. — This  is  a 
pleasant  yet  powerfully  excitant  bath 
Dr.  Johnson,  fi'om  whose  work  I  take 
the  illustrative  cut,  thus  describes  it : 

In  Fig.  171  a  and  b  are  two  tin  cylinders,  con- 
taining six  or  eight  gallons  each.  These  are 
fixed  at  the  top  of  the  frame-work  of  an  ordi- 
nary shower-bath,  the  common  cistern  and 
perforated  plate  being  removed.  By  pulling  a 
etring,  these  cylinders  are  tilted  so  as  to  dis- 
cbarge their  water,  as  is  seen  in  the  plate.  The 
inner  side  of  each  cylinder  should  have  a  lip,  to 
give  a  more  forward  direction  to  the  cataract 
of  water. 


The  cataract-bath  may  be  employed 
for  the  same  general  purposes  as  the  the  cataract-bath. 

douche.     It  is  a  good  substitute  for  the  wave-bath,  and  for  the.  plunge 
in  those  who  cannot  bear  the  exertion  required  by  the  latter. 


The  Dry  Pack,  or  Sweating-Bath. — Wrapping  in  the  dry 
blanket  is  managed  precisely  as  the  wet-sheet  packing,  with  the  omis- 
sion of  the  wet  sheet.  The  flannel  blanket  comes  in  contact  with  the 
body,  and  a  sufficient  quantity  of  blankets,  comfortables,  or  other 
bedding  is  thrown  around  to  retain  the  hnimal  heat.  Very  nervoua 
and  irritable  persons  should  not  be  wrapped  very  ti<:!;htly  about  the 
chest.  A  wet  napkin  should  always  be  applied  to  the  head,  and  the 
room  should  be  well  ventilated.  The  sweating  process  usually  occu- 
pies two  or  three  hours.  Some  few  persons  will  perspire  freely  in 
less  than  an  hour,  and  some  will  remain  four  or  fivo  hours  without 
sweating  much.  ,f^ 

When  the  patie  ^.t  perspires  with  difficulty,  exercising  by  extending 
the  limbs  forcibly,  accompanied  with  der^p,  full  inspirations,  will  very 
much  accelerate  the  process.  One,  two,  or  llirec  tumblers  of  watei 
are  taken  at  intervals  luring  the  envelopment.  Dr.  Johnson  recom- 
mends a  little  allopathi    5.uxiliaiy  i"  the.  sh-.ipe  of  "a  pint  of  hot,  weaR, 


THEORY    AND    PRACTICE. 


bliick  tea !"     I  would  recommend  the  patient  to  abstain,  teetotaliy,  fioni 
all  such  nonsense. 

The  patient  should  never  remain  long  enveloped  after  sweating  has 
become  copious ;  it  is  much  better  to  perspire  moderately  and  fre- 
quenll}'.  On  coming  out  of  the  sweating-blanket,  some  form  of  cool  or 
cold  bath  should  be  taken,  as  the  plunge,  douche,  shower,  shallovv-- 
bath,  or  dripping-sheet.  The  sweating  process  is  one  of  the  severest 
of  the  Water-Cure  appliances,  and  must  always  be  managed  with  care 
and  discrimination.  If  the  patient  becomes  very  restless,  or  if  trouble- 
some headache,  giddiness,  or  palpitation  come  on,  he  should  be  taken  out. 
Patients  will  usually  bear  this  application  better  after  a  few  repetitions. 
Many  people  suppose,  and  some  medical  writers  represent — among 
whom  is  Dr.  John  Bell,  in  his  able  work  on  Medical  and  Dietetical 
Hydrology- — that  the  sweating  process  is  a  regular  part  of  the  hydro- 
pathic routine.  This  is  a  gi-eat  mistake  ;  sweating  is  not  the  rule,  but 
the  exception  in  water-ti*eatment.  It  is  very  seldom  resorted  to  m 
any  respectable  establishment,  and  Priessnitz  recommends  it  now 
much  less  frequently  than  formerly.  It  is  the  nearest  approach  to 
^allopathic  ti'eatment  of  any  of  our  processes,  being,  when  long  contin- 
ued, depletive  and  debilitating. 

The  sweating  process  is  not  applicable  to  any  particular  disease  by 
name,  but  to  a  particular  condition  of  body  which  is  found  in  several 
disease.s.  This  condition  is  called  plethora  in  medical  books  ;  it  means 
over-fulluess,  grossnoss  of  the  system.  It  is  most  frequently  found  ii 
gouty  and  rheumatic  subjects.  All  very  fat  or  corpulent  persons  pos- 
sess it,  of  course.  It  is  the  result  of  high  living  and  indolence,  or  of 
active  alimentation  combined  with  defective  depuration.  Persons 
aSlicted  with  tihat  unsightly  disorder,  obesity,  can  be  assisted  down  to 
the  standard  of  riormal  bulk  and  personal  comeliness  by  this  manner 
of  sweating,  providing  the  alimentary  supplies  are  also  healthfully  cur- 
tailed. 

The  dry-blanket  packing  is  very  useful  for  those  invalids  who  are 
too  feeble  to  exercise  sufficiently  to  overcome  the  chill  produced  by 
tlie  wet-sheet  pack,  or  other  cold  applications.  With  such,  too,  wrap- 
ping for  half  an  hour  to  an  hour  is  a  good  preparatory  measure  for 
other  baths,  and  it  may  follow  any  bath  when  desirable  to  thus  assist 
reaction. 

There  is  another  class  &f  invalids  still  who  may  find  benefit  from  the 
dry  packing ;  those  who  suft)^r  occasionally,  and  at  irregular  intervals, 
severe  rigors  or  chills,  procee'ding  from  enlarged  liver  or  spleen,  or 
slight  ulcerations  Dr  tuberculati  ons  of  the  lungs.  Though  it  will  not 
prevent  the  chills,  it  will  mate  I'ially  mitisrito  their  severity,  and  thus 


WATEJR-CUKL    PROCESSES.  37 

indirectly  assist  the  final  removal  of  the  cause.     For  this  purpose  the 
'  patient  may  be  enveloped  at  any  time  when  the  chills  trouble  him,  and 
remain  until  comfortably  warm  and  fatigued  with  the  position. 

The  Vapor-Bath. — Somewhat  akin  to  the  sweating-blanket  is  the 
vapor-bath.  Some  hydropathic  practitioners  regard  the  vapor,  and 
shower,  and  all  other  modes  of  water-treatment  which  were  not  pre- 
scribed by  Priessnitz,  as  anti-hydropathic,  as  though  nothing  was  ever 
to  be  learned  save  what  Priessnitz  personally  tauglit,  and  nothing  ever 
to  be  done  save  a  routine  repetition  of  his  acts.  Between  the  vapor- 
bath  and  sweating-blanket  there  is  a  difference  in  favor  of  the  latter 
It  does  not  disturb  the  circulation,  quicken  the  pulse,  or  affect  the 
respiration  as  much  as  does  the  vapor-bath,  nor  is  it  as  liable  to  abuse 
from  ignorance  or  carelessness.  This  last  objection,  however,  applies 
rather  to  the  usual  than  the  necessary  result  of  the  vapor-bath  ;  for, 
if  not  made  too  hot,  nor  administered  too  long,  the  effect  is  scarcely 
ever  disagreeable.  It  is  better  adapted  to  torpid,  phlegmatic  constitu- 
tions, than  to  the  nervous  or  irritable,  other  circumstances  being  equal. 
It  is  valuable — yet  not  equal  to  the  wet-sheet — in  many  forms  of  skin- 
diseases  unattended  with  much  irritation.  In  sudden  colds,  coughs 
from  suppressed  perspiration,  in  the  incipient  stage  of  most  forms  of 
rheumatism,  in  the  first  access  of  simple  fevers,  in  influenza,  and  in 
mercurial  diseases,  it  is  more  especially  serviceable.  It  should  never 
be  continued  to  the  point  of  producing  dizziness;  faintness,  nausea,  nor 
great  lassitude.  Some  form  of  cold-bath  should  always  succeed  it,  as 
the  shower  or  plunge.  The  average  time  for  remaining  in  a  vapor- 
batn,  when  the  steam  is  as  hot  as  can  be  borne  without  discomfort,  is 
from  fifteen  to  twenty-five  minutes. 

The  "  steam  doctors"  have  brought  vapor-bathing  into  unmerited 
disrepute  by  overdoing  it.  Many  patients  have  been  "  steamed"  so  long 
as  to  produce  a  degi'ee  of  muscular  relaxation  and  vital  exhaustion,  not 
fully  recovered  from  in  years.  The  process  is,  in  their  hands,  usually 
accompanied  with  hot  and  stimulating  drinks,  "  coipposition,"  "No.  6," 
etc.,  and  frequently  followed  by  a  lobelia  emetic ;  all  together  making  a 
power  of  medication  which  only  very  robust  persons  can  endure  with- 
out serious  injury.  Another  error  in  the  steam  practice  consists  in  not 
employing  a  sufficient  amount  of  cold  water  after  the  hot  vapor.  Gen- 
erally the  patient,  when  excessively  heated,  is  dismissed  with  a  mere 
sprinkling  of  a  pint  or  quart  of  cold  water,  when  he  should  have  a 
dripping  sheet,  plunge,  or  half-bath.  A  vai)or-bath  can  be  contrived  in 
many  ways.  The  invention  of  Mr.  Jeremiah  Essex,  of  Bennington, 
Vt.,  combines  as  'nnny   ::onveniences  as  any  plan  T  have  seen. 


58 


THEORY    AND    PllACTICE. 


Fig.  17i 


Fig.  172  is  an  inside  elevation  of 
Mr.  Essex's  bath,  showing  the  ar 
rangeraent  by  which  a  person  can 
take  a  cold  or  warm  shower,  or  a 
vapor-bath  at  pleasure.  Tr.e  out- 
side casing  is  the  box  ot  the  bath, 
which  may  have  .°creen  sides,  like 
the  common  kind ;  and  the  tubes 
below,  as  they  are  small,  and  lying 
on  the  floor  (the  one,  F,  may  run 
below  the  floor),  caii  be  of  no  in- 
convenience. C  is  a  small  circular 
v.^ssel  of  water  surrounding  the 
tv  je,  E,  seen  in  section,  and  cora- 
♦ijunicates  with  it  by  a  small  open- 
ing inside,  near  its  bottom.  When 
the  tube,  E,  is  nearly  filled,  the 
vessel  or  chamber,  C,  contains 
water  to  the  same  height.  F  is  a 
conducting  pipe  extending  up  into 
the  tube,  E ;  and  A  is  the  handle  of 
a  piston,  which  extends  down  intJ 
E,  having  its  lower  end  made  to 
force  the  water  up  through  the 
pipe,  F,  past  the  valve,  H,  into  the 
shower  vessel,  G.  This  gives  a  cold 
shower-bath.  To  make  a  warm 
bath,  D  is  a  lamp  placed  under  the 
vessel,  E,  which  heats  the  water, 
when  it  may  be  lorced  up  as  in  the 
cold  shower. 

To  make  a  vaporbath,  the  pipe, 
M.  seen  parti}'  in  section,  is  attach- 
ed near  the  top  of  the  vessel,  C,  and  it  has  holes  at  its  lower  end  to  let  the  vapor  escape 
into  the  chamber.  When  used  for  a  vapor-bath,  the  piston  should  ,be  withdrawn,  and 
the  inside  hole  in  the  vessel,  C,  closed  up,  when  the  lamp  will  generate  the  steam  in  a 
short  time.  The  top  of  the  vessel,  C,  to  the  tube,  E,  is  made  of  a  funnel  shape,  as  rep- 
resented by  B,  to  allow  the  water  to  be  easily  poured  in.  I  is  a  faucet  to  drain  off  the 
water  that  may  be  in  the  pipe,  and  there  is  an  attachment  to  the  outside  of  the  valve- 
case,  O,  to  lift  the  valve,  H,  to  drain  off  the  water  above. 

Hot  stones  or  bricks  may  be  used  to  generate  vapor.  The  patient 
may  sit  naked  on  an  open-work  chair,  with  a  couple  of  blankets  pinned 
around  the  neck;  a  small  tub  or  a  common  tin  pan,  holding  a  quart  of 
water,  is  placed  under  the  chair,  and  red-hot  bricks  or  stones  occEision- 
ally  put  into  the  vessel,  so  as  to  keep  the  vapor  constanth^  rising  froir 
the  surface  of  the  water. 

Another  very  simple  plan  is  this  :  Procure  a  tin  boiler  of  one  or  two 
gallons  measure,  with  a  tin  pipe  having  two  or  three  joints  and  a  single 
elbow.  The  boiler  may  be  heated  on  any  ordinary  fireplace  or  furnace; 
the  pipe  can  be  conducted  under  a  chair  or  box  on  which  the  patient 
may  sit,  coveroi  with  blankets  fron^  the  neck  downward.     The  vapoi 


COLD  SHOWER,  TTARM  SHOWIER,  AND  VAPOR- 
BATH   COMBINED. 


^ATEPt-CURE    PROCESSES. 


39 


or  steam  may  be  increased  or  diminished  by  regulating  the  position  of 
the  boiler  over  the  fire. 

The  sweating-cradle  (fig.  173)  is  a  convenient  apparatus  for  such  in 
valids  as  are  obliged  to  k  3ep  the  bed. 

FiR.  173. 


PERSPIRATORY,    OR    SAVEATING-CR ADLE. 

Fig.  173  is  a  drawing  of  the  perspirator,  or  sweating-cradle,  a  is  a  tin  or  copper  bent 
funnel-shaped  chimney,  with  a  door,  which  is  seen  standing  open.  The  small  end  of 
this  chimney  is  open.  The  large  end  below  has  a  tin  bottom,  with  a  hole  in  it  to  receive 
the  little  upright  tin  saucepan,  b ;  c  ia  the  wooden  bottom  or  end  of  the  cradle,  with  a 
hole  in  it  to  receive  the  small  end  of  the  chimney,  into  which  it  fits  accurately,  but 
easily ;  d  d  d  d  are  hoops  of  wire  or  wicker ;  /  is  a  long,  narrow  piece  of  wood,  into 
which  the  ends  of  the  hoops  are  inserted ;  e  is  a  similar  piece  of  wood  running  along 
the  top,  and  perforated  by  the  hoops. 

When  the  cradle  is  to  be  used,  the  clothes  are  to  be  taken  off  the  bed,  and  the  patient 
is  to  lie  down  on  his  back,  with  his  head  on  the  pillow.  The  cradle  is  tJien  to  be  placed 
over  him  as  high  as  his  throat,  its  wooden  bottom  being  at  the  foot  of  the  bed,  even  with 
the  bedstead.  It  is  now  to  be  covered  with  the  whole  of  the  bedclothes,  and  an  addi- 
tional blanket  or  two.  The  clothes  are  to  be  neatly  tucked  in  every  where,  so  as  not  to 
let  out  the  heat  at  any  pcjint.  But  they  must  not  hang  down  over  the  wooden  bottom, 
and  the  foot  valance  of  the  bed  had  better  be  tucked  up  out  of  the  way.  The  tin  chim- 
ney must  be  kept  clear  of  all  clothes.  Every  thing  having  been  thus  neatly  prepared, 
the  tin  saucepan,  b,  is  to  be  filled  three-quarters  full  with  alcohol,  and  the  spirit  is  to  be 
set  on  fire.  Then,  taking  hold  of  the  long,  straight  handle  of  the  saucepan,  it  is  to  be 
carefully  let  down  through  the  hole  in  the  bottom  of  the  chimney,  and  the  door  closed. 

The  Wave-Bath. — This  process  consists  merely  in  extending  the 
body  at  length  in  a  swift  current  of  v/ater,  the  })atient  holding  on  to  a 
rope,  or  some  other  contrivance,  to  enable  him  to  keep  his  position.  It 
helps  to  make  an  amusing  variety  in  the  watery  part  of  our  materia 
medica,  but  has  no  other  advantage  not  obtainable  by  the  douche  and 
plunge. 

The  Rivef-}3ath. — This  amounts  practically  to  an  out-door,  cold. 


40  THEORY    AND    PRACTICE. 

or  tep.d  plunge-bath,  according  to  the  temperature  of  the  water.  In- 
valids should  not,  as  a  general  rule,  bathe  in  the  rivers  more  than  from 
ten  to  twenty  minutes,  when  the  water  is  tepid ;  at  all  events  they 
should  avoid  great  fatigue  and  the  second  chill.  When  the  water  is 
cold  the  time  must  be  correspondingly  diminished. 

The  Rain-Bath. — At  some  of  the  water-cures,  patients  have 
amused  themselves  with  rain-water  bathing  whenever  the  propitious 
clouds  have  furnished  the  requisite  shower.  For  those  who  are  able 
to  walk  rapidly  a  mile  or  two,  a_i-ain-bath  is  excellent.  The  constant 
evaporation  from  the  surffice  and  the  active  exercise  effect  a  rapid 
"change  of  matter;"  and  the  process  seems  to  combine  the  virtues  of 
the  wet-sheet  pack  and  the  dripping  sheet  in  an  efficacious  manner. 
It  is  scarcely  necessary  to  add  that  tlie  patient  should  be  dressed  in 
light,  thin  clothes  during  the  walk,  and  on  returning  to  his  room  be  well 
nibbed  with  the  dry  sheet,  and  keep  up  modei-ate  exercise  for  half  an 
hour  or  so  after  dressing. 

Fountain  or  Sprat-Bath. — This  is  a  modification  of  the  shower 
or  douche-bath,  or  rather  a  combination  of  both.  It  consists  of  a  num- 
ber of  small  streams  thrown  off  laterally,  and  diverging  as  they  recede 
froAi  the  fountain.  It  makes  a  pleasant  and  very  excellent  application 
to  the  chest  and  abdomen,  in  affections  of  the  viscera  of  those  cavities, 
when  the  sti'onger  impression  of  the  douche  cannot  be  borne,  or  is  not 
indicated.  Dys{)eptics  and  consumptives  can  generally  employ  it 
more  or  less  to  advantage.  It  is  a  good  process  in  pleurodynia,  or  pain 
in  the  side,  in  lumbago  and  neuralgia,  and  in  partial  palsy  or  extreme 
debility  of  the  muscles  of  any  part.  Applied  to  the  pelvic  region, 
it  is  well  adapted  to  excite  functional  action  in  atonic  states  of  the 
organs,  amenorrhea,  chlorosis,  constipation,  suppression  or  retention  of 
urine,  etc. 

Portable  Shower-Bath. — This  is  a  modification  of  aftusion,  the 
water  being  showered  instead  of  poured  over  the  body,  and  in  effect 
it  amounts  to  precisely  the  same  thing  as  the  ordinary  process  of  affu- 
sion. Convenient  macliines,  holding  two  quarts  or  more,  for  shower- 
ing by  hand,  sire  made  by  most  of  the  tinsmit'lis. 

The  Affusion-Bath. — Pouring  water  over  the  neck,  chest,  and 
shoulders,  tht  natient  standing  in  a  tub  when  it  is  desirable  not  to  wet 
the  fioor,  is  caL  d  afi'usion.  It  is  as  good  as  any  other  form  of  bath 
whei-e  its  indication  is  simply  to  cool  the  body,  as  in  tlie  hot  stage  of 


WATER-CUR  li    PROCESSES.  4i 

fevers  and  active  inflammations.  Dr.  Currie  employed  affusiong  ex- 
tensively, and  with  remarkable  success,  in  the  treatment  of  scai'.ol 
fever,  measles,  small-pox,  and  other  diseases,  at  Liverpool,  England, 
half  a  century  ago  ;  but,  unfortunately,  the  medical  fiiculty  of  the 
present  day,  who  acknowledge  the  superior  success  of  his  practice,  do 
not  see  fit  to  imitate  it.  Affusions  are  performed  with  tepid,  cool,  or 
cold  water,  according  to  the  degree  of  morbid  heat  attending  the 
disease. 

Towel  or  Spoage-Bath. — Washing  the  whole  surface  of  the 
body  with  a  towel  or  sponge  is  a  very  good  prophylactic ;  and  it  may 
be  employed  in  water-ti-eatment  as  a  substitute  for  various  other  baths, 
when  the  requisite  apparatuses  for  the  latter  are  wanting.  The  pecu- 
liar advantage  of  this  bath  is,  it  can  be  taken  at  any  time  and  place, 
whenever  and  wherever  desired.  The  tovv'el  is  preferable  to  the 
sponge,  because  its  friction  is  more  perfect  and  uniform.  I  should  be 
unwilling  to  dress,  on  rising  from  bed  in  the  morning,  without  first  rub- 
bing the  whole  surface  with  a  wet  towel,  unless  some  other  general 
bath  was  accessible  ;  and  a  towel  and  quart  of  water  can  always  be  had 
at  a  hotel  or  on  board  a  steamboat.  Five  minutes  can  never  be  em- 
ployed in  any  more  profitable  way.  That  parent  can  hardly  be  said  tc 
"  train  up  a  child  in  the  way  it  should  go,"  who  does  not  instruct  it  in 
the  use  of  a  towel  wash,  or  some  other  bath,  every  morning,  at  all 
seasons  of  the  year. 

Wet-Dress  Bath. — This  is  a  modification  of  the  wet  sheet,  ena- 
bling the  patient  to  dispense  with  the  services  of  an  attendant — a 
mode  of  self-packing.  A  linen  sheet  is  fashioned  into  the  form  of  a 
night-dress,  with  large  sleeves;  and  after  the  bed  is  prepared,  the 
dress  can  be  wet  and  thrown  on;  the  patient  can  then  get  into  bed,  and 
wrap  himself  sufficiently,, to  get  a  very  good  vv^arming  up.  If  the  bed- 
clothes are  not  too  heavy,  nor  wrapped  too  tightly,  almost  any  person. 
not  extremely  feeble,  can  remain  in  this  wet  dress  all  night  without  the 
least  injury,  shocking  as  the  idea  may  be  to  our  allopathic  friends. 

Warm  and  Hot  Baths. — These  are  objected  to  by  some  German 
hydropaths,  as  not  being  Priessnitzian,  but  for  no  other  reason  that  I 
can  imagine.  They  are,  however,  only  occasionally  employed  at  the 
American  establishments,  not  being  a  regular  part  of  any  judicious 
course  of  treatment.  But  for  quieting  particular  symptoms,  and  al- 
laj'ing  excessive  nei-vous  instability,  they  are  sometimes  eminently  ser- 
viceable.    In  cramps,  colic,  spasms,  and    :3nvulsions,  they  operate  ad- 


42  THEORY    A  :>  D    PRACTICE. 

mirably.  It  sonietiiiies  happens  thai  a  patient,  while  under  treatment, 
will,  witliout  any  unusual  exposure,  experience  all  the  syraptouis  of  a 
severe  cold,  leverishness,  headache,  sensitiveness  to  the  atmosphere, 
chilliness,  and  various  aches  and  pains  All  these  disagreeable  symp- 
toms can  generally  be  rejuoved  at  once  by  a  hot  bath  for  ten  minutes  ; 
and  if  the  bath  is  succeeded  by  a  pail  douche,  shov^rer  or  drippmg 
sheet,  no  appreciable  debility  will  result.  Patients  who  have  taken 
large  quantities  of  mercury,  antimony,  or  nitre,  are  peculiarly  liable  to 
febrile  disturbances,  and  to  occasional  swellings  of  the  joints  and  stiff- 
ness of  the  muscles,  which  a  warm  or  hot  bath  at  once  relieves.  For 
all  of  the  purposes  above  intimated  the  bath  should  be  as  warm  as  the 
patient  can  bear  without  discomfort;  a  temperature  that  is  warm  to 
3ne  may  be  hot  to  another ;  the  proper  temperature  ranges  from  90® 
to  110^. 

The  Swimming-Bath. — The  exercise  of  swimming  is  eminently 
health-preserving,  and  might  with  propriety  have  been  treated  of  in  our 
hygienic  department;  but  as  it  is  also  eminently  therapeutic  in  some 
forms  of  chronic  disease,  the  subject  is  not  inappropriate  here.  For 
that  large  class  of  invalids  who  are  consumptive  from  feeble  lungs  and 
contracted  chests,  and  for  a  still  larger  class  of  dyspeptics,  who  are 
costive  from  torpid  or  contracted  abdominal  muscles,  there  is  no  better 
exercise  than  that  of  swimming.  All  persons,  too,  whether  invalids 
or  not,  ought  to  know  how  to  swim,  on  prudential  considerations. 

As  all  the  exercises  involved  in  the  various  methods  of  learning  to 
swim  are  just  as  serviceable  to  the  invalid  or  well  person,  as  those 
which  may  be  practiced  after  the  art  is  acquired,  and  for  the  purpose 
of  enabling  the  inmates  of  hydropathic  establishments,  where  suitable 
streams  or  ponds  of  water  can  be  found,  to  do  themselves  two  services 
at  once,  I  copy  from  one  of  Fowlers  and  Wells'  publications  the  fol- 
lowing illustrations : 

Various  supjwrts  may  be  re- 

^^^'  ^^■*'  sorted  to  while  the  learner  is 

getting  accustomed  to  the  ne 
(|r=:ir?^4-  ^^^^^a^^  -=r=_r^^-_ .  ^  cessaiy   motions.      Corks   and 

r-      '  '  bladders  are  convenient.     Fig. 

?.£.,-  . rsamem^mmmvm-':-    ^''^  represents  a  bladder,  well 

^^  r^^^^B^sW^j^    blown,  and  fastened   over  the 

—  '"--"'^-"-t-^^gf!^^^g'^=-  shoulders  by  a  rope  passed  un- 

der the  chest.     Ijarge   pieces 

SWIMMING. WITH    A    BLADDER.  i        , 

01    cork    may    be   attached   to 
each  end  of  a*l-ope  and  ustd  for  tl  3  same  purpose.     The  supports 


WATER-CURE    PROCESSES. 


43 


Fig.  175. 


SWIMMING   WITH    THE    PLANK. 


Fisr.  176. 


must  always  be  carefully  secured  near  the  shoulders,  for,  should  they 
slip  down,  they  would  plunge  the  head  under  water. 

Swimming  with  the  plank  (fig.  175)  has  two  advantages.  The  young 
bather  has  always  the  means  of 
saving  himself  from  the  eft'ects 
of  a  sudden  cramp,  and  he  can 
practice  with  focility  the  neces- 
sary motions  with  the  legs  and 
feet,  aided  by  the  momentum 
of  the  plank.  A  piece  of  light 
wood,  three  or  four  feet  long, 
two  feet  wide,  and  about  two 
inches  thick,  will  answer  very  well  for  this  purpose.  The  chin  may 
be  rested  upon  the  end,  and  the  arms  used,  but  this  must  be  done 
carefully,  or  the  support  may  go  beyond  the  young  swimmer's  reach. 

The  rope  (fig.  176)  is  another  artificial  support,  which  has  its  ad- 
vantages. A  rope  may 
be  attached  to  a  pole,  fiis- 
tened — and  mind  that  it 
be  well  fastened — in  the 
bank,  or  it  may  be  at- 
tached, as  shown  in  the 
engraving,  to  the  branch 
of  an  overhanging  tree. 
Taken  in  the  hands,  the 
swimmer  may  practice 
witli  his  legs,  or  by  hold- 
ing it  in  his  teeth,  he  may 
use  all  his  limbs  at  once.  swimming  with  the  rope. 

The  rope,  however,  is  not  so  good  as  the  plank,  as  it  allows  of  less 
freedom  of  motion,  and  the  latter  might  easily  be  so  fixed  as  to  be  laid 
hold  of  by  the  teeth,  and  held  securely. 

Wherever  a  descending-  gi-ade  can  be  found,  the  learner  can  soon 
become  a  good  s\'\Tmmer,  with  no  artificial  assistance,  by  wading  in  the 
water  up  to  the  neck,  and  then  paddling  to  the  shore. 

In  swimming,  the  feet  should  be  about  two  feet  below  the  surface. 
The  hands  should  be  placed  just  in  front  o^'  the  breast,  pointing  for- 
ward, the  fingers  ke})t  close  together,  and  the  thumb  to  the  fingers,  so 
as  to  form  a  slightly  hollow  paddle.  Now  str-ke  the  hands  forward  as 
far  as  possible,  but  not  bringing  them  to  the  surface  ;  then  make  a 
Bweep  backward  to  the  hips,  the  hands  being  turned  downward  and 
outr«'ard ;  then  bring  thera  back  under  the  body,  and  ^ith  as  little  re* 


14 


THEORY    AND    PRACTICE. 


sistance  as  may  be,  to  their  former  position,  and  continue  as  before. 
The  hands  have  three  motions — First,  from  their  position  at  the  breast, 
thej  are  pushed  straight  forward ;  second,  the  sweep  round  to  tho 
liips,  like  an  oar,  the  closed  and  hollowed  hands  being  the  paddle  por- 
tion, and  their  position  in  the  water  and  descent  serving  both  to  propel 
and  sustain  the  body ;  and,  third,  they  are  brought  back  under  the 
body  to  the  first  position. 

Having  learned  these  motions  by  practicing  them  slowly,  the  pupu 
should  proceed  to  learn  the  still  more  important  motions  of  the  legs. 
These  are  likewise  three  in  numbei  :  one  of  preparation,  and  two  of 
propulsion.  First,  the  legs  are  drawn  up  as  far  as  possible,  by  bending 
the  knees,  and  keeping  the  feet  widely  separated;  second,  they  are 
pushed  with  force  backward  and  outward,  so  that  they  spread  as  far  as 
possible ;  and,  third,  the  legs  are  brought  together,  thus  acting  power- 
fully upon  the  wedge  of  water  which  they  inclosed. 

Some  works  upon  swimming  advise  that  the  propelling  sti'oke  of  the 
arms  and  legs  should  be  used  alternately ;  but  this  is  not  the  method 
used  by  good  swimmers,  or  by  that  best  of  teachers,  the  frog,  of  whom 
T  would  advise  all  new  beginners  to  take  lessons.  It  is  better  that  the 
feet  should  be  brought  up  at  the  same  time  that  the  hands  are  carried 
to  their  first  position ;  the  propelling  strokes  may  then  be  combined  so 
as  to  give  the  body  its  most  powerful  impetus,  as  a  boat  is  rowed  best 
with  simultaneous  sti'okes. 

The  motion  in  the  water  should  be  as  sti'aight  forward  as  possible, 
and  the  more  the  head  is  inmiersed  the  easier  is  the  swimmiiis:,  Ris- 
ing  at  every  stroke — breastmg,  as  it  is  called — is  both  tiresome  and 
inelegant. 

All  these  movements  should  be  made  with  slowness,  and  deliberately, 
without  the  least  flurry.  The  learner  will  soon  breathe  naturally,  and 
as  the  motions  are  really  nature,  he  will  not  be  long  in  acquiring  them. 
If  he  draw  in  his  breath  as  he  rises,  and  breathe  it  out  as  he  sinks,  he 


Fig.  177. 


PLtTPTOLN-G    OR    DIVIXG. 


will  time  his  strokes,  and  avoid 
swallowing  water.  Those  who 
have  been  accustomed  to  fresh 
water  must  be  particularly  care- 
ful when  they  go  into  the  sea, 
the  water  of  which  is  veiy 
nauseous. 

In  leaping  into  the  water, 
feet  first,  which  is  done  from 
rocks,  bridges,  and  even  from 
the  yards  and   masts  of  loftv 


WATER-CURE    PRO  JESSES. 


45 


Fig.  178. 


TREADING    WATER. 


vessels,  the  feet  must  be  kept  close  together,  and  the  arms  either  held 
close  to  the  side,  or  over  the  head.  In  diving  head  fofemost,  the 
hands  must  be  put  together,  as  in  the  engi-aving  (fig.  177),  so  as  (o  di- 
vide the  water  before  the  head.  The  hands  are  also  in  the  proper 
position  for  striking  out. 

Treading  the  water  (fig.  178)  is  a  favorite  position,  and  useful  as  a 
means  of  resting  in  swimming  long 
distances.  The  position  is  perpen- 
dicular ;  the  hauds  are  placed  upon 
the  hips,  as  in  *,he  vignette,  or  kept 
close  to  the  side,  to  assist  in  balanc- 
ing the  body,  being  moved  like  fins 
at  the  wrist  only.  The  feet  are 
pushed  down  alternately,  so  as  to 
support  the  head  above  water ;  and 
the  body  may  be  raised  in  this  way. 
to  a  considerable  extent.  While  in 
this  position,  if  the  head  be  thrown 
back,  so  as  to  bring  the  nose  and  mouth  uppermost,  and  the  chest 
somewhat  inflated,  the  swimmer  may.  sink  till  his  head  is  nearly  cov- 
ered, and  remain  for  any  length  of  time  in  this  position  without  motion, 
taking  care  to  breathe  very  sloAvly. 

In  swimming  on  either  side  (fig.  179),  the  motions  of  the  legs  have 
no  alteration,  but  are  performed  as 
usual.  To  swim  oa  the  left  side, 
lower  that  side,  which  is  done  with 
the  slightest  effort,  and  requires  no 
instructions.  Then  strike  forward 
with  the  left  hand,  and  sideways 
with  the  right,  keeping  the  back 
of  the  latter  to  the  front,  with  the 
thumb  side  dovrnward,  so  as  to  act 
as  an  oar.  In  turning  on  the  other  side,  strike  out  with  the  right  hand, 
and  use  the  left  for  an  oar.  To  swim  on  each  side  alternately,  sti'etch 
out  the  lower  arm  the  instant  that  a  strike  is  made  by  the  feet,  and 
strike  with  the  other  ai-m  on  a  level  with  the  head  at  the  instant  that 
the  feet  are  urging  the  swimmer  forward;  and  while  the  upper  hand 
is  caiTied  forward,  and  the  feet  are  contracted,  the  lower  hand  must 
be  drawn  toward  the  body.  This  method  is  full  of  vaiiety,  and  capa- 
ble of  gi'eat  rapidity,  but  it  is  alsr  very  fatiguing. 

Thrusting  (fig.  180")  is  a  beautiful  variety  of  this  exercise,  and  much 
used  by  accomplished  swimmers.     The  legs  and  feet  are  worked  as 


Fig.  179. 


SIDE    SWIMMING. 


46 


THEORY    AND    PRACTICE. 


Fiff.  180. 


THRUSTING 


Fig.  181. 


in  ordinary  swimnjing,  but  the  hands  and  arms  very  dififereutly.     One 

arm,  saj  the  right,  should 
be  lifted  wholly  out  of  the 
water,  thrust  forward  to  its 
utmost  reaching,  and  then 
dropped  upon  the  water 
with  the  hand  hollowed, 
and  then  brought  back  by 
a  powerful  movement,  pull- 
ing the  water  toward  the  opposite  armpit.  At  the  same  time  the  body 
must  be  sustained  and  steadied  by  the  left  hand,  working  in  a  small 
circle,  and  as  the  right  arm  comes  back  from  its  far  reach  to  the  arm- 
pit, the  left  is  carrying  in  an  easy  sweep  from  the  breast  to  the  hip. 
The  left  arm  is  thrust  forward  alternately  with  the  right  and  by  these 
varied  movements  great  rapiditj^  is  combined  with  much  ease. 

Swimming  on  the  back  (fig.  181)  is  the  easiest  of  all  modes  of  swim- 
ming, because  in  this  way  a  larger 
portion  of  the  body  is  supported 
by  the  water.  It  is  very  useful  to 
rest  the  swimmer  fi-om  the  greater 
exertion  of  more  rapid  methods, 
and  especially  w^hen  a  long  con- 
tinuance in  deep  water  is  unnvoid- 
~-  able.      The    swimmer    can    turn 

SWIMMING  ON  THE  BACK.  easily  to  this  position,  or  if  learn- 

ing, he  has  but  to  incline  slowly  backward,  keeping  his  head  on  a  linr» 
with  his  body,  and  letting  his  ears  sink  below  the  surface.  Then 
placing  his  hands  upon  his  hips,  he  can  push  himself  along  with  his 
feet  and  legs  with  perfect  ease  and  considerable  rapiditj*. 

The  hands  may  be  used  to  assist  in  propelling  in  this  mode,  by  bring- 
ing them  up  edgewise  toward  the  armpits,  and  then  pushing  them 
down,  the  fingers  fronting  inward,  and  the  thumb  part  down.  This  is 
called  ''winging." 

The  hands  may  be  used  at  discretion,  the  application  of  force  in  one 

direction,  of  course,  giving  motion  in  the  other;  and  the  best  methods 

Fig.  182.  are  soon  learned  when  once 

the  pupil  has  acquired  con- 
fidence in  his  buoyant  pow- 
ers. 

Floating  (fig.  182)   is  so 

useful  a  part  of  the  art  of 

riiOATiNG.  swimming,  that  it  cannot  be 


WATER-. 'URE    PROCESSES.  Al 

too  soon  obtained.  In  salt  water,  nothing  is  easier ;  and  in  fresh,  to 
most  persons,  it  requires  but  the  slightest  exertion.  The  feet  should 
be  stretched  out,  and  the  arms  extended  upward,  so  as  to  be  at  least 
as  high  as  the  top  of  the  head,  and  under  water.  The  head  must  be 
held  back,  the  chin  raised,  and  the  chest  expanded.  The  hands  will 
easily  keep  the  body  in  this  horizontal  position,  and  by  breathing  care- 
fully a  person  may  float  at  ease  for  hours.  Could  a  person,  unable  to 
swim,  but  have  the  presence  of  mind  to  take  this  position,  he  could 
scarcely  drown. 

To  heat  the  water,  the  legs  are  raised  out  of  it  alternately  while 
swimming  on  the  back,  the  body  being  sustained  by  the  hands. 

AVhile  swimming  on  the  breast,  one  leg  may  be  carried  backward, 
and  taken  hold  of  by  the  opposite  hand,  and  the  swimming  continued 
with  the  leg  and  hand  kept  unemployed.  This  is  said  to  be  usefu* 
when  taken  with  the  cramp  in  one  leg. 

Sivhnming  under  water  should  be  done  with  the  eyes  open.  If  you 
v/ould  swim  midway  between  the  bottom  and  the  surface,  make  the 
strokes  of  the  arms  and  the  hands  inward,  i.e.,  toward  you,  as  if  you 
would  embrace  the  water  by  large  armfuls,  keeping  the  thumbs  turned 
rather  downward.  These  are  most  important  manoeuvres.  You  are  thus 
enabled  to  pass  unseen  across  a  river  or  branch  of  water,  or  to  search 
for  any  thing  which  has  fallen  to  the  bottom,  and  also  to  rescue  any 
one  who  is  drovv^ning.  Beating,  and  swimming  under  water  should  not 
be  attempted  until  the  swimmer  becomes  expert  in  the  other  processes. 

Eye  and  Ear,  Baths. — Various  conti'ivances  have  been  employed 
to  bring  the  batlnng  processes  to  bear  on  the  eyes  and  ears  more  pow- 
erfully than  by  means  of  wet  cloths.  The  best  are  ascending,  or  ob- 
liquely ascending  douches  or  showers.  The  force  should  always  be 
moderate,  but  may  be  applied  for  a  considerable  time.  They  are 
useful  in  chronic  inflammation,  unattended  with  much  pain  or  intoler- 
ance of  light,  partial  blindness  or  deafness  from  torpor  of  the  nerves  or 
obstruction  of  the  vessels,  weakness  of  vision  Avithout  preternatui'a! 
sensibility,  specs,  incipient  amaurosis,  :;atheri  \g  in  the  ears,  etc. 

The  Nasal-Bath. — Sniffing  water  up  the  nostrils,  or  drawing  it 
so  far  into  the  nasal  cavities  as  to  be  ejected  by  the  mouth,  is  very 
useful  in  chronic  inflammation,  and  in  a  relaxed  or  weakened  state  of 
the  mucous  membrane  of  the  nose.  In  common  colds,  and  catarrhal  af- 
fections, the  process  is  salutary.  For  debility",  relaxation,  or  dryness  of 
the  mucous  membrane  from  tfee  use  of  snuff,  it  may  be  employed 
perseveringly  to  advantage.     For  nose-bleeding,  the  water  should  be 


iS  THEORY    AND    PRACTICE. 

as  cold  as  possible.  After  the  removal  of  soft  polypi  from  the  nostrils, 
iced-Avater  should  be  employed  frequently  to  constringe  the  vessels. 
In  em})loying  the  nasal-bath,  the  water  should  be  taken  up  by  gentle, 
full  inspirations,  not  by  a  sudden  jerking  motion,  fis  this  often  gives 
pain  and  increases  iiTitation. 

The  Oral,  or  Mouth-B.vth. — Gargling  the  mouth  with  pure 
cold  water  should  not  be  omitted  in  inflammatory  affections  of  the 
throat  or  palate.  For  sore  or  swelled  gums,  toothache,  hoarseness, 
and  all  vitiated  secretions,  cool  or  cold  water  should  be  frequently  held 
in  the  mouth  until  it  becomes  wa»-ra,  and  often  repeated.  In  apthous 
or  cankerous  affections  of  the  mou  h,  water  should  be  employed  in  the 
same  way.  Relaxation  or  falling  of  the  uvula,  or  soft  palate,  can  gen- 
erally be  relieved  or  cured  by  gargling  perseveringly  with  the  coldest 
water,  or  by  holding  lumps  of  ice  in  the  mouth.  Tobacco-chewers 
should  first  abandon  the  filthy  habit,  and  then  employ  the  cold  mouth- 
bath  to  restore  the  natural  sensibility  of  the  mucous  membrane,  and  a 
healthful  secretion  of  saliva. 

Thk  Arm-Bath. — For  old  ulcers,  and  recent  or  chronic  swellings 
of  any  part  of  the  arm,  holding  the  affected  pai't  in  cold  water  fiom 
fifteen  minutes  to  an  hour,  will  greatly  assist  in  healing  the  ulcer  or 
Absorbing  the  swelling.  Eruptive  and  rheumatic  affections,  in  fact,  ail 
morbid  conditions  of  the  upper  extremities,  attended  with  preternat- 
ural heat,  shorJd  be  treated  locally,  bj-  holding  the  part  diseased  in 
cool  or  cold  water,  or  wrapping  it  in  wet  cloths,  to  be  fj-equently 
changed,  until  the  temperature  becomes  natural.  In  erratic  complaints, 
"which  are  liable  to  change  the  seat  of  inflamm;ition,  as  with  gout, 
iheumatism,  especially  mercurial  rheumatism,  care  should  be  taken  to 
discontinue  the  cold  application  as  soon  as  the  morbid  heat  is  thoroughly 
subdued.  When  cold  applications  increase  the  pain,  warm  or  hot  may 
he  substituted. 

Thk  Ha>'d-Bath. — Habitual  coldness  of  the  hands,  or  numbness* 
is  relieved  by  holding  them  fi-equently  in  very  cold  water,  rubbing 
them  smartly  at  the  same  time.  Warty  excrescences  are  often  cured 
by  chilling  the  hands  severely  by  holding  them  a  long  time  in  the  cold- 
est water. 

The  Finger-Bath. — This  is  employed  for  felons  or  whitlows,  and 
other  similar  affections.  The  temperature  of  the  water  should,  in  all 
cases,  be  that  which  feels  most  agreeable  dii)ing  its  application 


WATERCU  RE    PROCESSES.  49 

The  Leg-Bath. — The  lower  limbs  are  much  more  liable  to  chronic 
swellings,  ulcers,  gouty  and  rheumatic  enlargements,  etc.,  than  the 
upper,  on  account  of  the  adverse  relation  of  the  force  of  gravitation  to 
the  weakened  vessels.  The  knee-joint  is  occasionally  affected  with  a 
chronic  inflammation  of  its  membranes — synovitis — for  which  the  leg- 
bath  is  serviceable.  A  tin  vessel,  shaped  something  like  a  boot,  large 
and  long  enough  to  take  in  the  leg  above  the  knee,  is  a  convenient 
means  of  administering  this  bath.  If  the  patient  is  crippled,  an  India- 
rubber  bag,  constructed  with  straps,  by  which  it  may  be  hung  upon  a 
chair,  or  fastened  to  the  side  of  the  bed,  is  more  convenient.  It  may 
be  employed  from  fifteen  minutes  to  one  hour.  There  is  no  danger 
of  producing  metastases,  or  driving  the  disease  to  internal  parts,  in 
any  forni  of  rheumatic  or  gouty  inflammation,  provided  the  application 
is  not  continued  beyond  the  point  of  reducing  the  temperature  to  the 
natural  standard. 

The  Drop-Bath. — This  process  is  not  often  resorted  to,  nor  is  it 
even  mentioned  in  some  hydropathic  books.  Still  it  is  sometimes  ser- 
viceable, and  ought  to  be  understood.  Wiess  gives  the  best  description 
of  it: 

"  This  term  is  applied  to  single  drops  of  water  falling  from  a  height 
of  several  fathoms.  A  vessel  is  filled  with  very  cold  water,  and  fur- 
nished with  a  small  aperture,  through  which  the  watei*  passes  in  the 
form  of  drops.  The  small  aperture  should  be  partially  closed  by  a 
plug,  to  prevent  the  drops  from  following  each  other  in  rapid  succession. 
By  these  means  their  operation  is  considerably  increased,  and  it  be- 
comes yet  more  potent  if  we  allow  the  drops  to  fall  upon  a  particular 
part  at  certain  periods,  and  rub  the  part  during  the  intervals.  The 
reaction  about  to  commence  will  indeed  be  thus  interrupted,  but  will 
afterward  make  its  appearance  in  a  more  powerful  and  energetic  form. 

"The  violent  excitement  and  irritation  of  the  nervous  system  pro- 
duced by  these  baths,  render  it  necessary  to  restrict  the  use  of  them 
to  half  an  hour ;  nor  are  they,  indeed,  adapted  for  vital  parts,  or  such 
as  are  abundantly  supplied  with  nerves. 

"  They  are  often  used  with  more  eflfect  in  obstinate  and  chronic  cases 
of  paralysis  than  the  douche  or  affusion,  with  which  they  may  alternate. 
Powerful  and  continued  friction  with  a  horse-hair  glove  is  never  in  this 
case  to  be  neglected  after  the  baths." 

The  Air-Bath. — This  is  not  quite  a  water-cure  process,  but  as  air, 
as  well  as  water,  in  all  its  adaptations  to  health-producing  purposes, 
belongs  to  the  V/ater-Cure  system,  the  air-bath  may  be  properly  con' 
11—6 


50  THEORY    AND    PRACTICE. 


sidered  in  this  place.  It  consists  of  the  sudden  exposure  of  the  whole 
body,  in  a  state  of  nudity,  to  cool  or  cold  air,  or  even  a  strong  currept. 
It  is  employed  under  precisely  the  same  regulations  as  a  cold-water 
bath.  It  is  certainly  a  very  invigorating  process,  and  may  always  be 
safely  applied  to  the  whole  body  when  the  body  is  in  a  sensible  glow 
or  when  the  temperature  is  above  the  natural  standard,  and  generally, 
also,  when  the  temperature  is  at  the  natural  standard,  provided  there 
is  no  sensation  of  chilliness  present.  It  is  useful,  moreover,  to  expose 
any  painful  or  inflamed  part  to  cold  air,  at  any  time  when  the  sensation 
of  cold  is  agi'eeable.  The  aii'-bath  has  sometimes  followed  the  wet- 
pack,  the  same  friction,  exercise,  etc.,  being  employed  to  keep  up 
comfortable  reaction  after  it. 

Sitting  naked  in  a  cold  room  for  from  ten  minutes  to  an  hour  has 
been  practiced  by  some  persons  as  a  hygienic  measure.  There  are 
few  persons  who  cannot  bear  a  moderate  degi-ee  of  such  exposure  to 
advantage.  Those  of  feeble  circulation  would  do  better  to  walk,  jump, 
dance,  or  exercise  in  some  other  way.  Franklin,  whose  practical 
sagacity  and  keen  observation  have  attained  a  world-wide  celebrity, 
accustomed  himself  to  sit  and  read  half  an  hour  or  an  hour,  on  rising 
in  the  morning,  before  dressing- 
Walking  the  room  in  a  state  of  entire  nudity,  has  been  resorted  to 
for  the  purpose  of  promoting  sleep  in  veiy  restless,  dream-disturbed 
i'idividuals,  and  it  is  said  to  conduce  remarkably  to  quiet  and  refreshing 
sleep.  1  have  known  the  experiment  tried  frequently,  and  always  w^ith 
good  efiect. 

Patients  suffering  fi'om  fevers  and  inflsramatory  disorders,  under  the 
popular  practice,  generally  have  their  sufferings  greatly  aggi'avated  by 
too  much  bed-clothing.  From  a  vague  apprehension  of  catching  cold, 
they  are  half  stifled  with  excess  of  heat.  There  is  no  danger  what- 
ever of  cold  air  in  any  quantity  or  degree  in  such  cases,  so  long  as  the 
whole  surface  is  preternatui*ally  hot 

Fomentations. — Warm  and  hot  fomentations  are  useful  in  a  variety 
of  morbid  conditions.  They  are  sedative  and  relaxant,  and  are  appro- 
priate in  cases  of  spasmodic  pains,  muscular  contractions,  periodicEd 
headaches,  hysterical  convulsions,  etc.,  when  the  state  of  the  system 
is  not  actively  inflammatory,  nor  the  local  part  preternaturally  hot.  In 
the  latter  case,  cold  applications  are  the  most  efficacious  to  allevia!'« 
pains  or  cramps.  A  very  good  and  perfectly  safe  rule  for  all  practical 
purposes,  in  the  selection  of  cold,  cool,  warm,  or  hot  local  applications, 
is  the  sensations  of  the  patient.  That  temperature  which  feels  the 
best  is  the  best.     This  rule  will  apply  to  cramps,  spasms,  coUc,  tooth- 


WATER-aURE    PROCESSES.  5> 

ache,  b'ackache,  prratic  and  irregular  pains  from  various  chronic  dis- 
eases, lumbago,  pleurodynia,  etc. 

But  it  must  be  recollected  that  all  very  warm  or  hot  applications  are 
always  for  occasional,  never  for  constant  employment.  They  are  to 
be  regarded  in  every  case  as  temporary  expedients,  sper'ally  intended 
to  quiet  pain,  subdue  local  irritation,  and  remove  irregular  muscular 
contractions,  or  as  adjuvants  to  the  general  curative  course;  and  rightly 
managed  with  this  view,  they  are  highly  important  as  well  as  pleasant 
resources.  They  produce  temporary  relaxation,  but  no  permanent 
debility  when  used  in  connection  with  more  or  less  cold  bathing,  as 
would  be  the  case  were  they  employed  alone. 

The  French  method  of  hot  fomentations,  so  highly  commended  by 
Dr.  Gully,  is  as  efficacious  and  perhaps  more  convenient  than  any  other 
in  use  :  A  piece  of  flannel  thrice-folded  is  put  into  a  dry  basin,  and 
very  hot  water  poured  on  it,  sufficiently  to  soak  it.  The  flannel  is  then 
put  into  the  corner  of  a  towel,  which  is  twisted  round  it,  and  wrung 
until  the  flannel  is  only  damp.  It  is  taken  out  of  the  towel,  and  imme- 
diately laid  over  the  par'r  to  be  fomented,  and  upon  it  is  placed  a  double 
fold  of  thick  flannel,  dry.  o:  part  of  a  light  blanket.  The  patient 
then,  if  it  be  the  abdomen  which  is  fomented,  draws  the  ordinary  bed- 
clothes over  him,  and  remains  quiet  for  five  or  six  minutes,  when 
another  flannel  freshly  wrung  out  is  applied,  the  former  one  being 
withdrawn. 

The  cloths  seldom  require  changing  more  than  three  or  four  times. 
Generally  relief  is  obtained  in  ten  or  fifteen  minutes.  I  have  very 
often  witnessed  the  best  eflfects  from  this  fomentation  in  nervous  and 
dyspeptic  headaches,  in  globus  hystericus — the  sense  of  suffocation 
often  accompanying  hysteria,  and  in  painful  menstruation.  It  is  also 
frequently  effectual  in  relieving,  for  the  time,  asthmatic  fits,  convulsions 
from  teething  or  indigestion,  neuralgia  in  the  head  or  face ;  it  will  gen- 
erally also  produce  relaxation  of  the  bladder  or  howels,  in  cases  of  re- 
tention of  urine  and  severe  constipation.  In  those  severe  derangements 
of  the  stomach  and  liver,  attended  with  excessive  nausea,  severe 
retching  and  vomiting,  intolerance  of  food  and  drink,  etc.,  its  use,  in 
connection  with  the  pouring  of  cold  water  over  the  back  of  the  head 
and  temples,  will  usually  afford  prompt  relief,  as  I  have  many  times 
experienced.  For  all  these  purposes  the  fomenting  cloth  should  be 
large  enough  to  cover  half  or  two  thirds  of  the  surface  of  the  abdomen. 

There  are  some  delicate  invalids,  of  bloodless  skin  and  feeble  vitality, 
who  find  it  extremely  difficult  to  get  comfortably  warm  in  the  wet 
sheet,  and  such  may  be  very  much  assisted  by  a  fomentation  to  the 
abdomen  for  five  minutes  before  and  after  the  pack. 


62  THEORY    AND    PRACTICE. 

Jiest,  and  not  exercise,  should  succeed  the  application  of*  hot  fo- 
mentations, except  when  they  are  employed  as  an  auxiliary  to  and 
followed  by  a  cold  bath. 

I  have  thus  far  spoken  only  of  hot  fomentations  to  the  abdomen; 
and  indeed  in  nine  cases  out  of  ten  where  this  process  is  indicated  at 
all,  the  place  and  manner  described  will  answer  all  purposes.  Yet  in 
various  local,  spasmodic,  or  periodical  pains  they  may  be  applied  as  near 
the  part  affected  as  possible.  In  affections  of  less  severity,  wet  cloths 
of  any  kind,  applied  as  hot  as  can  be  borne,  will  prove  sufficient. 

Bandages. — These  may  be  local  warming  or  cooling  processes,  as 
indicated,  and  answer  all  the  purposes  of  the  awkward,  bungling,  and  ex- 
pensive luachinery  of  liniments,  lotions,  poultices,  embrocations,  blisters, 
rubefacients,  epispastics,  cuppings,  issues,  burnings,  and  other  external 
drug  appliances  of  the  old  school. 

A  warming  bandage^  or  compress,  is  simply  one  or  more  folds  of  linen 
cloth,  wet  in  cold  water,  applied  to  the  part  aftected,  and  covered  with 
a  dry  cloth  or  other  material,  to  retain  the  animal  heat. 

A  cooling  bandage,  or  compress,  is  a  similar  w^et  application  without 
the  dry  covering,  or  with  the  covering  so  light  as  to  allow  the  animal 
heat  readily  to  pass  off.  In  both  cases  the  cloth  is  to  be  renewed  as 
often  as  it  becomes  dry.  As  usually  managed,  these  compresses  are 
both  cooling  and  warming,  the  first  impression  being  cold,  and  the  re- 
action leaving  a  glow  upon  the  surface ;  but  they  can  be  made  to  pro- 
duce a  constantly  cooling  effect  by  very  lightly  covering  and  frequently 
changing  them,  or  a  very  heating  effect  by  covering  them  with  flannel 
or  other  non-conducting  material. 

Coarse  hnen  cloth,  as  common  crash  toweling,  is  the  most  suitable 
cloth  to  be  wetted ;  and  for  the  dry  covering,  the  same  material,  or 
any  common  muslin,  will  answer  in  warm  w^eather,  and  soft  flannel  in 
cold  weather.  India  rubber,  gutta  percha,  and  oiled  silk  have  all  been 
in  repute,  and  a  few^  years  ago  were  very  generally  employed  for  cov- 
erings. I  regard  them  all  as  objectionable.  They  do  indeed  serve  to 
prevent  evaporation,  and  retain  more  peifectly  the  animal  heat,  and 
they  also  keep  the  part  moist  longer;  and  they  seem,  too,  to  have  a 
more  drawing  or  derivative  influence,  if  the  more  ready  production  of 
eruptions  or  boils  indicates  such  influence.  But  they  retain  the  effete 
perspirable  matter  which  should  pass  off;  and  their  non-conducting,  or 
non-electric  property  renders  them  relaxing  and  weakening  to  the  cu- 
taneous function. 

It  seems  to  me  that,  in  all  cases,  cloth  coverings  are  the  best.     If 
they  produce  a  less  number  of  boils  or  less  painful  eruptions,  the  cure 


WATER-CURE    PROCESSES.  63 

will  nevertheless  be  as  prompt  and  even  more  perfect.  When  the 
Bkin  is  torpid  and  cold.  Canton  or  soft,  light,  woolen  flanLel  answers 
every  purpose ;  and  if  necessary,  for  very  feeble  patients  who  are 
unable  to  take  much  exercise,  two  or  three  thicknesses  may  be 
used 

The  Chest-Wrapper. — This  is  advantageously  employed  in  nearly 
all  chronic  diseases  of  the  chest,  as  incipient  consumption,  bronchitis, 
in  the  very  early  stage  of  hydroihorax,  or  dropsy  of  the  chest,  spas- 
modic or  periodical  asthma,  etc.  It  may  be  made  of  crash  toweling, 
or  two  or  three  folds  of  muslin,  and  fitted,  with  arm-holes,  loosely  to 
the  trunk  of  the  body  from  the  neck,  nearly  or  quite  down  to  the  hips. 
The  outside  covering  is  l  similar  wrapper,  made  of  the  same  material^ 
or  of  flannel.  The  inner,  or  wet  wrapper,  is  tied  as  tightly  around  the 
body  as  desired  by  tapes,  which  are  attached  to  the  top,  bottom,  and 
middle,  and  the  outside  or  dry  wrapper  is  either  tied  around  it,  or  the 
nner  one  is  buttoned  to  the  outer. 

There  is  some  discrepancy  in  the  views  of  different  hydropaths,  &3 
to  whether  the  wet  cloth  should  extend  entirely  around  the  body,  or  a 
few  inches  over  the  spine  be  left  uncovered.  Here  again,  as  in  most 
of  the  vexed  questions  which  occur  in  hydropathic  bathing,  the  feelings 
of  the  patient  are  our  best  guide.  If  the  wet  cloth  over  the  spine  does 
not  produce  any  disagreeable  chilliness,  pain,  or  uneasiness,  different 
from  what  is  experienced  when  the  partial  wrapper  is  worn,  I  would 
have  it  entirely  encircle  the  trunk ;  otherwise  a  space  of  from  four  to 
six  inches  in  the  center  of  the  back  should  be  uncovered  by  the  wet 
cloth. 

This  may  be  worn  day  and  night  for  several  weeks,  provided  it  pro- 
duces no  uncomfortable  chilliness  during  the  day,  and  does  not  become 
so  warm  and  dry  as  to  make  the  patient  restless  during  the  night.  In 
the  former  case  it  should  only  be  worn  during  the  warmest  part  of  the 
day,  or  during  the  time  allotted  to  exercise,  or  from  the  morning  bath 
until  noon,  or  from  the  forenoon  bath  until  evening.  In  the  latter  case 
it  may  be  worn  during  the  day,  and  omitted  at  night.  It  usually  re- 
quires wetting  when  worn  constantly,  in  the  morning,  toward  noon, 
toward  evening,  and  at  bedtime. 

The  Abdominal  Wrapper. — The  wet  girdle,  or  abdominal  com- 
press, as  this  is  generally  called,  is  more  generally  employed  than  any 
other  local  hydropathic  application.  Derangements  of  the  digestive 
organs  are  so  preva  ent  nowadays  that  those  who  do  not  thus  complain 
are  exceptions  to  th?  general  rule  ,  and  for  all  of  these  complaints  this 


U  THEORY    AND    PRACTICE. 

bandage  is  ftppropriate.  It  is  also  serviceable  in  all  chronic  diseases  of 
the  liver,  and  in  acu  e  diseases  of  the  abdominal  viscera,  as  inflamuintiou 
of  the  stomach  and  bowels,  cholera,  dysentery,  cholera  morbus,  diairhea, 
etc.,  it  is  always  employed  w  ith  benefit. 

A  gi-eat  deal  of  ingenuity  has  been  wasted  in  conti'iving  abdominal 
compresses.  But  the  best  invention  of  all  is  three  yards  of  common 
crash  towel  cloth.  One  half  of  this  is  wet,  and  moderately  wi-ung; 
the  wet  end  is  applied  to  tne  side  of  the  abdomen,  then  the  bandage  is 
passed  across  the  abdomen,  and  around  the  body,  followed  by  the  dry 
half.  This  brings  two  folds  of  the  wet  part  over  the  front  of  the  abdo- 
men, and  one  behind.  Whether  it  is  to  be  extended  entirely  around 
the  body,  must  be  determined  by  the  rule  mentioned  as  applicable  to 
the  chest-wrapper.  The  proper  crash  cloth  is  from  twelve  to  sixteeh 
inches  wide,  and  covers  the  trunk  from  the  short  ribs  to  the  hips,  de- 
scending a  little  over  the  latter.  As  with  the  chest-wrapper,  it  may 
be  worn  constantly  or  occasionally.  It  should  never  be  applied  so 
tightly  as  to  hinder  in  the  least  free  respiration.  It  may  be  kept  in 
place  by  tapes  or  pins. 

This  bandage  is  employed  more  or  less  in  all  cases  of  dyspepsia, 
liver  complaints,  constipation,  paralysis  of  the  lower  limbs,  affection  of 
the  pancreas,  spleen,  kidneys,  and  bladder,  obstructions  of  the  mesen- 
teric glands,  all  forms  of  mismensti'uation  and  female  weakness,  in  a 
word,  in  all  chronic  morbid  conditions  of  the  abdominal  and  pelvic 
viscera,  and  in  all  states  of  weakness  or  relaxation  in  their  ligaments 
or  muscles.  Persons  who  have  weakened  the  abdominal  muscles  and 
viscera  by  sedentary  habits  and  crooked  bodily  positions,  experience 
great  benefit  from  its  use. 

Frictio'. — Hand-rubbing,  towel-rubbing,  nibbing  the  skin  over  the 
wet  or  dry  sheet,  and  with  a  flesh-brush  or  horse-hair  gloves,  are 
among  the  accompaniments  of  the  bathing  processes.  Their  object  is 
to  assist  reaction  and  promote  capillary  circulation.  As  a  general  rule, 
patients  should  practice  as  much  self-rubbing  as  convenient,  at  the 
same  time  that  they  are  assisted  by  the  attendant,  because  the  exercise 
of  so  doing  is  an  advantage  of  itself.  As  a  general  inile,  too,  the  amount 
of  friction  in  each  case  should  be  proportioned  to  the  bloodlessness  and 
torpor  of  the  skin ;  and  another  general  rule  may  be  stated  in  relation 
to  friction,  which  is,  tliat  it  should  be  active  and  rapid,  i-ather  than 
harsh  or  scraping;  rather  magnetic  than  forcible.  Some  invalids,  on 
the  mistaken  notion  that  the  harder  they  are  rubbed  the  more  wiL 
they  bectme  vitally  magnetized,  I  eep  the  attendants  at  work,  if  they 
be  good-natured,  and  object  not,  intil  completelj    exhausted ;   hence 


WATER-CURE    PROCESSES.  56 

the  physician  should  always  insti'uct  the  attendants  well  in  this  partic- 
ular duty. 

Temperature  of  Baths. — Hot,  warm,  tepid,  cool,  and  cold  are 
only  employed  as  approximate  terms.  Water  that  feels  hot  to  one 
may  be  only  warm  to  another,  and  what  is  cold  to  one  is  sometimes 
tepid  to  another.  The  sensations  of  the  patient  are  generally  a  bet- 
t(!r  guide  for  regulating  the  temperature  of  a  given  bath  than  is  the 
thermometer ;  still,  the  latter  is  indispensable  in  many  cases,  and  in  all 
convenient.  As  a  general  rule,  the  more  feeble  and  delicate  the  pa- 
tient, the  more  sti'ictly  should  we  follow  the  test  of  his  feelings  in  ad 
ninistering  tepid,  warm,  cool,  or  cold  baths.  When  the  circulation  is 
I'igorous,  and  the  vital  temperament  well  developed,  we  may  regulate 
any  bath  with  sufficient  precision  by  the  thermometer.  It  is  a  useful 
precaution,  when  commencing  treatment  with  very  susceptible  pa- 
tients, to  test  their  sensibility  to  different  temperatm"es  of  water, 
after  w^hich  the  physician  or  patient  can  prescrirje  them  thermomet- 
rically-  Some  Water- Cure  books  seem  to  make  it  an  especial  point  to 
be  thermometrically  exact  in  directing  particular  baths  for  given  dis- 
eases, as  for  example  :  sitz-bath,  at  59'^,  shallow-bath,  at  63°,  half-bath, 
at  74°,  etc.  These  nice  distinctions  are  not  to  be  arbitrarily  imitated, 
but  may  be  regarded  as  landmarks,  to  keep  us  within  reasonable 
bounds. 

Baths  may  be  distinguished  into  cold,  below  65^  Fahr.  ;  tepid,  65^ 
to  80° ;  warm,  80°  to  98° ;  and  hot,  above  98°.  But  a  better  division 
may  be  made  thus  : 

-    Very  cold,    32  no  40°. 
Cold,  40°  to  55°. 

Cool,  55°  to  65°. 

Temperate,  65°  to  72°. 

The  term  moderately  tepid,  warm,  cool,  or  cold,  when  occurring  in 
this  work,  means  some  degree  between  the  bath  named  and  temper- 
ate, or  the  next  bath  in  the  scale,  reckoning  toward  temperate-;  thus 
moderately  hot  would  mean  a  temperature  between  98^  and  85°,  etc. 

Duration  of  Baths. — There  is  the  same  mystical  yet  unmeaning 
exactness  about  the  time  of  continuing  a  given  bath,  to  fulfill  a  particu- 
lar indication,  in  many  Water-Cure  books,  that  there  is  about  the  tem- 
oerature.  But  here,  again,  we  have  better  guides  than  seconds  and 
"•ninutes,  in  the  feelings  of  the  patients  and  in  the  effects  produced.     It 


Tepid, 

72°  to  85°, 

Warm, 

85°  to  98°. 

Hot, 

98°  to  115°. 

Vapor, 

98°  to  125°. 

56  THEORY    AND    PRACTICE. 

is  true  an  experienced  hydropath  can,  on  examining  a  patient,  determ- 
ine at  once  about  the  proper  length  of  time  to  administer  most  of  his 
baths ;  but  this  time  should  nhvays  have  a  nearer  relation  to  the  condi- 
tion of  the  patient,  and  the  sum  total  of  all  the  treatment  prescribed, 
than  to  the  name  of  the  disease.  A  general  rule  may  be  laid  down, 
that  all  patients  should  limit  all  baths  to  a  period  shott  of  producing  any 
very  depressing  chill ;  and  never  continue  any  one  to  the  point  of  pro- 
ducing a  second  chill  after  the  reaction  has  once  taken  place  in  the 
bath.  In  home-treatment  the  safer  way  is  to  incline  to  frequent  and 
short  baths,  rather  than  few  and  long. 

General  Rules  for  Hydropathic  Bathing. — 1.  No  bath  should 
be  taken  on  a  full  stomach.  General  baths,  as  the  wet-sheet,  plunge, 
douche,  shower,  etc.,  should  not  be  taken  until  the  process  of  diges- 
tion is  nearly  or  quite  completed — from  three  to  four  hours  after  a  full 
meal.  Local  baths,  as  the  hip,  foot,  hand,  leg,  etc.,  may  be  taken  in 
an  hour  after  a  light,  and  two  hours  after  a  heai'ty  mea'  Bandages 
may  be  applied  at  any  time. 

2.  Patients  should  not  eat  immediately  after  a  bath.  An  hour  is 
soon  enough  after  a  full,  and  half  an  hour  after  a  local  bath. 

3.  All  patients  who  are  able  should  exercise  moderately  previous  to 
a  bath,  unless  at  the  bath,  time  the  body  is  already  in  a  Avai*m  glow ; 
and  after  a  bath,  according  to  muscular  strength.  The  more  exercise 
short  of  absolute  fatigue  the  better.  By  absolute  fatigue  I  mean  that 
degree  of  exhaustion  which  is  not  readily  recovered  from  on  resting. 

4.  In  very  warm  weather  the  most  active  exercise  should  be  taken 
before  breakfast;  and  during  the  heat  of  the  day  it  should  not  be 
crowded  beyond  what  is  perfectly  agi'eeabie. 

5.  No  strong  shock  should  ever  be  made  upon  the  head.  A  shower 
or  pail- douche,  poured  but  not  dashed  on,  is  not  objectionable  for  those 
who  enjoy  a  tolerably  well-balanced  circulation,  and  are  not  subject  to 
nervous  headache. 

6.  Profuse  perspiration,  or  great  heat  of  the  body,  is  no  objection  to 
any  form  of  cold  bath,  provided  the  body  is  not  in  a  state  of  exhaustion 
from  over-exertion,  nor  the  breathing  disturbed.  This  point  is  gene- 
rally misunderstood  by  physicians,  and  medical  books  of  the  old  schooa 
are  wholly  in  error  about  it.  The  majority  of  peopit  imagine  that  the 
sudden  transition  from  cold  to  hot  is  dangerous.  The  danger  is  all  on 
the  other  side — in  applying  cold  when  the  body  is  already  too  cold. 
Again,  it  is  thought  that  a  cold  bath,  when  the  body  is  dripping  with 
sweat,  will  check  the  jjerspirafion,  and  do  inimense  mischief  by  driving 
it  in!     This  is  a  irere  phantasy.     The   matter  of  perspiration  is  a 


WATER-CURE    PROCESSES.  57 

viscid,  waste,  dead,  effete  material,  and  its  presence  on  the  surface  has 
nothing  whatever  to  do  with  the  effect  of  a  cold  bath.  It  may  be  as 
safely  washed  of!'  v>'ith  cold  water  when  the  body  is  hot,  as  can  any 
other  extraneous  matter  adherent  to  the  surface. 

But  persons  are  often  injured  by  going  into  cold  water  when  the 
body  is  hot  and  perspirable.  Granted.  I  have  known  several  young 
men  made  cripples  for  life  by  this  practice.  Now  what  is  the  ex- 
planation ?  Either  the  body  was  too  cold,  or  in  a  state  of  exhaustion, 
or  the  respiration  was  materially  disturbed,  or  the  stomach  was  loaded, 
or  all  of  these  conditions  existed  together.  There  is  a  reciprocal  re- 
lation between  circulation  and  respiration,  which  cannot  be  greatly 
disturbed  without  injury.  If  a  person  jumps  into  cold  water  when  out 
of  breath  from  violent  exercise,  he  endangers  his  health,  because  the 
intimate  sympathy  between  the  action  of  the  heart  and  lungs  will  pre- 
vent reaction  to  the  surfjice,  and  the  result  is  internal  congestion. 
Under  all  other  circumstances,  a  warm  or  hot  skin  is  favorable  to  any 
cold  application,  while  the  state  of  perspiration  is  a  matter  of  no  sort 
of  consequence  one  way  or  the  other.  Dr.  Johnson  remarks  :  "Being 
in  a  state  of  perspiration  is  no  objection  to  taking  any  bath,  except  the 
sit'/,,  foot,  and  head-bath."  If  the  rules  I  have  laid  down  are  duly  ob- 
served, there  can  be  no  force  in  the  objection  of  Dr.  Johnson. 

7.  When  full  treatment  is  prescribed,  as  three,  four,  or  five  baths  a 
day,  the  patient  should  take  the  most  powerful,  or  those  which  produc 
the  gi'eatest  shock,  on  rising,  and  in  the  early  part  of  the  day. 

8.  Wetting  the  head,  and  even  the  chest,  is  a  useful  precaution  be- 
fore taking  any  full  bath,  and  especially  important  for  patients  who  are 
liable  to  head  affections. 

Water-Drinking. — The  indiscriminate  drinking  of  large  quantities 
of  water,  as  has  been  the  custom  at  some  establishments,  is  not  to  be 
commended.  The  amount  that  can  be  taken  to  advantage  varies 
greatly  according  to  disease,  temperament,  exercise,  diet,  etc.  Per- 
sons of  large  chest  and  abdomen,  of  florid  complexion  and  active  capil- 
lary circulation,  can  drink  with  satisfaction,  and  require,  Avhile  under 
ti'eatment,  a  free  use  of  water  as  drink — from  twelve  to  twenty  tum- 
blers. On  the  contrary,  those  of  thin,  spare  body,  nervous  tempera- 
ment, and  especially  if  the  skin  appears  bilious,  and  the  pores,  as  it 
were,  glued  together,  cannot  take,  with  profit,  more  than  three  to  six 
tumblers  daily.  In  the  former  case  the  water  is  rapidly  absorbed  from 
the  stomach,  and  thrown  off  by  the  skin;  in  the  latter  case  it  lies,  as 
it  were,  like  a  dead  weight  in  the  first  passages^  and  i«  finally  carried 
"id'  mainly  by  the  kidneys. 


68  THEORY    AND    PRACTICE. 

Considerable  allowance  must  also  be  made  for  the  amount  of  exer- 
cise the  patient  can  take,  and  the  kind  of  food  partaken  of  The 
greater  the  amount  of  exercise,  the  more  cutaneous  ti-anspiration,  and 
the  more  water  required.  Those  who  use  much  animal  food,  salt,  or 
other  seasonings,  grease  of  any  kind,  or  concenh'ated  farinaceous  food, 
require  a  much  larger  quantity  of  water — other  circumstances  being 
equal,  than  those  who  resti'ict  tliemselves  to  a  plain  vegetable  diet. 
Patients  should  always  drink  to  the  extent  of  thirst ;  but  for  a  general 
rule  while  under  treatment,  water  should  be  taken  most  freely  early 
in  the  morning,  after  the  bath,  and  again  about  the  middle  of  the  fore- 
noon ;  a  less  quantity  still  in  the  afternoon,  and  little  or  none  in  the 
evening.     Very  little  should  be  drank  at  meals. 

There  are  some  few  dyspeptics  whose  stomachs  are  so  contracted 
and  sensitive,  whose  livers  are  so  torpid,  and  whose  capillary  circula- 
tion so  diminished,  that  even  a  single  tumbler  of  cold  water  produces  a 
painful  heaviness  and  disti'essing  chilliness  of  the  stomach.  Such  in- 
Viilids  should  begin  with  half  a  tumbler,  or  even  less,  and  gi-adually  but 
carefully  increase  the  quantity,  as  it  can  be  borne  without  producing 
unpleasant  sensations.  In  such  cases,  too,  the  water  drank  should  never 
be  very  cold  ;  the  best  temperature  is  from  55°  to  65-'. 

Drs.  Gully,  Johnson,  Wilson,  and  Rausse,  very  severely  and  very 
iustly  repudiate  the  indiscriminate  practice  of  large  water-drinking, 
which  is  so  highly  and  exti'avagantly  recommended  in  some  works  on 
Water-Cure.  I  have  seen  not  a  little  mischief  result  from  it ;  in  home 
practice  water-drinking  is  particularly  liable  to  be  overdone.  Some 
persons  have  boasted  of  the  "ravenous  appetite"  produced  by  drinking 
twenty  or  thirty  tumblers  of  water  a  day ;  but  I  cannot  understand  the 
advantage  of  ravenous  appetites  ;  they  are  generally  indicative  of  ex- 
cessive morbid  irritation  in  the  stomach. 

The  rule  for  those  who  have  not  an  intelligent  hydropath  to  advise 
with,  is  to  foUow  the  sensations  of  the  stomacli ;  take  all  that  produces 
pleasurable  sensations,  and  no  more.  More  or  less  water  should  always 
be  taken  after  each  bath.  Exercise  should  succeed  water-drinking, 
and,  ;is  already  intimated,  it  should  be  proportioned  to  the  amount  of 
water  taken. 

Lavements  and  Injections. — These  are  used  as  cleansing  and 
relaxing,  or  tonic  and  contracting  processes.  For  the  former  purposes 
tepid  or  \varm  water  is  employed,  and  for  the  latter  cool  or  cold.  On 
the  first  attack  of  acute  diseases  of  the  bowels,  cholera,  dysentery, 
colic,  diai'rhea,  etc.,  copious  tepi3  injections  should  be  promptly  resort- 
ed to.  and  succeeded,  aftei  the  alimentary  canal  is  well  cleansed,  by 


CRISES.  59 

cool  iijjections.  In  obstinate  constipation  from  debility,  cold  injections 
should  bo  employed  daily  until  general  treatment  and  diet  can  repro- 
duce the  ordinary  peristaltic  action.  In  hemorrhoids  an  injection  of  a 
small  quantity  of  cold  water  just  previous  to  the  expected  movement  of 
the  bowels,  greatly  assists  the  healing  process.  Chronic  diarrhea  gen- 
erally requires  cool  or  cold  injections  occasionally.  In  all  chronic  mu- 
cous or  muco-purulent  discharges  from  the  bowels,  bladder,  urethra, 
or  vagina,  injections  of  a  temperature  suited  to  the  susceptibility  of  the 
part  affected,  or  the  degree  of  inflammation,  are  an  indispensable  part 
of  the  treatment.  In  gleel,  leucorrhea,  prolapsus,  and  monorrhagia,  they 
should  be  freely  used  as  strengthening  processes.  After  parturition 
the  vagina  should  be  cleansed  with  a  cool  injection.  The  most  conve- 
nient instrument  for  self-treatment  is  the  pump  syringe  for  the  bowels. 
The  curved  tube  vaginal  syringe  is  indispensable  for  females.  In  some 
affections  of  the  uterus  and  vagina,  a  small  tube  speculum  is  necessary 
to  be  introduced  to  enable  the  water  to  come  in  contact  with  as  large  a 
surface  as  possible  while  employing  the  sitz-bath.  The  Union  India 
Rubber  Company,  of  this  city  (office  19  Nassau  Street),  has  just 
brought  out  an  admirable  apparatus  for  throwing  water  up  the  rectum 
or  vagina  with  any  degree  of  force  required.  It  consists  of  a  bag, 
holding  a  gallon  or  more,  which  is  filled  with  water  and  elevated,  by 
hanging  on  a  hook  or  nail,  six,  eight,  or  ten  feet.  The  force  of  tlie 
stream  is  regulated  by  pressure  on  a  long  tube  which  conveys  the  water 
from  the  bag  or  fountain  ;  and  to  the  end  of  this  tube  suitable  pipes  are 
adjusted  to  convey  the  water  up  the  vaginal  or  intestinal  passage.  This 
apparatus  is  cheap  and  not  liable  to  get  out  of  order. 


CHAPTER  III. 

CRISES. 


Doctrine  of  Crisis. — The  doctrine  of  crisis  is  as  ancient  as  Hip- 
pocrates. Acute  diseases,  when  left  to  themselves,  often  terminate  by 
some  spontaneous  evacuation ;  and  chronic  diseases,  when  left  to  the 
unaided  remedial  powers  of  nature,  are  frequently  resolved  by  some 
external  eruption  or  internal  abscess.  Under  water-treatment,  acute 
diseases  are  generally  relieved  by  mild  yet  ejffectual  functional  efforts 
of  all  the  excretory  organs,  unattended  with  any  gi'eat  commotion  in 


60  THEORY    AND    PR  A  CnCE. 

the  organism,  or  strong  determination  to  any  me  em  inctory,  or  sinA- 
log  of  the  vit'al  powers,  which  can  be  called  in  any  sense  critical. 

But  with  chronic  diseases  the  case  is  often  very  different.  Many 
cases,  indeed,  recover  without  any  disturbance  which  can  properly  be 
denominated  a  crisis  ;  others  recover  after  repeated  disturbances,  more 
or  less  severe,  which  ma}'  be  called  critical  efforts ;  and  others,  after 
one  or  several  pai'oxysras  of  general  or  local  excitement,  attended  with 
some  profuse  evacuation,  severe  boils  or  eruptions,  a  general  feverish- 
ness,  or  an  aggravation  of  old,  half-forgotten  aches,  pains,  or  other  local 
affections. 

Forms  or  Crises. — The  most  common  forms  in  wnich  crises,  or 
critical  efforts,  present  themselves  are,  diarrhea,  boils,  and  general 
feverisliness.  Ba'ls  present  all  manner  of  appeai^^nces  from  the  hard, 
diffused,  inflammatory  swelling,  with  scarcely  any  suppurating  point, 
to  the  deep,  fully-matured,  sub-cutaneous  abscess ;  there  may  be  one 
or  several  at  the  same  time,  or  they  may  succeed  each  other  for  weeks 
or  months,  and  be  very  painful,  or  scarcely  troublesome.  Those  of 
full  habit,  sanguine  temperament,  and  active  external  circulation,  are 
most  subject  to  boils  and  eruptions. 

Diarrheas,  when  purely  critical,  come  on  without  any  accidental  or 
unusual  exposure  or  dietetic  error,  and  continue  with  greater  or  less  se- 
verity from  three  days  to  two  weeks.  There  is  not  usually  much  pain, 
griping,  or  disti-ess  of  any  kind  in  the  bowels,  but  the  evacuations  are 
thin,  Avatery,  and  frequent ;  generally  there  are  from  three  to  six  or 
eight  motions  in  tsventy  hours.  In  persons  who  have  been  most  sub- 
ject to  piles,  the  motions  will  be  most  frequent,  and  attended  with  con- 
siderable hearing  down  or  dragging  sensation  about  the  lower  bowel, 
and  the  discharges  will  exhibit  a  great  amount  of  mucous  or  slimy  mat- 
ter, often  intermixed  with  blood.  A  critical  looseness  of  the  bowels  is 
not  attended  with  debility  like  an  ordinaiy  diarrhea ;  if  long  contin- 
ued, there  is,  of  course,  some  degree  of  languor,  but  then  the  dis- 
ckarges  are  very  easily  checked  by  hot-sitz-baths  and  cold  injections. 
Those  who  have  long  'abored  under  derangements  of  the  digestive  or- 
gans, and  particularly  those  with  torpid  livers  and  constipated  bowels ; 
more  especially,  if  these  conditions  are  complicated  with  pale,  yellow, 
bloodless  skin,  and  shriveled,  superficial,  capillary  vessels,  are  most  lia- 
ble to  critical  evacuaticns  by  the  bowels  ;  and,  as  far  as  my  observa- 
tion extends,  they  are  iu 'ariably  beneficial,  always  being  succeeded  by 
B  decided  sense  of  improvement  in  the  patient's  entire  physiological 
condition. 

The  term  "  feverishness,"  does  not  very  well  express  the  other  coca- 


CRISES.  61 

moa  form  of  critical  action,  but  I  know  of  no  better  one  to  employ.  It 
is  characterized  by  more  or  less  of  the  symptoms  which  attend  an  at- 
^ack  of  simple  fever,  but  they  appear  in  a  more  disguised  and  irregular 
form.  There  is  chilliness  and  heat,  languor,  depression,  backache, 
headache,  genei'al  restlessness,  great  sensitiveness  to  cold,  etc.,  etc., 
but,  unlike  the  same  symptoms  in  a  paroxysm  of  simple  fever,  they  do 
not  follow  each  other  in  the  order  of  the  cold,  hot,  and  sweating  stages. 
This  febrile  disturbaace  continues  from  one  day  to  a  week,  when,  un- 
less aggravated  by  improper  ti-eatment,  the  body  recovers  its  balance  of 
action  and  feeling,  and  the  patient  feels  himself  advanced  at  least  one 
step  on  the  road  to  health.  Other  manifestations  of  critical  disturb- 
ance, as  eruptions,  rashes,  profuse  sweatings,  copious  discharge  of 
urine,  vomitings,  free  evacuation  of  bile,  etc.,  stiffness  of  the  muscles, 
pain  and  swelling  of  gouty  and  rheumatic  joints,  fetid  perspirations, 
where  compresses  are  worn,  etc.,  occasionally  occur,  but  require  no 
especial  management  save  moderating  or  suspending  a  part  or  all  of 
the  cold  treatment,  as  the  general  disturbance  of  the  system  is  more  or 
less  violent,  and  employing  soothing  applications,  as  indicated. 

Management  of  Crises. — The  management  of  crises  is  not  diffi- 
cult ;  generally  all  that  is  required  is  an  omission  of  some  part  or  all  of 
the  stronger  baths,  according  to  the  violence  of  the  crisis,  and  the  use 
of  such  mild  and  soothing  appliances  as  are  most  agreeable  to  the  pa- 
tient. The  patient  should  exercise  or  rest,  as  he  finds  either  most 
comfortable,  diet  very  simply,  and  use  water  locally  to  boils,  eruptive 
or  inflamed  parts — of  the  temperature  that  feels  most  pleasant.  If 
there  is  violent  headache,  it  may  be  soothed  with  the  hot  abdominal  fo- 
mentations. If  the  whole  body  is  sore,  tender,  restless,  and  irritable, 
a  hot  bath  should  be  taken  for  ten  minutes  ;  and  if  diarrhea  progress- 
es so  for  as  to  materially  weaken  the  patient,  the  hot  fomentation,  or 
hot  sitz-bath,  with  cold  injections,  should  be  employed.  Full  treat- 
ment should  not  be  resumed  until  the  critical  disturbance  is  entirely 
abated. 

Rationale  of  Crisis. — I  do  not  know  that  it  is  possible  to  explain 
catisfactorily  to  the  professional  or  non-professional  reader  the  true  ra- 
tionale of  critical  action,  since  all  the  language  employed  in  relation  to 
vital  laws,  organic  instincts,  remedial  actions,  etc.,  is  necessarily  more 
or  less  figurative.  Authors  on  Water-Cure  all  agree  that  crises  do  oc- 
cur ;  some  regard  them  as  of  general  occurrence,  the  cures  without 
such  phenomena  being  exceptions  to  a  general  rule ;  others  con'^end 
that  cures  can  generally  be  made  without  crises,  these  being  the  ex- 
6 


«2  THEORY    AND    PRACTICE. 

ceptions ;  and  still  others  regard  the  majority  of  the  crises  as  the  re- 
sult of  injudicious  or  excessive  treatment. 

It  is  perfectly  certain  that  many  bad  cases  of  chronic  disease  are 
cured  without  any  appearance  of  crises  whatever;  it  is  equally  certain, 
in  my  judgment,  that  some  few  cases  are  utterly  incurable  without  the 
production  of  a  decided  crisis ;  and  1  am  full^  ronvinced  that  in  many 
ciises  crises  are  rendered  unnecessarily  and  even  dangerously  severe 
by  excessive  or  injudicious  ti'eatment — generally  too  cold  or  too  shock- 
ing treatment.  If  a  patient  is  kept  continuously  chilled,  so  that  com- 
fortable reaction  does  not  take  place  between  the  baths;  or  the  douche 
is  applied  so  severely  as  to  produce  a  state  of  unusual  nervousness,  the 
crises  will  be  very  apt  to  be  injuriously  violent.  Hence  the  safei'  gen- 
eral plan  of  treatment,  especially  in  home  practice,  is  to  take  the  slower 
yet  surer  way — do  only  wdiat  is  clearly  proper,  and  keep  always  on  the 
safe  side.  In  this  way  we  only  lose  a  little  time,  for  which  life  or 
health  should  never  be  periled. 

The  diet  has  an  important  bearing  on  the  severity  of  the  crisis.  In 
all  cases,  the  more  plain,  simple,  and  sti'ictly  physiological  is  the  food 
taken,  the  less  severe  and  disti-essing  will  be  the  critical  efforts.;  all 
gross,  greasy,  high-seasoned  food,  or  complicated  dishes  render  a  se- 
vere treatment  necessary  to  cure,  and  this  necessarily  involves  a  more 
violent  crisis.  It  is  a  great  error  on  the  part  of  some  physicians  to  al- 
low a  hotel  table,  and  then  depend  on  harsher  water  processes  to  ef- 
fect the  cure ;  the  blame,  however,  is  not  all  on  the  side  of  the  physi- 
cians, for  many  patients  prefer  to  "  eat  what  their  souls  lust  after,"  and 
take  the  harder  treatment,  greater  suffering,  and  less  perfect  cure. 

Doctor  J.  Weiss  sa^'s  {Hand-Book  oj  Hydropathy) :  "  This  natural 
vital  process  is  not  to  be  regarded  a''  morbid,  for,  with  the  existing  dis- 
ease, it  has  nothing  in  common.  While  a  disease  lasts,  therefore,  no 
crisis  can  ensue.  The  appearance  of  the  crisis  announces  a  return  of 
the  vessels  in  the  diseased  parts  to  their  normal  activity,  the  resump- 
tion of  the  proper  functions  assigned  to  them  ;  or,  in  other  words,  the 
emancipation  of  the  organism  or  its  organs  from  disease.  This  is  the 
sole  signification  of  the  crisis,  according  to  experience  and  nature." 

Doctor  E.  Johnson  remarks  :  "That  the  system,  by  virtue  of  its  own 
inherent  energies,  sometimes  purges  itself  of  morbid  matters  by  a 
crisis;  that  is,  by  establishing  some  temporary  outlet  through  which 
such  morbid  matters  may  and  do  escape,  is  perfectly  certain.  The 
Alei)po  boil,  small-pox,  measles,  and  many  other  well-known  diseases, 
prove  this  to  demonstration,  and  beyond  the  possibility  of  question.  In 
all  these  rases  the  crisis  is  clearly  the  means  of  cure.  Without  such  or 
riome  si)7iilar  crisis,  the  patient  must  die.     Whether  the  water-treat- 


CRISES  63 

ment  has  the  power  of  urging  nature  to  the  establishment  of  such 
temporary  outlets  is  another  question,  to  which  I  can  only  reply,  that  I 
believe  it  has." 

Doctor  GuWy  remarks  {Water- Cure  in  Chronic  Diseases) :  "In  the 
course  of  the  efforts  which  nature  makes,  with  the  co-operation  of  the 
Water-Cure,  it  sometimes  happens  that  the  new  distribution  of  blood 
which  they  bring  about  is  so  energetically  affected  as  to  cause  morbid 
congestions  of  blood  in  other  organs  than  the  diseased  viscera.  In  this 
manner  congestion  of  the  lower  bowel  takes  place,  and  is  exhibited  in 
diarrhea  ;  general  congestion  of  the  skiti  takes  place,  and  is  exhibited 
in  sweats  of  various  kinds  ;  or  partial  but  more  intense  congestions  of 
the  skin  take  place,  and  are  exhibited  in  eruptions  of  various  liinds, 
and  in  boils  of  various  degrees.  To  these  exhibitions  of  transferred  ir- 
ritation and  circulation  the  name  of  crisis  is  given.  *  *  *  Critical  ac- 
tion, then,  as  a  result  of  the  water-treatment,  signifies  that  the  viscera 
have  been  enabled  to  throw  their  irritation  and  blood  upon  some  other 
owgans,  the  lower  bowels,  or  skin ;  and  that  this  excess  of  blood,  and 
this  irritative  action  attempts  relief  by  throwing  out  large  fcecal  secre- 
tion, or  unusual  cutaneous  secretion.  This  is  all  that  can  be  said  of  a 
crisis;  it  is  an  outward  and  visible  sign  of  the  exercise  of  a  power  on  the 
part  of  the  inward  organs  to  save  themselves  by  a  transfer  of  mischief 
to  parts  less  essential  to  life." 

Doctor  Shew  observes  {Water- Cure  Manual):  "A  crisis  may  be 
said  to  be  a  visible  effort  on  the  part  of  nature  or  the  natural  powers  of 
the  system,  to  rid  it  of  some  morbid  matter  or  matters  in  it,  or  expelling 
them  at  some  of  the  natural  outlets  of  the  system,  as  the  skin,  bowels, 
and  kidneys.  These  appearances  occur  in  the  form  of  boils,  eiTiptions, 
sweatings,  diarrhea,  mucous  and  bloody  discharges,  high-colored  urine, 
feverishness,  and  the  like.  *  *  *  The  true  philosophy  of  these  appa- 
rent aggravations  of  disease  is  probably  this:  As  the  living  power,  or 
that  which  we  call  nature,  becomes  invigorated,  a  greater  antagonism 
against  disease  is  set  up ;  the  disease  then  makes  a  more  desperate  ef- 
fort to  remain,  and,  in  the  commotion  thus  caused,  there  appears  to  be 
an  increase  of  the  same." 

Doctor  J.  H.  Rausse  remarks  {Water- Cure  in  every  Known  Dis 
ease)  :  "  The  conditions  of  disease  during  the  Water-Cure,  and  partic 
ularly  during  the  critical  periods  are,  throughout,  different  from  every 
thing  which  has  formerly  been  witnessed.  It  cannot  be  otherwise, 
because  this  cure  stirs  up,  little  by  little,  all  latent  and  most  deeply-hid- 
den matters  of  disease,  and  eliminates  them  through  boils,  etc. ;  on  the 
contrary,  all  former  methods  of  cure  suppress  the  commotion  of  the 
struggles  of  disease,  and  force  the  causes  of  disease  inward.     The  es- 


04  THEORY    AND    PRACTICE 

sential  distinction  between  water  and  medicine  is,  that  the  former 
drives  the  peccant  matter  out  of  the  body  ;  the  latter,  however,  drives 
it  into  the  bod}'.  For  this  reason  the  mediciner  seldom  perceives  that 
the  causes  of  diseases  are  material,  the  water-doctor,  however,  makes 
this  sensual  perception  in  every  disease.  Hence  arise  the  various  views 
of  the  corpondity  and  spirituahty  of  disease." 

Essentially  all  the  authors  above  quoted  mean  the  same  things,  how- 
ever fancifully  or  fantastically  their  ideas  may  be  clothed  in  language. 
Remedial  efforts  are  always  going  on  in  the  organism  when  it  is  in  any 
way  morbidl}' affected ;  and  when  those  efforts  are  disproportionately 
manifest  at  one  or  more  points  of  the  body,  or  through  one  or  more  of 
the  depurating  organs,  this  manifestation  is  called  a  crisis.  Critical  ef- 
forts attempt  to  perform  a  threefold  duty  :  eliminate  morbid  matters, 
balance  the  circulation  of  blood,  and  equalize  the  distribution  of  nerv- 
ous energy.  This  latter  duty  is  too  generally  overlooked.  Some  au- 
thors write  as  though  all  the  good  effected  by  a  crisis,  a  boil,  for  exam- 
ple, was  the  riddance  of  a  specific  quantity  of  morbid  material ;  but  this 
is  a  very  narrow  view  of  the  subject :  that  is  indeed  one,  but  the  least 
of  the  remedial  effects  accomplished.  The  amount  of  morbid  matter 
deterged  from  an  extraordinary  boil  in  a  week  would  not  equal  the  or- 
dinary daily  elimination  of  morbid  matter  from  the  skin  or  kidneys. 
The  greatest  effect,  therefore,  is  the  restomtion  of  more  efficient  vital 
action,  the  better  radiation  of  vital  power  from  the  presiding  centers  of 
organic  life. 

All  morbid  actions  are  evidences  of  the  remedial  efforts  of  nature  to 
overcome  morbid  conditions  or  expel  morbid  materials.  All  that  any 
truly  philosophical  system  of  medication  can  do,  or  should  attempt  to 
do,  is  to  place  the  organism  under  the  best  possible  circumstances  for 
the  favorable  operation  of  those  efforts.  We  may  thwart,  embarrass, 
interrupt,  or  suppress  them,  as  is  usually  the  case  with  aUopathic  prac- 
tice, or  we  may  direct,  modify,  intensify,  and  accelerate  them,  as  is 
the  legitimate  province  of  hydropathic  practice.  But  we  must  confeSv'» 
to  the  parodoxical  proposition,  that  the  symptoms  of  disease  are  the  evi 
dences  of  restorative  effort ;  the  effort,  however,  may  be  unequal  to  the 
end  in  view,  and  hence  the  powers  of  nature  are  to  be  assisted  by  re- 
moving obstacles,  diverting  irritation,  etc. 

To  place  this  subject  in  a  stronger,  and  perhaps  clearer  light,  let  us 
imagine  that  before  our  eyes  stands  an  invalid,  laboring  under  a  corapli- 
calion  of  common  infirmities,  having  also  "suffered  many  things  of 
many  physicians,"  and  that  by  some  clairvoyant  or  other  kind  of  vision, 
we  can  see  through  him.  What  do  we  discover  ?  The  whole  mass 
of  blood   is  thick,  dark,  >iscid,  and  loaded  with  bilious  particles;  the 


CRISES.  65 

liver  is  indurated  and  torpid,  and  secretes  but  .ittle  bile,  and  that  little 
remains  so  long  in  the  biliary  passages  that  it  becomes  partially  decom- 
posed, and,  to  some  extent,  putrescent  and  acrid:  and  wliere  it  enters 
the  duodenum,  it  corrodes  its  mucous  surface ;  the  stomach  has  been 
BO  long  plied  with  luxurious  living,  that  its  vessels  are  red,  inflamed,  and 
its  secretion  of  gastric  juice  almost  entirely  suspended ;  the  colon  or 
large  bowel  is  clogged  up  with  hardened  fcecal  matters,  and  the  rectum 
or  lower  bowel  is  full  of  hemorrhoidal  tumors ;  the  mucous  membrane 
of  the  throat  and  mouth  is  covered  with  an  erythematic  eruption,  and 
the  nerves  of  the  tongue  and  palate  are  semi-paralytic ;  the  skin  is 
livid,  rough,  and  eruptive,  its  capillary  vessels  over-distended  with  thick 
blood,  and  its  pores  clogged  up  with  dead,  effete  matters;  from  the  de- 
ficient external  capillary  circulation  the  internal  vessels  are  overloaded 
and  engorged ;  the  heart  labors,  throbs,  and  flutters  ;  the  lungs  are 
so  oppressed  they  cannot  expand  freely,  and  the  system  is  not  sufB- 
ciently  decarbonized ;  the  kidneys  are  distended,  swelled,  and  their 
secretion  imperfect,  high-colored,  and  full  of  sediment;  and  last,  though 
not  least,  the  brain  is  constantly  pressed  upon  by  the  current  of  ve- 
nous blood  which  is  there  dammed  up,  as  it  were,  by  the  general  ob- 
structions, producing  vertigo,  headache,  and  a  thousand  indescribable 
morbid  sensations,  etc.,  etc. 

Such  is  not  an  overdrawn  picture  of  a  large  proportion  of  Water- 
Cure  invalids.  Now,  what  happens  under  treatment  ?  The  first  ef- 
fect of  the  water  processes  is  to  relieve  the  more  prominent,  yet  more 
external,  and  less  important  of  the  symptoms,  as  morbid  heat,  inflam- 
matory action,  pain,  irritability,  symptomatic  fever,  restlessness,  sense 
of  general  oppression,  etc. ;  this  is  usually  accomplished  within  four 
weeks,  and  the  patient  feels  a  newness  of  life  ;  his  spirits  becojue  buoy- 
ant, his  step  more  elastic,  and  he  experiences  a  sort  of  general  bodily 
exhilaration ;  but,  like  the  marred  and  scarred  sapling,  which  has  been 
bent  to  the  ground,  and  rises  up  again  when  tfie  superincumbent 
pressure  is  removed,  he  has  wounds  and  bruises  to  heal.  During  the 
treatment,  changes  have  been  going  on  in  all  the  machinery  of  vitality  ; 
obstructions  have  been  more  or  less  cleared  away ;  torpid  muscles 
aroused  to  action ;  long-smothered  sensibilities  stirred  up  in  half-pal- 
sied nerves;  the  excitability  of  the  contractile  tissues  re-developed; 
universal  commotion  has  pervaded  the  domain  of  organic  life. 

In  this  state  of  general  perturbation,  when  some  parts  and  organs  are 
surcharged  with  blood,  and  others  blood'ess — some  inflamed,  and  oth- 
ers torpid — some  excessively  irritable,  and  others  almost  paralytic — 
some  preternaturally  sensitive,  and  ot-:ers  almost  devoid  of  sensation — 
some  oppressed  witii  heat,  and  others  depressed  by  cold — with  impure 


66  THEORY    AND    PRACTICE. 

secretions  in  many  organs,  and  excrenientitious  matters  choking  up  the 
capillary  vessels  more  or  less  in  the  different  structures,  it  may  well  be 
supposed  that  the  vis  medlcatrix  naturcB  vio\x\di  present  many  phases  of 
irregular  and  disorderly  action  ;  sometimes  concentrating  the  whole 
remedial  effort  in  one  direction  or  to  one  outlet ;  sometimes  dividing  it 
between  several  parts,  and  sometimes  making  it,  with  more  or  less 
force,  successively  in  various  dhections. 

These  efforts  are  attended  with  waste  or  expenditur  of  organic 
force,  and  sometimes  this  expenditure  for  a  time  exceed,  the  replen- 
ishment; hence  "reaction,"  as  it  is  called,  fails,  and  the  patient  feels  a 
temporary  depression,  in  which  condition  he  is  veiy  apt  to  imagine  the 
treatment  "does  not  agree  with  his  constitution."  Now  it  is  that  the 
faith  and  skill  of  the  patient  and  physician  are  put  to  the  severest  test. 
If  the  patient  now  takes  his  feelings  for  his  guide,  and  abandons  all 
treatment,  he  may  commit  a  fatal  error  for  himself,  and  give  the  whole 
water-system  a  bad  name ;  and  if  the  physician  perseveres  in  the  use 
of  very  sti'ong  impressions  oi-  very  cold  treatment,  this  temporary  de- 
pression may  become  permanent,  or,  at  least,  unnecessarily  painful  and 
protracted.  All  the  patient  requires  is  rest,  soothing  appliances,  and  en- 
couragement. If  he  feels  very  weak,  let  him  follow  his  feelings  in  the 
matter  of  exercise  ;  walk,  sit,  or  keep  his  bed  precisely  as  he  can  best  en- 
joy or  endure  himself.  If  he  is  feverish,  chilly,  or  in  pain,  administer  lo- 
cal fomentations,  or  the  warm  or  hot  bath.  In  brief,  he  needs  an  expec- 
tant, nursing  management  until  the  organic  powers  have  thoroughly 
rested  themselves,  and  in  three,  six,  or  ten  days,  more  or  less,  full 
treatment  may  be  resumed  to  advantage. 

But  where  disease  and  disorganization  have  pervaded  a  large  extent 
of  the  domain  of  life,  these  efforts,  and  these  sinkings,  these  general  or 
partial  crises,  these  "  ups  and  downs"  may  be  many  before  health  is 
re-established  ;  and  the  physician  who  undertakes  specifically  to  i^ro- 
voke  a  crisis,  with  the  view  of  curing,  as  it  were,  at  a  single  dash,  com- 
mits a  gi'ave  mistake.  Crises,  or  any  number  of  critical  efforts  or  dis- 
turbances, are  always  to  be  desired,  but  never  to  be  sought  by  vio- 
lence. 

It  often  happens  that  patients  whose  bodies  are  extensively  diseased, 
yet  not  verj'  much  exhausted  in  muscular  power,  experience  very  gi'Ctit 
benefit  at  a  Water-Cure  during  the  first  month,  after  which  they  suf- 
fer a  slight  aggravation  of  many  of  their  difficulties,  and  thus  remain 
several  months  npparently  in  statu  quo,  not  realizing  within  themselves, 
or  manifesting  externally,  any  decisive  indications  of  restoration,  and 
yet  in  a  few  months  longer  find  themselves  in  good  health.  Such  cases, 
if  which  I  have  seen  many,  prove  to  us  that  tie  process  of  repara- 


THE   PULSE.  67 


tion,  in  the  domain  of  the  organic  economy,  like  that  of  growth  and  de- 
velopment, is  slow,  silent,  gradual,  and  almost  imperceptible,  and  that, 
although  we  may  rid  the  system  of  obstructions,  morbid  deposits,  and 
active  disease  by  the  diligent  employment  of  the  Water-Cure  pro- 
cesses, the  re-establishment  of  firm  and  vigorous  health  requires  weeks 
months,  or  years,  and  is  influenced  favorably  or  adversely  by  every  cir- 
cumstance and  habit  of  life. 


CHAPTER   IV. 

OF  THE  PULSE. 

Mature  of  the  Pulse. — All  persons  who  undertake  the  general 
direction  of  hydropathic  appliances,  ought  to  be  familiar  with  the  char- 
acter and  indications  of  the  arterial  pulsation.  There  is  no  surer  test 
of  the  degree  of  existing  vitality,  or  of  the  balance  of  circulation,  and 
no  better  guide  for  the  administration  of  water-treatment;  while  its  va- 
riations denote,  with  considerable  accuracy,  many  pathological  condi 
tions  of  the  different  organs  and  systems  of  the  vi-tal  domain.  For 
these  reasons,  this  chapter  may  properly  form  a  connecting  link  be- 
tween the  theoretical  and  practical  departments  of  this  work. 

The  beating  of  the  arteries,  caused  by  the  afflux  of  blood  propelleci 
through  them  by  the  contractions  of  the  heart,  is  called  the  pulse.  Its 
characters  relate  to  the  force,  frequency,  strength,  and  equality  of  the 
pulsations  themselves,  and  of  their  intervals.  The  most  convenient 
method  of  ascertaining  the  state  of  the  pulse  is  by  compressing  the  ra- 
dial artery  at  the  wrist,  with  the  balls  of  the  first  and  second  fingers  ] 
the  main  force  is  to  be  applied  by  the  finger  which  presses  on  the  ar- 
ter3^  above,  or  toward  the  heart.  Its  streyigth  is  determined  by  the  de- 
gree of  compression  it  will  bear  before  it  will  cease  to  be  felt  by  the 
^ngGY  farthest  from  the  heart. 

Varieties  of  Pulse. — Medical  authors  enumerate  many  kinds  of 
pulse,  which  are  both  fanciful  and  ridiculous.  All  the  distinctions  which 
are  of  practical  utility  are  the  following  : 

The  pulse  is  called  regular  when  its  beats  are  uniform  in  force,  fre- 
quency, fullness,  etc  and  irregular  when  it  lacks  uniformity  in  thesa 
respects. 


68  THEORY    AND    PRACTICE. 


A  normally  strong  pulse  resists  moderate,  yet  yields  readily  to  sa 
vera  pressure. 

X  pretcrnaturalhj  strong  pulse  is  almost  incompressible.  A  strong 
pulse  is  never  very  frequent,  mrely  exceeding  80,  and  never,  i>er- 
baps,  90. 

A  hard  pulso  offers  nearly  as  great  resistance  at  first  as  a  sti'ong 
pulse,  but  yields  more  easily  and  con:pletely  to  strong  pressure. 

A  soft  pulse  feels  full  and  round  to  the  finger,  but  yields  steadily  and 
readilj'  to  pressure. 

A  full  pulse  gives  to  the  finger  the  sensation  of  repletion  or  fullness. 

A  contracted  pulse  is  neai'ly  the  opposite  of  the  full  pulse,  the  pulsa- 
tions being  narrow,  deep,  and  somewhat  hard. 

A  frequent  pulse  has  an  unusual  number  of  strokes  in  a  given  time. 
The  natural  frequency  of  the  pulse  at  the  vai'ious  stages  of  life  is  sub- 
ject to  considerable  diversity.  The  average  may  be  stated  as  follows  : 
In  the  embryo,  150  ;  at  birth,  130;  one  month,  120;  one  year,  112  ; 
two  yeai-s,  105;  three  years,  100;  seven  years,  90 ;  twelve  years,  85 ; 
puberty,  60  ;  adult  age,  70;  old  age,  65. 

A  slow  pulse  makes  less  than  the  usual  number  of  strokes  in  a  given 
time. 

A  quick  pulse  is  one  which  strikes  sharply  and  suddenly,  as  it  were, 
against  the  finger  without  reference  to  the  number  of  pulsations  :  hence 
it  may  be  quick  and  frequent,  or  quick  and  slow.  A  quick  pulse  is 
never  very  frequent,  seldom  over  90. 

The  pulse  is  said  to  be  tense  when  the  arteiy  resembles  a  cord  fixed 
at  each  extremity ;  when  it  feels  still  harder  and  smaller,  it  is  called 
winj. 

A  deep  pulse  is  that  which  cannot  be  felt  without  difficulty  nor  with- 
out strong  pressure. 

A  tremulous  pulse  is  one  wherein  each  pulsation  oscillates. 

A  weak  or  feeble  pulse  beats  lightly  against  the  finger,  ceasing  en- 
tirely on  very  slight  compression. 

A  small  pulse  unites  the  character  of  the  weak  or  feeble  with  the 
contracted  pulse. 

A  sharp  pulse  is  a  combination  of  the  quick  and  frequent ;  the  arteiy 
Bti'ikes  the  finger  both  abruptly  and  mpidly. 

The  pulse  is  called  critical  when  it  becomes  free,  open,  soft,  etc., 
after  having  been  irregular  or  abnormal  in  these  respects. 

The  dicrotic  or  double  pulse  is  that  in  which  the  finger  is  struck 
twice  at  each  contraction  of  the  heart :  once  lightly  and  once  more 
forcibly. 

An  intermittent  pulse  is  that  in  which  a  beat  is  occasionally  missed 


THE   PULSE.  69 


as  it  were  ;  the  intermissions  are  usually  quite  irregular,  as  one  in  five, 
six,  ten,  or  twenty. 

There  are  many  technical  distinctions  of  pulse,  which  are  either 
unimportant,  or  merely  subdivisions  of  those  already  named,  as,  ardent^ 
when  the  artery  seems  to  raise  itself  to  a  point  in  order  to  strike  the 
finger ;  goat-leap,  an  imperfect  dilatation  of  the  artery,  being  suc- 
ceeded by  a  fuller  and  stronger  one — the  artery  seems  to  leap,  as  it 
were;  convulsive,  unequally  frequent,  or  unequally  hard ;  deficient,  a 
feeble  beat,  which  seems  every  instant  about  to  cease ;  depressed,  a 
pulse  both  weak  and  contracted,  or  deep; /iZz/brm,  resembling  a  thread, 
slightly  vibrating;  fiichering,  i.  e-,  deficient;  hectic,  the  weak,  feeble 
pulse  observed  in  hectic  fever ;  intercussent,  one  in  which  a  superflu- 
ous pulsation  seems  to  occur  occasionally  ;  intricate,  unequally  slow 
and  imperfectlj^  developed  ;  jarring,  jerking  and  sharp  ;  languid,  slow 
and  feeble ;  large,  an  open  and  full  beat ;  long,  one  which  strikes  the 
finger  to  a  great  extent  in  length ;  low,  the  pulsations  scarcely  per- 
ceptible ;  resisting,  slightly  tense  or  hai'd  ;  undulating,  the  pulsations 
resembling  the  motion  of  waves  ;  unequal,  the  pulsations  being  unlike, 
.or  returning  at  unequal  intervals  ;  vermicular,  resembling  the  motions 
of  a  worm ;  vibrating,  jarring,  like  the  motions  of  a  musical  string ; 
oppressed,  small,  contracted,  and  slow  ;  laboring,  the  blood  seeming  to 
be  but  partially  emptied  at  each  pulsation,  etc. 

Indications  of  the  Pulse. — The  preter naturally  strong  piulse 
is  characteristic  of  high  fevers  and  active  inflammations.  It  is  the 
kind  of  pulse  which  is  said  to  hear  bleeding  well ;  bleeding  does  not 
immediately  nor  sensibly  prostrate  the  patient ;  but  often  relieves  pain 
and  lessens  sensibility.  When  this  pulse  exists,  no  matter  by  what 
name  the  disease  is  called,  the  cold  ablution  or  wet  sheet  may  be  freely 
employed  and  safely  continued  until  the  pulse  is  reduced  to  the  natural 
standard. 

The  hard  pulse  indicates  a  less  degree  of  inflammatory  action,  or  a 
great  degree  of  irritation,  without  gi'eat  debility.  It  is  found  in  many 
forms  of  acute  and  sub-acute  inflammation,  as  gout,  rheumatism,  pneu- 
monia ;  in  that  form  of  continued  fever  called  synochus ;  in  many 
cases  of  what  is  called  bilious  remittent  fever,  in  the  early  stages  of 
intermittent  fever,  during  the  hot  stage  of  the  paroxysm,  and  gener- 
ally in  the  early  stages  of  the  exanthems — measles,  small-pox,  scarla- 
tina, erysipelas,  etc.  Bleeding  renders  it  softer  for  a  few  hours,  but, 
unless  the  cause  is  removed  by  some  other  means,  the  hardness  soon 
returns.  Cold  applications  may  be  employed  ui  der  the  same  restric- 
tions as  for  the  strong  pulse. 


TO  THEORY    AND    PRACTICE 

The  soft  pulse  is  always  found  in  the  normal  state  of  the  circulation. 
and  sometimes  attends  diseases  which  are  not  marked  by  active  inflam 
mation,  nor  much  debility.     Bleeding  always  sinks  this  to  a  weak,  con- 
tracted pulse.     In  water-treatment  mild  applications  are  most  bene- 
ficial. 

The  full  pulse  indicates  a  good  degi'ee  of  superficial  capillary  circu 
lation.     Bleeding  always  permanently  depresses  this   kind  of  pulse  , 
but  cold  applications  are  generally  veiy  well  borne.     It  is  generall}i 
found   in    apoplexy,  the  hot   stage  of  fevers,  the  mcipient  stage  ol 
pulmonary  consumption,  etc. 

The  contracted  pulse  indicates  capillary  obstruction  and  intense  en- 
gorgement. Epidemic  cholera  affords  an  exti'eme  example  of  this 
kind  of  pulse.  It  often  "  rises"  on  bleeding,  to  sink  more  deeply  soon 
after. 

The  frequent  pulse  indicates  irritation  or  inflammation,  and  when 
very  frequent  gi'eat  debility.  Irritable  temperaments  manifest  a  more 
frequent  pulse  than  the  phlegmatic  ;  and  females  have  a  more  rapid 
pulsation  than  males.  A  frequent  pulse  may  be  strong  up  to  about  90 
per  minute  ;  but  beyond  that  point  debility  is  generally  proportioned  to 
the  frequency.  In  complicated  affections  of  the  thoracic  and  abdom- 
inal viscera,  the  frequency  of  the  pulse  is  an  important  indication  of 
the  locality  of  the  principal  morbid  condition.  Thus,  in  dyspeptic  con- 
Bumptian — an  affection  which  commences  with  a  diseased  liver  and 
stomach,  and  ends  with  tubercles  or  ulcers  in  the  lungs — the  pulse 
will  be  modemtely  slow  while  the  abdomen  is  the  principal  seat  of 
disease :  it  will  gi-adually  increase  in  frequency,  as  the  disease  extends 
itself  to  and  occupies  the  lungs;  and  be  very  frequent  when  the  vis 
cera  of  the  chest  have  become  the  point  most  dangerously  affected 
Nothing  is  more  common  than  for  experienced  physicians  to  make  the 
most  egi'egious  mistiikes  in  diagnosticating  between  diseases  of  the 
liver  and  lungs,  or  between  dyspepsia  and  consumption ;  but  the  fre- 
quency of  the  pulse,  aided  by  other  symptoms,  ought  always  to  insure 
a  correct  diagnosis.  The  importance  of  this  symptom  is  enhanced  by 
the  fact,  that  in  most  chronic  diseases  of  the  abdominal  organs,  the 
pulse  is  preternaturally  slow :  while  in  all  idiopathic  affections  of  the 
chest  it  is  more  or  less  preternaturally  frequent.  In  those  dyspeptic 
affections  or  disorders  of  the  liver,  attended  with  a  dfy,  husky  cough, 
a  tenacious  secretion  of  the  throat,  or  a  glutinous  mucous  expectora- 
tion from  the  lungs,  there  is  always  danger  of  confirmed  consump- 
tion when  the  pulse  begins  to  beat  with  considerable  frequency,  say 
from  80  to  100. 

The  slow  pulse  indicates  torpor,  inaction,  especially  in  the  functiong 


THE   PULSE.  71 


auxiliary  to  digestion.  Compression  of  the  brain,  from  contusion,  or  ef- 
fusion, or  engorgement,  not  unfrequently  produces  a  very  slow  pulse. 
Dyspeptics  and  hypochondriacs  often  manifest  an  extremely  slow  pulse. 
In  all  of  the  above  cases  the  pulse  frequently  sinks  to  50,  and  oc- 
aionally  to  40.  A  change  in  dietetic  habits„if  it  bo  from  highly-season 
*^d,  stimulating,  or  animal  foods,  to  plain,  simple,  vegetable  dishes,  is 
always  accompanied  with  a  reduction  in  the  frequency  of  tVie  pulse. 
The  long  and  slender  arteries  of  tall  and  slim  individuals  beat  less 
frequently  than  the  shorter,  thicker  vessels  of  an  opposite  organization. 

The  quick  pulse  is  similar  in  its  indications  to  the  hard  pulse  ;  but 
usually  denotes  a  greater  degr&e  of  irritation  or  inflammation. 

The  tense  pulse  denotes  excessive  irritation  with  considerable  de- 
bility. It  is  usually  found  in  constitutions  which  possess  great  activity 
with  little  strength. 

The  deep  pulse  is  merely  owing  to  the  situation  of  the  artery, 
which  runs  deeper  beneath  the  integument  than  usual. 

The  tremulous  pulse  indicates  extreme  nervous  debility  with  violent 
irritation,  or  excessive  internal  congestion.  Tea,  snuff,  alcoholic  bev- 
erages, and  cigars  are  among  its  common  causes. 

The  iveak  ov  feeble  pulse  indicates  debility  merely. 

The  small  pulse  denotes  debility  with  more  or  less  local  irritation. 

The  sharp  pulse  indicates  more  or  less  debility  with  gi*eat  irritation. 

The  critical  pulse  denotes  the  subsidence  of  irritation ;  a  more 
perfect  equilibrium  in  the  circulation,  and  a  general  improvement  in  the 
patient's  condition. 

The  double  pulse  usually  attends  organic  affections  of  the  heart  or 
large  arteries ;  yet  it  is  sometimes  found  in  very  nervous  dyspeptics, 
especially  those  who  have  indulged  freely  in  nervines  and  narcotics,  aa 
coffee  and  tobacco. 

The  intermittent  jmlse  is  exti'emely  common  with  dyspeptics,  nerv- 
ous invalids,  sedentary  persons,  and  those  who  are  subj^^ct  to  constipa- 
tion, and  also  with  old  pereons.  It  not  unfrequently  occasions  great 
alarm,  being  erroneously  supposed  to  indicate  aneurism,  heart  disease, 
or  some  other  formidable  and  fatal  malady.  It  indicates  thick,  viscid 
blood,  capillary  obstruction,  or  nervous  exhaustion.  Overloading  a 
weak  stomach,  almost  always  produces  an  intermittent  pulse  for  a  time, 
as  do  night  suppers,  and  going  to  bed  soon  after  eating. 

The  sub-varieties  of  pulse  indicate  complications  of  the  conditions 
which  give  rise  to  the  more  distinct  varieties,  and  are  attributable  to 
constitutional  peculiai'ities,  personal  habits,  local  irritations,  and  many 
other  circumstances  relative  to  the  individual,  the  disease,  and  the  treat- 
ment- 


72 


PART    V   . 


PATHOLOGY   AND    THERAPEUTICS. 


CHAPTER  I. 

OF  FEVERS. 

Olassification  of  Fevers. — The  nosological  arrangements  of  fe- 
vers, as  found  in  medical  books,  are  all,  in  my  judgment,  unphilosoph- 
ical  and  absurd.  Without  wasting  any  of  my  limited  space  in  exposing 
their  errors,  I  will  at  once  propose  a  classification  which  shall,  at  least, 
make  a  nearer  approximation  to  pathological  propriety. 

Nosological  Arrangement  of  the  Simple  Fevers. 


0. 

D 

11 


Marsh  Fever. 


1.  Ephemeral. — One  day  Fever, 

2.  Inflammatory. — Synochus — General  Inflammation, 

C  Yellow  Fever,       (  Ship  Fever, 

3.  Typlwid.  <  Nervous  Fever,       Spotted  Fever, 

(  Putrid  Fever.        {  Camp  Fever, 
I  Jail  Fever, 
(^  Hospital  Fever. 

4.  Remittent.       \  ^^^^  Remittent, 

I  rutrid  Kemittent. 

i  Quotidian — Everyday  Ague, 
6.  Intermittent.    <  Tertian — Third  day  Ague, 
(  Quartan — Fourth  day  Ague. 
'  Hectic  Fever, 

Symptomatic.     P^^'-peral  Fever, 
"^    ^  Mesenteric  Fever, 

^  Milk  Fever. 
'  Small-pox, 

Chicken-pox, 

Cow-pox, 

Measles, 

Scarlatina, 

Erysipelas. 

Miliaria. 
^  Plague 


6. 


Eruptive. 


FEVERS.  7S 

From  this  arrangement  I  have  excluded  the  "  bilious  fever"  and  the 
*'  syuochus,"  or  "  mixed  fever"  of  authors.  A  mild  form  of  the  putrid 
typhus,  when  accompanied  with  bile  in  the  stomach,  and  a  yellowish 
conjunctiva,  is  often  called  bilious  fever ;  so,  also,  is  either  form  of  re- 
mittent. The  "synochus"  is  said  by  some  authors  to  be  bilious  in  the 
beginning,  and  typhus  in  the  end.  This  is  simply  absurd.  Other  au- 
thors denominate  it  inflammatory  at  the  outset,  tending  to  a  typhoid 
termination.  This  is  mistaking  an  aggravation  of  symptoms  for  a 
change  of  type.  Bystanders  are  often  astounded  at  the  bedside  of  the 
patient  by  hearing  the  physician  announce  that  the  fever  has  changed 
type,  from  bilious  or  inflammatory,  to  typhus  or  typhoid.  All  this  1 
regard  as  sheer  nonsense.  All  that  it  can  mean  in  plain  English  is, 
the  patient  is  worse,  or  has  approached  the  critical  period  or  turn  of 
the  fever. 

The  "congestive  fever,"  as  it  is  generally  called  in  our  Southern  and 
Western  states,  is  merely  a  severe  form  of  intermittent  or  remittent, 
attended  with  the  symptoms  of  a  disproportionate  engorgement  of  the 
brain  or  lungs.  Sometimes  a  malignant  form  of  typhus  is  called  con- 
gestive fever,  and  occiisionally  almost  all  forms  of  fever,  accompanied 
with  severe  congestion  of  some  important  viscus,  are  designated  by 
this  unmeaning  term.  European  authors  have  entitled  similar  cases 
"pernicious  fevers,"  by  way  of  distinction  :  a  more  uncouth  and  sense- 
less appellation  than  congestive. 

Doctor  William  Jenner,  professor  of  pathology  in  University  College 
{BraWnvaiWs  Retrospect,  Part  XXIII.),  has  lately  classified  continued 
fevers  into  tifphoid,  typhus,  relapsing  and  fab  ricula.  This  "relapsing 
fever,"  we  are  told,  is  known  by  a  reproduction  of  most  of  the  febrile 
symptoms  in  about  a  week  after  the  patient  has  become  convalescent. 
He  is  then,  without  any  apparent  exciting  cause,  without  any  error  or 
indiscretion  on  his  part  ^'eattacked  with  violent  fever,  which  lasts  sev- 
eral days,  and  then  termmates  in  profuse  perspiration.  A  more  ap- 
propriate name  for  this  febrile  disturbance  is  drug-fever.  It  is  per- 
fectly clear  to  my  mind  that,  after  the  patient's  body  has  been  satu- 
rated, as  it  were,  with  drugs,  as  in  the  ordinary  treatment  of  a  fe- 
ver, the  vital  powers  will  endeavor  to  get  rid  of  the  dnig-medicines  aa 
soon  as  they  have  recovered  sufficient  energy  to  make  the  effort ;  and 
this  eflbrt  is  what  Dr.  Jenner  distinguishes  as  a  distinct  species  of  fe- 
ver, which  he  calls  "  relapsing,"  and  treats  with  another  couree  of 
drugging. 

This  explanation  is  confirmed,  if  not  demonstrated,  by  the  fact  that 
the  patients  whose  fevers  are  treated  hydropathically,  never  have  a  re- 
lapsing repetition  of  the  fever,  nor  any  thing  like  it. 
11—7 


7i  PATHOLOGY   AND    THERAPEUTICS. 

General  Character  of  Fever. — A  fever  is  a  simultaneous  ab- 
normal disturbance  of  most  or  all  of  the  bodily  functions,  such  disturb- 
ance being  manifested  in  periodical  paroxysms,  more  or  less  severe  and 
prominent,  of  cold,  hot,  and  sweating  stages. 

It  commences  with  languor,  lassitude,  and  general  disquiet,  followed 
by  shivering,  rigors,  or  chills,  then  succeeded  by  hot  flashes  over  the 
surface,  with  aching  sensations  in  various  parts  of  the  body,  particular- 
ly about  the  small  of  the  back.  Finally  a  preternatural  heat,  redness, 
and  turgescence  pervades  the  whole  body,  accompanied  with  head- 
ache, furred  tongue,  frequent  pulse,  deficient  secretions,  and  prostra- 
tion of  strength.  Sooner  or  later  the  superficial  heat  and  redness  par- 
tially or  totally  subside,  and  the  paroxysm  is  terminated  with  more  or 
less  general  or  local  sweating.  Either  stage  of  the  paroxysm  may  be 
disproportionately  severe,  and  eithei  "^ay  be  so  slight  as  to  escape 
notice. 

Causes  of  Fever. — It  would  be  a  profitless  waste  of  words  to  enu- 
merate specifically  all  the  circumstances  which  ai'e  supposed  to  be 
among  the  predisposing  and  exciting  causes  of  fever.  In  a  general 
sense  they  may  be  summed  up  very  briefly  :  local  contagions  or  poi- 
sons, unheakhful  food,  impure  water,  vitiated  air,  personal  uncleanli- 
ness,  over-exertion,  atmospheric  vicissitudes,  gluttony,  intemperance, 
etc. 

Medical  books  are  lull  of  amusing  specimens  ot  thoughtless  state- 
ments on  this  prolific  subject.  Thus  Hooper,  in  his  "  Physician's 
Vade-Mecum,  with  Improvements  by  Guy  and  Stewart,"  gives  us  the 
oredisposing  causes  of  inflammatory  fever  in  the  following  v>'ords : 
'  Plethoric  habit  of  body,  with  a  strong  muscular  system  ;  a  good  and 
unimjjuircd  constitution  !^^  If  muscular  strength  and  a  good  constitu- 
tion predispose  us  to  disease,  it  is  certainly  very  dangerous  to  have 
good  health !  The  same  author  gives  us,  as  among  the  predisposing 
causes  of  yellow  fever,  "the  male  sex,"  and  among  those  of  miliary  fe- 
ver, "the  female  sex  I"  It  is  of  such  stuff"  that  many  medical  books 
are  made.  I  only  mai'vel  that  some  transcendent  genius  has  not  re- 
corded human  nature  as  a  predisposing  cause  of  disease  ! 

Theory  of  Fever. — Since  medicine  became  a  system — it  never 
was  a  science — theories  of  fever  have,  nore  than  any  other  subject, 
displayed  the  genius  of  ihe  great  masters  of  the  profession.  The  very 
names  of  all  the  different  ones  that  have  been  written,  would  fill  a  vol- 
ume ;  yet,  at  this  day,  we  have  in  our  medical  schools  no  generally- 
recognized  theory       All  is  now  as  vague,  indefinite,  and  unsatisfactor} 


FEVERS.  75 

as  in  "the  dark  ages;"  and  the  existing  opinions  of  living  authors  re- 
garding the  nature  of  fever,  are  specularions  of  the  most  chimerical 
character. 

Still,  the  whole  subject  seems  simple  enough.  The  reason  wliy  an 
explanation  has  never  been  found  is,  I  apprehend,  because  it  has  never 
been  sought  in  the  right  direction.  A  man  who  shou^j  look  to  the 
moon  all  his  lifetime  in  search  of  the  "philosopher's  stone,"  might  not 
discover  it  though  lying  at  his  feet.  Medical  philosophers,  instead  of 
rationally  tracing  the  effects  of  riotous  living  and  abused  hygienic  agen- 
cies, have  expended  oceans  of  midnight  oil  and  centuries  of  brain  la- 
bor in  trying  to  Lliink  out  some  specific,  strange,  hidden,  occult,  myste- 
rious, extra-natural  thing,  substance,  elemeni,  or  cause,  whose  exist- 
ence should,  in  some  magical  manner,  account  for  all  the  phenomena 
of  fever.  Of  course,  all  their  toil  has  been  in  vain.  It  has  been  rathei 
worse  than  labor  lost,  for  the  writings  and  teachings  of  medical  books 
and  medical  schools  are  so  tinctured  and  mystified  with  the  vagaries  of 
medical  professors,  that  the  student  of  n^^dicine  is  morally  certain  to 
get  his  mind  more  or  less  befogged,  and  his  judgment  to  some  extent 
warped  by  their  influence. 

Type  of  Fever. — A  man  of  strong,  vigorous  constitution,  accustomed 
to  an  active  out-door  life,  yet  regardless  of  healthful  habits,  eating  and 
drinking  what  comes  in  his  way,  as  is  the  fashion  of  the  world,  is  ex- 
posed to  unusual  cold,  wet,  heat,  labor,  or  some  similar  vicissitude.  In 
a  day  or  two  he  has  a  fever.  Its  type  will  be  injiammatory^  because 
his  vital  energies  are  strong  and  his  viscera  powerful,  and  in  him  na- 
ture— the  organic  instinct  of  self-preservation — is  successful  in  throw- 
ing the  morbid  action  to  the  surface.  If  the  disturbing  causes  are 
slight,  it  will  be  ephemeral  in  duration;  if  more  severe,  typhoid. 

Another  man,  of  feeble  constitution  and  sedentary  life,  is  similarly 
exposed  and  similarly  attacked.  His  fever  will  be  typlins.  There  is 
less  ability  to  react  successfully,  and  the  ujuernal  commotion  is  pro- 
portionally greater.  The  surface  is  less  turgid,  but  the  viscera  sutler 
more  internally.  The  brain  manifests  delirium,  the  lungs  engorge 
ment,  the  liver  congestion,  the  stomach  and  bowels  torpor  or  relaxa 
tion,  and  some  physicians  will  call  it  congestive  fever. 

If  either  of  the  above  patients  has  been  gross  in  his  eating  habits ; 
if  pork,  ham,  sausages,  cheese,  and  fine,  constipating,  farinaceous  food 
have  constituted  a  large  proportion  of  his  diet,  he  will  have  a  yellow 
tongue,  bitter  taste  in  the  moulph,  bile  in  the  stomach,  etc.  Then  hia 
fever  may  be  called  hilious. 

The  man  of  impaired  constitution  ani.'  wea*-:  digestive  powers,  who 


76  PATHOLOGY    AND    THERAPEUTICS. 

is  attacked  with  typhoid  fever,  will  have  the  nervous  form,  if  his  brain 
and  nervous  system  have  been  particularly  abused,  overworked,  or 
stimulated  by  tea,  coffee,  liquor,  or  tobacco,  and  the  putrid  form  if  his 
personal  and  dietetic  habits  are  gross,  and  particularly  constipating  and 
obstnicting. 

The  yellow  variety  is  produced  by  causes  which  especially  operate 
to  impair  the  secretion  of  the  liver,  as  excessive  heat,  animal  or  vege- 
table miasms,  combined  with  gross  diet  and  stimulating  drinks.  Every 
kind  of  animal  food,  except,  perhaps,  milk,  in  very  warm  climates,  I 
regard  as  a  predisposing  cause  of  yellow  fever. 

The  other  forms  of  typhus,  called  ship^  spotted^  jail,  camp,  and  Jios- 
pilal  fevers,  are  nothing  more  nor  less  than  the  common  or  typhoid 
fever,  modified  by  local  causes  and  particular  personal  habits. 

Remittent  fever  may  be  of  the  neiTOus  or  putrid  tendency,  for  the 
reasons  already  assigned.  Its  remittent  character  is  owing  undoubt- 
edly to  a  disproportionate  affection  of  the  liver  and  spleen,  a  condition 
of  obstruction  and  engorgement  produced  by  noxious  effluvia,  or  any 
impurities  from  decaying  vegetable  and  animal  matter,  to  which  the 
system  has  been  for  a  long  time  exposed. 

Intermittent  fever  is  the  result  of  the  same  causes  operating  more 
gradually,  that  is,  in  less  force,  and  for  a  longer  time.  The  periodicity 
of  the  paroxysms  must  be  referred  in  part  to  organic  laws  and  in  part 
to  constitutional  peculiarites.  This  view  of  remittent  and  intermittent 
fevers  is  confirmed  by  the  fact  that  enlargements  and  indications  of  the 
large  glandular  structures,  the  liver,  spleen,  and  pancreas,  are  most 
frequent  in  those  who  have  been  the  subjects  of  protracted  agues. 

Symptomatic  fevers  are  merely  states  of  constitutional  irritation 
from  local  causes,  generally  chronic  topical  inflammation.  Thus  hectic 
fever  is  a  general  febrile  distm-bance  from  tubercles  or  ulceration  of 
the  lungs.  Puerperal  fever  is  a  consequence  of  inflammation  ot  some 
one  or  more  of  the  abdominal  or  pelvic  viscera  or  appendages,  gen- 
erally peritoneal  inflammation  afi;er  childbirth.  Mesenteric  fever 
arises  from  worms,  indigestible  food,  etc.  Milk  fever  is  occasioned 
by  an  inflammatory  state  of  the  female  breast. 

Eruptivt  fevers  are  characterized  by  an  accompanying  rash,  effior- 
esence,  eruption,  or  pustular  aflfection  of  the  skin.  They  are  gener- 
ally contagious,  and  depend  on  a  specific  virus,  which  works  through 
the  blood  like  a  ferment.  The  precise  modus  operandi  by  which  this 
infectious  element  is  first  produced  cannot  be  precisely  explained;  yet 
the  principle  or  law  of  its  generation  and  operation  is  sufficiently  ob- 
vious. Vegetable  ferment,  called  yeast,  it  is  known  is  produced  from 
decomposition  of  vegetable  matter.     This  is  in  reality  a  rotting  process. 


FEVERS.  77 

by  which  certain  proximate  principles  are  decomposed  and  so  rear- 
ranged as  to  constitute  an  entirely  new  product.  The  new  product, 
of  course,  holds  an  unphysiological  scale  of  chemical  affinities  in  rela- 
tion to  the  constituents  of  tht  healthy  fluids,  and  hence  when  brought 
into  contact  with  those  fluids,  another  set  of  chemical  actions,  decom- 
positions, and  recombinations  takes  place,  by  which  some  element  is 
changed,  modified,  or  destroyed. 

We  know,  too,  that  when  animal  secretions  or  excretions  are  in  a 
certain  decomposing  state,  which  is  exactly  analogous  to  vegetable  fer- 
mentation, they  will,  by  being  brought  into  contact  with  the  blood  of  a 
healthy  person,  produce  more  or  less  of  a  similar  change  or  decom- 
position in  its  elements.  Poisoning  from  dissection  is  a  familiar  illus- 
tration. Personal  filthiness,  combined  with  foul  and  unclean  food, 
will  develop  an  infectious  matter  and  disease  the  sti'uctures,  and  by 
contact,  communicate  a  similar  morbid  action  to  another  in  compara- 
tive health,  as  the  horrible  story  of  prostitution  in  cities  can  tell.  We 
can  then  easily  understand  the  law  which  develops  infection  of  all 
kinds,  if  we  cannot  detect  its  chemical  nature  ;  and  for  all  practical 
purposes,  a  knowledge  of  the  law  is  sufficient. 

All  large  collections  of  rotting  or  decaying  vegetable  and  animjd  sub- 
stances engender  the  poisonous  ferment  of  contagious  and  other 
fevers  ;  and  if  we  look  over  the  whole  surface  of  the  globe,  we  can 
easily  find  sources  enough  to  account  for  all  the  infection,  whose  re- 
sults are  manifested  in  putrid,  malignant,  and  contagious  fevers,  dys- 
entery, cholera,  etc.  Theusands  of  human  bodies,  and  the  carcasses 
of  beasts,  lie  rotting  on  the  battle-fields  of  this  blood-stained  earth,  from 
which  currents  of  deadly  virus  are  borne  by  the  winds  to  infect  the 
breath  and  blood  of  people  at  a  distance  of  hundreds  and  thousands  of 
miles  ;  the  graveyards  and  cesspools  of  all  large  cities  are  constantly 
sending  forth  streams  of  death  in  all  directions ;  and  hardly  a  country 
place  can  be  found  where  there  are  not  local  sources  of  this  deadly 
ferment  in  the  shape  of  hog-pens,  distilleries,  slaughter-houses,  etc. 
And  when  the  infectious  ferment  is  once  produced,  it  has  the  power 
of  propagating  itself  whenever  it  can  find  congenial  elements  in  the 
fluids  of  our  bodies,  our  only  defense  being  vigorous  functions  and 
pure  bbod — good  health. 

Rationale  of  Fever. — The  living  organism  is  endowed  with  the 
inherent  power  of  self-preservation.  Each  organ  or  part,  to  a  certain 
extent,  resists  all  morbific  influences,  and  expels  all  morbific  materials 
from  the  body  through  the  various  excretories.  If  the  causes  of  dis- 
ease— all  of  which  may  be  suaiJied  up  under  the  heads  of  impure  or 


78  PATHOLOGY    AN!/    THERAPEUTICS. 

obstructing  materials,  and  exhausted  nervous  power — diminish  the  dep- 
urating power  of  the  skin,  the  liver,  bowels,  kidne^-s,  and  lungs,  in- 
crease their  labors  to  keep  the  body  pure.  If  the  liver  becomes  clog- 
ged up,  the  lungs,  skin,  bowels,  and  kidneys  undertake  the  office  of 
the  impaired  organ.  If  the  kidneys  are  impaired  functionalh%  the 
skin,  lungs,  etc.,  have  an  augmented  duty.  But  the  causes  of  disease 
often  operate  and  increase  sc  gradually  that  all  the  excretory  functions 
are  impaired.  Hence  the  effort  to  relieve  the  system  must  be  gen- 
eral— universal  commotion  takes  place.  Some  organs  were  originally 
stronger  than  others ;  some  have  been  more  injured  than  others  by 
bad  habits  or  previous  diseases ;  hence  the  stniggle  will  not  be  equally 
balanced.  Though  all  the  vital  energies  co-operate  in  the  "  effoit  of 
nature,"  they  will  act  with  in-egular  and  unequal  energy.  The  whole 
vital  machinery  is  thrown  into  disorder.  There  is  a  fever.  The  kind 
of  fever  depends  on  the  circumstances  already  adverted  to. 

But  alternate  action  and  repose  is  a  general,  universal  law  of  the 
animal  economy.  After  the  organism  has  prepared  itself  for  the  rem- 
edifd  and  expulsive  effort  (the  cold  stage),  the  vital  instincts  (vis  medi- 
calrix  natum)  direct  their  whole  energies  to  the  surface  (the  reactive 
or  hot  stage),  as  the  best  channel  of  purification.  At  length  fatigue 
ensues,  and  repose  must  and  will  be  had.  The  heat  abates,  the  heart's 
action  becomes  milder,  the  turgescence  subsides,  and  the  collapse,  or 
sweating  stage,  concludes  the  pai'oxysm. 

If  the  morbific  causes  were  slight  in  intensity,  and  the  morbid  ma- 
terial small  in  quantity,  the  single  struggle  may  have  sufficed  to  set  the 
vital  "house  in  order."  Then  the  paroxysm  VviU  not  be  renewed. 
Othenvise  it  will  be  repeated  again  and  again,  until  "victory  or  death" 
results. 

If  this  view  of  fever  is  right,  the  drug-system  of  treatment  must  be 
^vl•ong.  Instead  of  "aiding  and  assisting  nature,"  it  tends  to  smother 
her  efforts,  and  adds  still  other  extraneous  agents  for  the  vital  powers 
to  contend  against. 

But  it  may  be  asked,  by  way  of  objection  to  the  treatment  I  shall 
advocate :  Why,  then,  if  the  paroxysm  of  fever  is  a  remedial  effoit, 
do  you  disturb  this  effoit  with  your  cold,  or  tepid,  or  hot-water  pro- 
cesses ?  Why  cool  the  hot  stage  of  a  fever  with  cold  bathing,  and 
object  to  cooling  it  by  cold  bleeding  and  cold  ditigging  ?  I  answer : 
The  organic  instincts  are  true  to  nature :  they  are  infallible  in  the 
matter  of  mere  existence.  But  they  are  not  intelligent ;  they  ai'e 
not  reasoning  entities.  It  the  stomach  is  attacked  with  a  poison,  say 
a  "  blue  pill"  or  a  glass  of  grog,  it  will  be  true  to  itself,  and  yet  be  sat- 
isfied to  pass  the  offending  agents  off  to  the  liver  or  the  skin.     If  the 


FEVERS.  79 

bowels  are  attacked  with  a  portion  of  epsom  salts,  or  a  dose  of  "  No. 
6,"  they  will  either  pass  it  off  rapidly,  or,  failing  in  that,  pour  out  se- 
rum to  defend  themselves.  If  the  circulating  fluids  are  charged  with 
animal  oils,  the  capillary  vessels  will  deposit  it  in  the  cellular  tissues. 
All  these  particular  functions  act  also  for  the  general  good  ;  but  while 
each  and  every  function  participates  in  a  general  way  in  the  preserva- 
tion of  the  w^iole  domain  of  life,  each  organ  has  its  own  special  law 
of  self-preservation.  Hence  when  all  the  organs  are  struggling  to  re- 
lieve themselves,  disorder,  and  riot,  and  excess  may  result.  And  here 
right  reason  may  come  to  the  aid  of  instinct  by  supplying  favorable 
conditions,  as  perverted  judgment  has  brought  the  ti'ouble  about  by 
forcing  unnatural  conditions  upon  the  organism.  By  all  those  means 
which  help  those  efforts  of  nature  to  maintain  or  obtain  the  circum- 
stances which  constitute  the  normal  state,  without  calling  out  a  further 
expenditure  of  vital  power,  nor  adding  still  other  morbific  agents,  nor 
chemically  ;j?juring  the 'sti'uctures,  we  may  truly  practice  "the  heal- 
ing art." 

Crisis  of  Fever. — Since  the  days  of  Hippocrates,  the  opinion  has 
prevailed  that  fevers  naturally,  if  left  to  themselves,  evince  a  tendency 
to  run  a  certain  course,  and  terminate  in  a  given  time  by  a  sudden  ag- 
gravation of  the  symptoms,  called  sinking,  or  a  complete  subsidence  of 
them,  and  the  commencement  of  convalescence.  This  change  has 
been  called  the  crisis,  and  the  days  on  which  it  occurs,  critical  days. 
The  3,  5,  7,  9,  11,  14,  17,  and  20,  have  been  regarded  as  critical  days. 
Because  of  this  tendency,  many  drug-authors  are  opposed  to  all  at- 
tempts to  break  up  the  disease  or  shorten  its  course.  Their  plan  is  to 
conduct  it  through  its  course ;  but  how  do  they  propose  to  conduct  it 
through  its  course  ?  Why,  by  poisoning  the  body  through  and  through, 
with  course  after  course  of  drugs!  There  is  nothing  known  to  civili- 
zation more  thoroughly  barbarian  than  the  drug-treatment  of  a  fever. 

The  subject  of  crises  in  acute  diseases  is  of  no  practical  consequence 
v/hatever.  Under  water- treatment,  the  only  crisis  observable  is  the 
cure.  Crises  proper,  under  hydropathic  management,  are  known  only 
in  chronic  diseases,  and  in  these  neither  crises  nor  cures  are  scarcely' 
known  in  allopathic  practice. 

Duration  of  Fever. — The  ordinary  duration  of  inflammatory  fe 
ver  is  from  one  to  two  weeks ;  the  nervous  form  of  typhus,  from  four 
t'"  R'x,  or  even  eight  weeks  ;  the  putrid  form  from  two  lo  three  w^eeks; 
remittent  fever  from  two  to  four  weeks,  when  treated  according  to  the 
popular  system.     Intermitting  fever  is  often  -'broken"  in  a  few  days, 


80       PATHOLOGF  AND  THERAPEUTICS. 

but  seldom  cured,  and  generally  reoccurs  at  uncertain  intervals  for 
months  or  years.  E})liemeral  fever  is  frequently  converted,  by  one 
unfortunate  dose,  or  a  severe  bleeding,  into  a  protracted  fever  which 
runs  several  days  or  weeks.  Under  water-treatment  it  is  very  rare  for 
any  fevers,  except  the  eruptive,  to  hold  out  over  a  week ;  and  in  erup- 
tive diseases,  whose  febrile  excitement  usually  continues  from  seven  to 
eleven  days,  the  violence  of  the  disease  is  generally  entii*ely  subdued 
within  one  week.  I  have  never  yet  personally  known  a  fever  run 
over  a  week  under  water-treatment,  and  I  have  treated  all  the  common 
forms  in  New  York  city  for  the  last  seven  or  eight  years — ephem- 
eral, inflammatory,  typhus,  ship,  scarlet,  measles,  small-pox,  etc. 

General  Treatment  of  Fever  — The  indications  are  :  1.  To 
equalize  the  circulation.  2.  To  purify  the  body.  Practically  these 
distinctions  may  be  more  nice  than  wise  ;  for  all  the  means  best  calcu- 
lated to  fulfill  one  indication  are  also  the  best  adapted  to  the  other. 

Bathing. — Nothing  in  the  way  of  medication  is  more  beautifully  sim- 
ple and  promptly  successful  than  the  hydropa,thic  management  of  a  fe- 
ver. The  temperature  of  the  body  is  the  sure  and  invariable  guide  for 
the  water  processes.  If  the  whole  surface  of  the  body  is  hot,  cold  wa- 
ier  is  to  be  applied  by  frequent  ablutions,  or  the  rubbing  wet  sheet,  or 
the  wet-sheet  pack,  and  often  repeated  until  the  temperature  is  re- 
duced to  the  natural  standard.  The  pack  is  the  most  pleasant  and 
most  eftectal  process,  and  its  soothing  and  tniuquilizing  effects  upon 
the  whole  nervous  system  far  exceed  all  the  opiates  in  the  world.  If 
the  temperature  rises  again,  the  processes  are  to  be  repeated  in  the 
same  manner.  If  the  feet  are  cold,  they  should  be  held  in  hot  water 
a  few  minutes,  or  a  bottle  of  hot  water  may  be  applied  to  them.  Es- 
pecial attention  must  be  given  to  warming  the  feet  in  all  cases  where 
the  head  is  oppressed  and  the  lower  extremities  are  inclined  to  be  cold. 
In  what  are  called  low  or  nervous  fevers,  there  is  often  great  heat  and 
irritation  of  the  head,  and  great  torpor,  coldness,  or  numbness  of  the 
lower  limbs.  In  these  cases  it  is  indispensable  to  balance  the  circula- 
tion by  cold  applications  to  the  head  and  hot  to  the  feet  before  resort- 
ing to  tlie  wet  sheet.  In  very  low  fevers,  and  in  all  cases  attended 
with  extreme  prostration  and  unequal  temperatm^e  at  the  outset,  fre- 
quently sponging  the  body  with  tepid  water,  is  better  than  the  wet- 
sheet  pack,  or  very  cold  ablutions,  for  the  reason  that  the  shock  of  the 
latter  tends  still  more  to  disturb  the  equilibrium  of  the  circulation. 
Local  pains,  spasms,  etc.,  are  to  be  relieved  by  cold  applications  or  warm 
fomentations,  jis  either  feels  most  gi-atefVil.  As  a  general  rule,  cold 
compresses  are  most  beneficial  \Ahen  there  is  constant  heat,  tender- 


FEVERS.  81 

ness,  and  distention ;  and  warm  applications  are  indicated  when  the 
disti-ess  is  periodic  or  spasmodic,  or  when  unattended  with  heat,  tur- 
gescence,  or  soreness.  Severe  headache  may  be  generally  relieved  by 
cold  wet  cloths,  and  always  readily  subdued  by  pouring  cold  water  over 
the  temples  and  back  part  of  the  head  for  several  minutes.  This  pro-  1 
cess  will  also  generally  relieve  the  severest  retching,  nausea,  and 
vomiting. 

I  have  never  tried  the  process  of  immersion  in  treating  fevers,  but 
have  every  confidence  that  it  would  prove  eminently  efficacious  in  all 
high  fevers — fevers  attended  with  uniform  and  general  heat  of  the  sur- 
face, and  a  strca^,  hard  pulse. 

There  is  now  living  in  a  secluded  town  in  Missouri  an  old  farmer, 
who  has  practiced  Water-Cure  even  longer  than  Priessnitz.  A  com- 
munication from  him,  addressed  to  the  publishers  of  the  Water-Cure 
Journal,  will  occupy  two  or  three  pages  with  as  valuable  matter  as  1 
could  select  from  any  source  whatever  ;  and,  notwithstanding  the  au- 
thor modestly  desires  to  have  some  other  name  take  the  credit  of  giv- 
ing his  experience  to  the  world,  1  shall  take  the  liberty  to  record  hia 
name,  and  present  his  letter  in  his  own  farmer-like  and  unaffected  sim- 
plicity of  style  and  language : 

"  East  Prairie,  Mississippi  Co.,  Mo.,  JVbu.  30,  1850 
"Messrs.  Fowlers  and  Wells:* 

"I  am  a  farmer,  in  my  seventy-fifth  year.  I  have  t;iken  your  Jour 
nal  since  January  last,  and  have  taken  Wilson  &c  Co.'s  little  Dispatch 
for  two  or  three  years,  and  have  always  sent  to  him  for  any  books  he 
advertised  on  the  subject  of  the  Water-Cure,  with  the  request  that  he 
would  send  me  the  best  and  plainest  he  could  procure.  I  think  I  have 
seven  or  eight  of  them,  but  in  .'lone  of  your  Journals,  nor  in  them,  do  I 
see  where  fevei's  have  been  treated  with  the  success  that  I  have  treat 
ed  them  with  for  more  than  thirty  years,  and  I  have  never  failed  in  & 
single  case  to  make  a  perfect  cure  in  a  few  minutes.  Strange  as  this 
may  seem,  it  is  nevertheless  a  fact,  and  this  is  the  reason  why  I  trouble 
you  with  these  lines.  I  have  no  -nterest  in  deceiving  you  or  any  other 
person ;  and  as  for  having  my  name  published  in  your  Journal  as  a 
gi"eat  Water-Cure  doctor,  I  wish  you  not  to  publish  this,  but  give  it  to 
some  person  of  your  acquaintance  in  w^hom  you  have  confidence,  who 
will  give  it  a  fair  trial,  or  to  several,  and  if 'it  succeeds,  as  I  know  it  will, 
publish  the  fact  in  any  person's  name  you  please  except  mine. 

"  I  have  treated  all  fevers,  fever  and  ague,  etc.,  alike.  My  plan  is 
simply  to  bathe  at  the  time  the  fever  is  the  highest;  if  the  fever  hag 
passed  its  highest  point,  and  is  g.^ing  oflf,  I  let  the  patient  alone  until  it 


82  PATHOLOGY    AND    THERAPEUTICS. 

returns.  I  know  nothing  of  wet  sheets,  bandages,  etc. ;  but  when  the 
fever  returns,  or  gets  as  high  as  I  think  it  will  go,  I  put  the  patient  in 
a  hogshead  that  I  keep  for  bathing.  I  have  him  go  entirely  under  wa- 
ter, head  and  all,  for  thi-ee  or  four  tini'^s,  keeping  his  head  under  each 
time  as  long  as  he  can  conveniently  hold  his  breath ;  then  let  him  dab- 
ble in  it  up  to  the  chin  until  the  heat  is  reduced  to  the  natural  temper- 
ature, and  the  patient  feels  comfortable ;  then  let  him  come  out  and 
wipe  dry  with  towels,  put  his  clothes  on,  walk  about,  lie  down,  or  do  as 
hi^  inclination  leads ;  eat  what  he  will,  drink  w^hat  he  pleases ;  as  for 
rubbing,  I  do  nothing  of  the  kind.  I  pay  no  attention  to  the  temper- 
ature of  the  water,  the  object  being  to  bring  the  patient  to  the  naturd 
heat,  and  this  can  be  done  in  fifteen  or  twenty  minutes. 

"When  I  have  no  convenience  for  bathing,  and,  in  fact,  sometimes, 
as  a  matter  of  preference,  I  pour  water  on  the  patient's  head,  instead 
of  bathing;  and,  surprising  as  it  may  seem,  this  always  has  the  same 
effect  that  bathing  has,  and  I  do  not  know  that  it  takes  longer  to  cool 
the  body  in  this  way  than  it  does  by  bathing.  I  have  the  patient 
lie  with  the  head  over  the'  edge  or  side  of  the  bed,  so  that  the  water 
will  not  wet  the  bedding.  I  then  get  a  bucket  of  the  coldest  water, 
place  it  under  the  head,  and  pour  the  water  over  the  back  of  the  head 
from  one  temple  to  the  other,  the  patient  lying  with  the  face  down- 
ward. I  pour  it  on  moderately,  and  at  the  height  of  the  fever ;  I  think 
it  will  have  little  effect  if  done  at  any  other  time.  Pouring  water  on 
the  head  in  this  way  will  cool  the  whole  body  nearly  or  quite  as  soon 
as  going  all  under  water,  as  before  directed.  If  the  water  is  not  poured 
on  long  enough  at  first,  the  fever  will  return  in  a  few  minutes,  but  re- 
peat the  pouring  then  as  at  first.  I  have  known  the  fever  return  twice 
before  it  was  finally  driven  away. 

"  The  next  day  after  the  treatment  the  patient  is  capable  of  attend- 
ing to  business  as  usual,  and  I  do  not  recollect  a  case  in  which  the  pa- 
tient had  another  attack  the  same  season.  There  is  one  thing  I  can- 
not understand — how  pouring  water  on  the  head  should  relieve  the 
stomach  of  bile  ;  but  so  it  is ;  let  the  fiatient  be  ever  so  sick  at  the 
Btomach,  and  incline  to  vomit  ever  so  much,  in  two  minutes  after  you 
begin  to  pour  water  on  the  head,  the  stomach  is  relieved,  and  there  is 
no  more  of  that  trouble.  As  before  stated,  the  cure  is  completed  in  a 
few  minutes,  and  it  is  a  permanent  cure,  and  a  cu'  e  that  all  persons 
can  perform  at  home  without  any  inconvenience.  The  shortest  time  I 
have  seen  noted  in  any  of  your  books  to  cure  tl  e  fever  and  ague  is  five 
diiys,  and  that  with  your  wet  sheet,  etc. ;  I  am  sure  this  plan  is  a  great 
deal  easier,  and  much  quicker ;  and  again,  these  books  give  no  direc- 
tions wheB  io  commence  the  treatment,  which  I  am  certain  is  a  mate- 


FEVERS.  63 

rial  point.  I  am  sure  if  my  mode  is  not  employed  as  directed,  cit  the 
height  of  the  fever,  it  will  fail.  As  stated  in  the  beginning,  I  am  no 
doctor,  neither  did  I  make  this  discovery  myself.  I  lived  forty-two 
years  on  the  Sciota  bottom-land'',  in  Sciota  county,  Ohio,  the  most  no- 
ted place  for  bilious  complaints  pe-haps  in  the  world.  A  physician  who 
had  attended  my  family,  being  about  to  move  away,  I  asked  him  whom 
1  should  apply  to  after  he  was  gone,  in  case  of  sickness.  He  then  told 
me  how  to  apply  water  in  all  cases  of  fever  I  have  now  tried  it  more 
than  thirty  years,  and  have  never  failed. 

"  The  effect  the  cold  bath  had  on  me  last  spring,  in  the  worst  dysen- 
tery I  ever  experienced,  which  I  learned  from  Dr.  Show's  Water- 
Cure  for  the  cholera,  no  person  would  believe.  I  could  name  a  great 
many  cases  of  different  kinds  of  bowel  complaints,  which  have  been 
successfully  treated  with  Water-Cure  ;  but  it  is  a  very  smart  under- 
taking for  me  to  write  a  few"  lines,  my  hand  is  so  unsteady,  and  I  fear 
it  will  be  a  greater  task  still  for  you  to  read  them.  But  I  thought  it 
was  a  duty  I  owed  the  community  to  make  known  my  experience  in 
the  treatment  of  fevers  with  water,  especially  as  there  is  considerable 
stir  at  this  lime  about  the  Water-Cure.  But  I  have  found  that  almost 
ninety-nine  in  a  hundred  have  been  opposed  to  the  application  of  cold 
water  in  any  case  whatever.  The  few  who  have  tried  the  cure  as  di- 
rected, have  never  failed  to  get  well  speedily ;  yet,  even  they  would 
almost  always,  on  the  next  attack,  apply  to  a  drug-doctor.  In  the  cases 
of  small  children,  I  have  induced  their  mothers  to  hold  them  in  a  buck- 
et or  tub  of  water,  and  wet  their  heads  continually  for  five  minutes.  I 
have  never  known  this  fail  to  cure  the  chills  and  fever ;  let  it  be  done 
also  when  the  fever  is  at  the  highest. 

"I  am  respectfully  yours,  etc., 

"Abraham  Millar." 

Since  I  have  been  in  possession  of  the  old  farmer's  experience, 
I  have  employed  the  pouring  head  bath  more  freely  than  ever  be- 
fore, and  never  without  decided  benefit.  I  deem  it  a  valuable  aux- 
iliary to  the  wet  sheet  in  all  high  fevers ;  in  low  fevers  it  cannot  be  as 
promptly  successful,  yet  may  be  very  serviceable ;  but  care  must  be 
taken  to  keep  the  lower  extremities  warm,  lest  its  application  should 
produce  reaction  toward  the  brain.  It  will  not,  of  course,  cure  pro- 
tracted agues  which  are  complicated  with  enlargement  of  the  liver  or 
spleen,  but  may  in  those  cases  very  much  shorten  the  duration  of  the 
disease  if  employed  according  to  Mr.  Millar's  directions. 

There  is  another  very  simple  and  very  efficacious  method  of  treating 
an  ordinaiy  fever,  which  has  the  advantage  of  always  being  convenient 


84       PATHOLOGY  AND  THERAPEUTICS. 


and  may,  fcr  this  reasou,  be  preferred  by  those  who  do  not  well  un- 
derstand the  management  of  the  wet  sheet,  or  who  have  not  convex 
nieuces  for  the  immersion  or  plunge-bath.  Place  the  patient  in  a  hip- 
bath— a  common  wash-tub — and  two  pails  of  water  will  answer ;  let 
the  water  be  of  a  moderate  temperature,  65°  to  75°,  and  wash  him  all 
over  the  back  and  chest  while  in  the  tub ;  apply,  also,  several  folds  of 
linen  to  the  head,  wet  in  cold  water,  and  changed  very  often  until  the 
head  becomes  cool,  and  if  there  is  the  least  tendency  to  coldness  of 
the  feet — as  there  will  be  if  there  is  great  determination  to  the  head — 
put  them  in  a  pail  of  warm  water.  The  patient  may  remain  in  the 
bath  five,  ten,  or  fifteen  minutes,  if  his  strength  permits.  This  process 
may  be  repeated  as  often  as  theie  is  an  exaggeration  of  the  hot  stage  of 
the  febrile  paroxysm.  When  the  patient  is  too  weak  to  sit  in  the  tub, 
the  head  and  feet  maybe  treated  as  just  recommended,  and  the  whole 
surface  of  the  body  frequently  sponged  with  tepid  water  while  the  hot 
stage  continues. 

There  are  some  cases  of  low  nervous  fevers  wherein  the  heat  is 
very  unequally  developed — the  pulse  very  small  and  weak,  the  head 
oppressed  or  giddy,  with  great  tendency  to  faint  on  slight  exertion.  In 
these  cases  reaction  is  so  feeble  that  the  full  pack,  so  far  from  soothing 
the  patient,  increases  the  internal  congestions,  rigors,  and  local  pains. 
Here  the  proper  plan  of  treatment  is  to  soak  the  feet  occasionally  in 
warm  water,  applying  very  cold  compresses  to  the  head  at  the  same 
time ;  apply  cold  wet  towels  to  the  stomach,  bowels,  and  back  when- 
ever there  is  continuous  heat  and  tenderness  about  those  parts,  and 
sponge  the  whole  surface  of  the  body  over  with  tepid  water  frequently 
whenever  there  is  general  and  uniform  heat  and  dryness.  Continue 
this  plan  until  the  fever  is  gradually  and  finally  abated. 

Water-drinking. — Water  should  always  he  taken  freely  when  there 
is  thirst ;  and  when  the  heat  and  dryness  of  the  surface  is  great,  and 
the  tongue  parched,  it  should  be  taken  as  copiously  as  the  stomach  will 
bear  without  unpleasant  distention,  even  though  there  be  no  distinct 
sensation  of  thirst.  In  this  case  it  should  be  taken  frequently,  but  in 
small  quantities  at  a  time. 

The  Excretions. — When  the  bowels  are  not  entirely  free,  they  should 
be  moved  bj'^  one  or  more  tepid  injections.  This  may  be  done  either  be- 
fore or  after  the  cooling  processes  have  been  employed.  Subsequent- 
ly injections  are  only  required  whenever  a  sense  of  fullness,  hardness, 
distention,  etc.,  of  the  abdomen  indicate  an  accumulation  of  foecal  mat- 
ters, whether  this  condition  occurs  daily,  or  only  once  in  two  or  three 
days.  Indian  or  wheat-meal  gruel  promotes  the  action  of  the  bowels, 
and  for  this  purpose  they  may  be  taken  to  advantage  when  the  consti- 


F  E  V  E  H  S.  8& 

miion  is  considerable.  Emetics  are  rarely  necessary ;  I  never  pre- 
scribe them,  except  there  is  evidence  of  crude  ingesta  recently  taken 
into  the  stomach.  In  this  case  the  patient  should  drink  warm  vs^ater 
until  vomiting  occurs,  or  relief  is  obtained  without.  Copious  warm  wa- 
ter-drinking will  often  relieve  nausea  and  distress  from  offensive  acids. 
acrid  bile,  or  irritating  secretions  in  the  stomach  and  duodenum,  even 
though  it  does  not  produce  sickness  or  vomiting. 

Regimen. — Of  the  importance  of  free  ventilation,  perfect  cleanli- 
ness about  the  room,  frequent  changing  of  the  bedding,  and  the  prompt 
removal  of  all  offensive  dejections  or  excretions,  I  hardly  need  speak. 
Common  sense  ought  to  be  a  sufficient  guide  in  this  respect.  But  there 
is  general  error  committed  by  physicians  and  nurses,  in  the  manage- 
ment of  a  fever,  to  which  I  wish  to  call  especial  attention.  While  all 
admit  the  free  access  of  air,  many  are  inclined  to  shut  out  the  light.  This 
error  is  more  prevalent,  according  to  my  observation,  in  the  country  than 
in  the  city.  The  patient  is  often  kept  in  a  room  so  darkly  shaded  that  there 
is  an  uncomfortable  feeling  of  dampness  or  chilliness  within,  especially 
when  the  room  is  opposite  the  sun  side  of  the  house,  or  the  house 
thickly  surrounded  with  trees  and  shrubbery.  The  influence  of  light 
is  not  only  vivifying  to  the  patient,  but  it  tends,  also,  to  decompose  and 
dissipate  putrescent  or  infectious  particles  which  gather  in  the  sick 
room.  There  may  be  cases  where  the  eyes  are  so  excessively  irri- 
table and  tender  to  light  that  it  is  necessary  to  shade  them,  but  tliis 
should  be  done  by  a  green  vail  or  other  eye-shade,  while  a  good  de- 
gree of  light  is  admitted  into  the  room.  These  remarks  apply,  of 
course,  to  natural  or  daylight,  not  artificial  or  lamp-light. 

In  relation  to  food  and  drink,  the  rule  of  practice  is  not  difficult  to 
memorize.  The  patient  should  drink  at  all  times  to  the  full  satisfac- 
tion of  the  sensation  of  thirst;  although,  as  just  observed,  when  thirst 
is  violent  it  should  be  taken  frequently  in  small  quantities.  Crust-wa- 
ter, corn-coffee,  lemonade,  apple  tea,  etc.,  are  no  better  than  pure 
water  in  any  case ;  but  as  patients  often  have  a  craving  for  them,  and 
as  they  are  both  grateful  and  harmless,  I  would  never  object  to  them. 
Food  should  not  be  taken  at  all  until  the  violence  of  the  fever  is  mate- 
rially abated,  and  then  very  small  quantities  of  the  simplest  food  only 
should  be  permitted,  as  gruel,  with  a  little  toasted  bi-ead  or  cracker, 
boiled  rice,  mealy  potatoes,  baked  apples,  etc.  There  is  not  a  more 
mischievous  or  more  irrational  error  abroad  in  relation  to  the  treat- 
ment of  fever  th5iin  the  almost  universal  practice  of  stuffing  the  patient 
continually  with  stimulating  animal  slops,  under  the  name  of  "  mild, 
nourishing  diet,"  beef  tea,  mutton  broth,  chick  m  soup,  panada,  etc. 
The  fever  will  always  starve  out  before  the  patient  is  injured  by  absti- 
8 


86  PATHOLOGT    AND   THERAPEUTICS. 

nence,  at  le<ast  under  hydropathic  treatment,  and  the  appetite  will  al- 
ways return  when  the  system  is  capable  of  assimilating  food. 

Local  Complications. — Among  the  common  incidents  attending 
the  ])i"ogress  of  a  fever  treated  in  the  ordinary  drug  way,  are,  ex- 
cessive irritability  of  the  stomach,  vomiting,  diarrhea,  hemorrhage  from 
tlie  liver,  bloated  abdomen,  or  tympanitis,  falling  oif  of  the  hair,  ab- 
scesses, boils,  obstinate  constipation,  retention  or  suppression  of  urine, 
topical  inflammations,  dropsical  swellings,  etc.  Most  of  these  compli- 
cations are  factitious,  and  owe  their  existence  entirely  to  drug  medica- 
tion, and  are  hence  wholly  unknown  to  the  water-treatment.  But  as 
we  are  often  called  to  patients  who  have  been  drugged,  more  or  less, 
since  the  attack,  we  shall  frequently  have  these  incidents  or  accidents 
to  manage.  The  stomach  can  generally  be  quieted  by  the  free  use  of 
warm  water,  followed  by  bits  of  ice  or  sips  of  very  cold  water,  and  the 
cold  compress  externally.  lu  a  severe  case  apply  also  hot  bottles  to 
the  feet  and  cold  cloths  to  the  head ;  and  if  the  head  be  very  hot  pour 
cold  water  on  it  for  several  minutes,  until  it  becomes  perfectly  cool. 
Diarrhea  may  be  checked  by  the  hot  fomentation  or  w^arm  hip-bath, 
followed  by  cool  or  cold  injections.  Hemorrhages  require  the  cold 
compress,  cool  or  cold  injections,  and  bits  of  ice  or  frequent  sips 
of  very  cold  water,  with  the  hot  foot-bath.  Tympanitis  requires  the 
same  treatment,  with  occasional  hot  fomentations.  Abscesses  and 
boils  need  nothing  but  the  wet  compress.  When  the  hair  inclines 
to  fall  off,  it  should  be  cut  very  short,  and  the  head  often  wet  with  cold 
water,  but  not  covered.  Constipation  is  to  be  treated  with  tepid  injec- 
tions, as  copiously  as  the  exigency  of  the  case  demands.  Ditficult 
urination  can  generally  be  obviated  by  the  fomentation  or  hot  sitz- 
bath,  or  these  followed  by  the  cold  compress,  or  a  dash  of  cold  water 
upon  the  pelvic  region.  In  exti'eme  cases  the  catheter  must  be  em- 
ployed. Topical  inflammations  and  dropsical  sweUings  each  require 
cold  compresses  frequently  renewed. 

Relapses. — I  mention  this  subject  only  to  contrast  the  condition  of 
convalescent  patients  who  have  been  through  a  course  of  allopathic 
drugging,  with  those  who  have  had  exclusive  water-ti-eatment.  The 
former  are  always  liable  to  relapses ;  the  latter  never. 

Ephe.mkral  Fever — Febris  Ephemeris. — Some  authors  have  dis- 
tinguished this  fever  into  three  species,  acute,  mild,  and  sweating;  but 
the  distinction  is  of  no  practical  utility. 

Diagnosis. — Rigors  slight,  stages  of  short  duration,  mental  functions 
scarcely  distmbed,  terminating  in  a  few  hours  in  a  moderate  sweat. 


FEVERS  S7 


i 


The  disease  often  disappears  with  a  single  paroxysm,  and  seldom  ex- 
ceeds two  or  three. 

Special  Causes. — A  slight  cold,  an  indigestible  meal,  a  debauch,  over- 
exertion. 

Peculiarities  of  Treatraent. — The  wet-sheet  pack  for  an  hour,  fol- 
lowed by  the  dripping-sheet,  or  cold  ablution,  or  free  injection,  with 
fasting  for  twenty-foui"  hours,  will  always  remove  this  kind  of  fever. 

Inflammatory  Fever — Synochus. — The  terms  synocha  and  sy- 
noclius  are  employed  quite  promiscuously  in  medical  books.  Generally, 
nowever,  a  distinction  is  made,  the  former  term  being  applied  to  what 
IS  usually  denominated  inflammatory  fever,  and  the  latter  to  a  form  of 
fever  which  is  regarded  as  a  compound  of  inflammatory  and  typhus — 
inflammatory  in  the  commencement  and  typhus  in  the  end.  The 
truth  is,  these  forms  of  fever  are  but  difl'erent  degrees  in  the  violence 
of  the  same  essential  type,  which  may  be  called  injiammatory  or  high 
fever,  in  contradistinction  to  typhus  or  loic  fever. 

Diagnosis. — This  form  of  fever  is  rather  peculiar  to  vigorous  con- 
stitutions, and  to  persons  of  active,  out-door  habits  of  life.  It  may  be 
distinguished  from  all  others  by  th*»  following  assemblage  of  symptoms  : 
Tongue  generally  white  with  red  odges,  pulse  full,  hard,  strong,  and 
quick,  though  never  very  frequent.  Temperature  of  the  body  uni- 
formly high  after  the  fever  lii  fully  developed ;  eyes  reddish ;  urine 
scanty  and  high  colored ;  the  whole  surface  preternaturally  flushed 
and  turgid ;  'the  mental  functions  but  slightly  disturbed,  or  not  at  all. 

If  this  fever  runs  much  beyond  the  ninth  day,  or  if  it  is  maltreated 
at  the  outset,  the  tongue  becomes  yellow,  then  brown,  then  black,  and 
many  symptoms  of  an  original  tj^phoid  supervene.  Like  all  continued 
fevers  it  is  chai-acterized  by  two  exacerbations  during  the  day;  the  first 
and  mildest  in  the  forenoon,  and  the  second  and  severest  toward  evening. 

Peculiarities  of  Treatment. — Of  this  fever  it  has  been  well  said  : 
"  The  blood  is  on  fire  ;  extinguish  the  flame,  and  the  patient  will  be 
well."  The  hydropathic  treatment  is  more  simple  and  direct  than  in 
any  other  form  of  fever.  Wrap  the  patient  in  double  wet  sheets, 
rightly  covered  with  bedding ;  let  him  remain  as  long  as  he  is  com- 
paratively comfortable  ;  then  wash  him  ofl*  wi'di  cold  water.  Repeat 
the  process  as  often  as  the  febrile  heat  increases.  The  immersion- 
oath  and  pouring  head-bath,  as  practiced  by  Mr.  Millar,  are  peculiarly 
adapted  to  this  form  of  fever.  In  fact,  a  sufficient  quantity  of  cold 
water  applied  in  almost  any  manner,  will  finally  effect  a  cure.  Usually 
the  bowels  are  constipated  in  the  outset;  hence  free  injections  of 
tepid  water  are  necessary. 


88  PATHOLOG\     AND    Til  ER  A  P  EU  TIC  S. 

Yellow  Fever — Typiids  Icterodes — Syxochus  Icterodes. — 
Yellow  fever  is  generally  regarded  as  peculiarly  contagious,  though,  I 
think,  quite  erroneously.  Some  authors,  among  whom  are  Dr.  Good, 
have  placed  it  among  the  remittents,  on  account  of  the  peculiar  re- 
mission which  occurs  during  its  progi-ess. 

Character} sties. — Partial  or  general  yellowness  of  the  skin ;  parox- 
ysms somewhat  irregular  ;  great  tenderness  or  pain  about  the  epigas- 
trium, or  pit  of  the  stomach  ;  type  irregular,  which  irregularity  con- 
sists in  a  marked  remission  of  the  febrile  symptoms,  occurring  during 
the  first  day  or  two,  usually  about  forty-eight  hours  after  their  access. 
In  severe  cases  the  eyes  ai*e  intensely  red ;  there  is  extreme  pain  in 
the  eyeballs,  back,  and  limbs.  The  black  vomit,  so  alarming  to  friends 
and  physicians,  does  not  always  take  place,  and  when  it  does  happen, 
I  believe  it  is  owing  more  to  mal-medication  than  to  all  other  causes 
combined. 

Peculiarities  of  Treatment. — The  excessive  determination  to  the 
bmin  requires  the  constant  application  of  the  coldest  wet  cloths,  or 
pounded  ice,  or  the  pouring  head-bath.  The  stomach  is  usually  ex- 
tremely irritable,  and  requh'es  the  cold  compress.  When  retching  or 
nausea  is  distressing,  warm  water  should  be  freely  drank  for  a  short 
time,  followed  by  sips  of  cold  water,  or  bits  of  ice.  The  feet  should 
also  be  placed  in  hot  water  for  five  or  ten  minutes.  The  bowels  are 
usually  severely  constipated,  hence  a  succession  of  warm  water  injec- 
tions should  be  promptly  resorted  to.  The  general  treatment  is  the 
eame  as  for  inflammatory  fever. 

Nervous  Fever — Typhus  Mitior. — This  has  been  called  "  mild 
typhus,"  "low  tj'phus,"'  and  "slow  fever."  It  usually  runs  from  six 
to  eight  weeks  under  allopathic  management.  Some  cases  are  attend- 
ed with  such  prostration  of  the  nervous  system,  that  the  patient  either 
sinks  or  becomes  convalescent  in  one  or  two  weeks. 

Diagnosis. — Great  disturbance  of  the  mental  functions;  dejection 
of  mind;  frequent,  weak,  irregular  pulse;  tongue  covered  with  a 
white,  thick  mucus  :  eyes  suffused ;  heat  of  the  surface  more  or  less 
unequal ;  frequent  turns  of  muttering  delirium  ;  countenance  peculiarly 
expressionless;  the  skin  is  liable  to  irregular  dryness  and  sweats ;  the 
early  symptoms  are  miid,  and  increase  in  violence  gradually ;  the  evac- 
uations are  not  particularly  oflfensive ;  the  urine  is  commonly  whey- 
like. 

Peculiarities  of  Treatment. — In  the  neiTous  form  of  tj'phus,  the  m- 
dications  ai'e  rather  to  equalize  irregulai'  temperature  and  action  than  to 
reduce  excessive.     In  son  e  cases  the  external  heat  is  so  high  and 


FEVEES.  »9 

uniform,  as  to  call  for  the  wet-sheet  pack;  but  more  frequently  the 
morbid  heat  is  pent  up,  as  it  were,  in  the  head  and  epigastric  region, 
while  the  extremities  are  either  of  the  normal  temperature  or  cold. 
Under  tliese  circumstances,  the  expectant  plan  of  treatment,  as  it  has 
been  called,  is  the  best.  Apply  cold  applications  to  the  head,  cold,  wet 
towels,  often  changed,  to  the  abdomen,  and  bathe  the  feet  in  warm 
water,  or  apply  hot  bottles  to  them;  and  whenever,  under  this  man- 
agement, the  preternatural  heat  of  the  body  becomes  general,  sponge 
the  whole  surface  fi'equently  with  tepid  water  until  the  febrile  heat 
subsides.  Nausea,  vomiting,  and  diarrhea  are  frequent  incidents,  and 
require  the  process^  already  ft-eq"*^ntly  named  for  those  symptoms. 

Putrid  Fever — Typhus  Gravior. — This  is  a  more  violent  and 
malignant  form  of  typhus  than  the  preceding.  Jail,  camp,  ship,  hos- 
pital, and  several  other  fevers,  usually  considered  as  distinct  species, 
are  but  modifications  of  the  putrid  form  of  typhus,  as  influenced  by 
local  circumstances,  and  require  no  special  pathological  or  therapeutic 
notice.  The  spotted  or  petechial  fever,  so  called  from  purple  spots  ap- 
pearing on  the  skin  before  death,  has  prevailed  extensively  in  many 
parts  of  New  England  and  New  York  since  1806.  I*"  has  been  very 
fatal,  and  was  formerly  denominated  typhus  syncopalis,  or  sinking 
typhus.  Medical  books  also  make  a  useless  and  groundless  distinction 
between  tj^phus  and  typhoid  fever,  on  the  vague  supposition  that  the 
atter  has  its  seat  more  especially  in  a  disease  of  the  mesenteric  and 
Peyer's  glands.  I  reject  this  distinction  as  fanciful,  if  not  puerile,  and, 
as  the  reader  will  perceive,  employ  the  terms  typhus  and  typhoid  in- 
discriminately. 

Diagnosis. — Attack  sudden  ;  progress  rapid  ;  rigors  severe  ;  early 
md  great  prostration  of  strength ;  extreme  anxiety  and  restlessness ; 
the  countenance  is  expressive  of  anguish  and  horror ;  pulse  hard,  but 
small  and  rapid ;  tongue  dry  and  brown  or  black ;  the  skin  imparts 
more  or  less  of  a  peculiar  stinging,  prickling,  or  burning  sensation  to 
the  touch ;  the  breath  is  hot  and  offensive ;  there  is  ringing  in  the 
ears ;  throbbing  of  the  temples ;  intense  headache ;  ferrety  redness 
of  the  eyes;  the  excretions  of  urine  and  foeces  are  dark  and  offensive. 
In  the  advanced  stage,  spots  or  blotches  appear  on  the  skin  from  ef- 
fused blood  ;  forming  petechias,  mnculce,  vibices,  etc.  There  is  great 
exhaustion  of  muscular  power,  and  the  face  wears  a  livid  instead  of  a 
florid  flush. 

Peculiarities  of  Treatment. — Perfect  quiet,  and  abundance  of  fresh, 
unconfined  air  are  indispensable.  The  bowels  should  be  promptly 
moved  by  tepid  injections,  to  be  followed  by  enema  of  cool  water,  to 


00       PATHOLOGY  AND  THERAPEUTICS. 

act  as  a  tonic.  In  the  early  stages  of  a  majoiitj-  of  cases  of  putrid 
fever,  the  morbid  heat  is  sufficiently  developed  and  uniform  to  demand 
the  wet-sheet  pack  frequently  repeated  ;  but  it  is  generally  necessary 
to  apply  hot  bottles  to  the  f'oet  and  cold  compresses  to  the  head  at  the 
same  time.  When  the  heat  is  too  irregular,  and  the  circulation  too 
low  for  the  full  wet  sheet,  the  abdomen  should  be  fi'equently  wrapped 
in  wet  towels,  and  the  whole  body  very  frequently  sponged  over  with 
cool  or  cold  water.  In  other  respects,  the  rules  ali'eady  given  are  suf- 
ficient to  regulate  the  ti'eatment. 

REMITTK^'T  Fever. — Remittent  fever  is  distinguished  from  contin- 
ued, by  being  attended  w  :h  only  one  daily  exacerbation  of  the  febrile 
paroxysm,  instead  of  two ;  there  is  also  a  greater  remission  of  all  the 
febrile  symptoms  at  the  end  of  the  paroxysm,  though  this  remission  is 
not  complete  as  it  is  in  intermittent  fever.  The  remitteu-t  type  of  fever 
is  common  to  hot  climates,  but  rare  in  the  temperate.  It  is  also  espe- 
cially prevalent  in  low,  marshy  districts,  in  the  neighborhoods  of  stag- 
nant waters,  in  the  vicinity  of  lands  occasionally  inundated,  and  in  local- 
ities where  the  atmosphere  is  loaded  with  the  effluvia  of  decaying  ani- 
mal and  vegetable  matters.  It  is  generally  attended  with  great  biliary 
disturbance,  and  in  our  southern  and  southwestern  states  it  is  often 
called  •  bilious  remittent."  Sometimes  it  is  called  "  autumnal  remit- 
tent," because  it  more  generally  prevails  in  the  autumnal  months. 

The  nervous  and  putrid  forms  of  remittent  are  distinguished  by  the 
same  symptoms  which  denote  the  same  forms  of  typhus  fever ;  a  gen- 
eral disproportionate  disturbance  of  the  nervous  system  marking  the 
former,  and  all  the  evidences  of  putrescency  and  extreme  exhaustion 
manifesting  the  latter. 

All  the  general  and  special  directions  for  ti'eating  the  different  forms 
of  continued  fever  will  equally  appl}^  to  the  same  forms  of  remittent. 
It  should  be  remarked  that  many  cases  of  remittent  fever — and  the 
same  is  true  of  typhus  fever — do  not,  on  their  first  access,  exhibit 
distinctly  either  the  nervous  or  putrid  type,  although  they  always  con- 
form more  especially  to  one  or  the  other  as  they  progress.  In  all 
these  cases,  the  chiu'acter  of  the  fever  will  approximate  inflammatory 
synochus,  or  ]iigh  fever,  and  should  be  managed  accordingly. 

Intermittent  Fever — Ague  and  Fever.—  Fever  and  ague 
seems  to  be  especially  connected  with  congestions  in  and  functional 
derangements  of  the  liver  and  spleen.  Enlarged  livers  and  spleens, 
called  ague  cakes,  are  very  common  sequelae  of  intermittents,  although 
they  are  not  unf/equeully  de  3cted  after  protracted  or  repeated  remit 


E  E  V  ±.  PwS.  91 

tents.  WhaL  are  called  "chill  fever"  and  "dumb  ague,"  are  disguised 
Of  imperfectly-developed  forms  of  intermittent.  This  disease  is  com- 
mon to  miasmatic  localities  and  new  countries,  where  decomposing  veg- 
etation abounds,  and  places  where  the  dense  foliage  and  stagnant  waters 
fill  the  air  with  carbonaceous  and  hydrogenous  gases,  are  much  more 
subject  to  it  than  those  which  have  been  longer  under  cultivation.  It 
is  very  prevalent  in  many  parts  of  our  Western  States ;  and  with  the 
bad  living  which  helps  to  produce  it,  and  the  huge  doses  of  calomel, 
arsenic,  and  quinine  given  to  cure  it,  a  large  proportion  of  those  who 
"westward  follow  the  star  of  empire,"  find  their  constitutions  irretriev- 
ably ruined. 

Diagnosis. — The  intermittent  type  of  fever  is  readily  distinguished 
by  the  violence  of  the  paroxysm,  the  regular  succession  of  the  cold, 
hot,  and  sweating  stages,  and  the  complete  subsidence  of  all  the  febrile 
phenomena  at  the  end  of  the  sweating  stage,  this  subsidence  amounting 
to  a  periodical  intermission  of  the  disease. 

Peculiarities  of  T'reatment. — Intermittent  fever  exhibits  a  variety 
of  forms,  as — quotidian  ague,  having  an  intermission  about  every 
twenty-four  hours ;  tertian  ague,  the  intermission  about  forty-eight 
hours;  ^aarte^i  ao'Me,  intermission  about  seventy-two  hours;  to  which 
some  authors  add  sub-varieties,  called  irregular  imdi  complicated.  These 
distinctions  do  not  affect  the  question  of  treatment.  The  bowels  should 
be  well  cleansed  with  tepid  injections,  and  when  there  is  much  nausea, 
or  bitter  taste  in  the  mouth,  a  warm  water  emetic  is  advisable.  The 
wet  sheet,  or  the  immersion,  must  be  resorted  to  during  the  hot  stage, 
and  the  pouring  head-bath  when  there  is  great  determination  to  the 
brain,  with  severe  headache.  During  the  intermission,  a  hot  bath, 
followed  by  the  cold  dripping-sheet,  or  cold  shower,  will  generally 
soothe  the  nervous  system,  and  mitigate  the  severity  of  the  succeeding 
paroxysm.  As  the  liver  is  always  in  a  state  of  greater  or  less  congestion, 
the  abdominal  bandage  should  be  worn  constantly. 

We  find  this  disease  under  such  diverse  circumstances,  and  with  so 
various  complications,  that  there  is  room  for  considerable  skill  in  its 
management.  Recent  cases  are  effectually  cured  by  a  few  packs,  or 
a  single  immersion,  except  when  the  causes  have  been  a  long  time  ac- 
cumulating. But  frequently  the  liver  or  spleen  is  enlarged,  or  both 
may  be  in  a  state  of  congestion,  and  there  is  a  dyspeptic  condition 
attending  it.  Very  often  the  skin  is  extremely  torpid,  and  full  of  viscid, 
hardened,  and  impacted  bile,  the  conjunctiva  of  a  reddish-yellow,  and, 
although  sweating  is  easily  produced,  the  real  function  of  perspiration 
is  scarcely  performed  at  all.  In  these  cases  we  may  perhaps  very 
soon  "break  the  fits,"  but  to  effect  a  permanent  cure,  the  functional 


92      PATHOLOGY  AND  THERAPEUTICS. 

actions  of  the  liver,  spleen,  and  skin  must  be  establislied.  Until  this 
is  done,  the  feverish  and  agueish  symptoms  will  exist  in  a  more  or  less 
disguised  form,  or  the  disease  will  exhibit  some  other  irregular  form, 
and  constitute  a  predisposition  to  glandular  enlargements,  dropsical  ac- 
cumulations, chronic  and  spasmodic  rheumatism,  etc.  These  cases 
require  an  active  treatment  for  several  weeks;  and  in  some  few  cases, 
where  the  constitution  has  been  shattered  by  repeated  fevers  in  mala- 
rious districts,  and  more  especially  when  the  patient  has  been  repeat- 
edly cured  by  arsenic,  quinine,  calomel,  etc.,  several  months'  time  are 
required  to  effect  a  cure. 

Regimen. — In  continued  and  in  remittent  fevers,  and  in  most  other 
acute  diseases,  we  have  very  little  ti'ouble  abou*"  the  diet,  save  keeping 
it  away  from  the  patient:  nor  much  difificulty  it  this  vespect,  for  gener- 
ally there  is  no  morbid  appetite  in  the  way.  But  with  intermittent 
fevers,  which  may  be  regarded  as  chi'onic  diseases  with  acute  parox' 
ysms,  the  case  is  somewhat  different.  In  those  cases  which  linger 
several  weeks,  we  must,  of  course,  look  to  the  nutritive  function. 
Here  we  have  not  unfrequently  to  restrain  the  dyspeptic's  craving  for 
accustomed  stinmlants,  the  hypochondriac's  rage  for  excessive  quantity, 
and  the  epicure's  goading  desire  for  tit-bits  and  seasonings.  We  cannot 
turn  the  patient  off  "old-school"  fashion,  with,  "Eat  and  drink  what 
you  find  agi'ees  best,"  and  draw  on  the  apothecary  for  the  curatives, 
but  it  is  our  business  to  know  exactly  what  will  agree  best,  and  so  pre- 
scribe "according  to  knowledge." 

The  best  diet  is  wheat- meal  bread,  cracked-wheat  mush  with  a  very 
little  milk  and  sugar  for  seasoning,  a  very  moderate  quantity  of  th* 
milder  vegetables,  and  the  free  use  of  good,  ripe,  sweet  apples,  eitaer 
baked  or  boiled.  Grapes,  tomatoes,  prunes,  and  good  dried  fruits,  are 
not  objectionable.  The  crust  of  good  sweet  bread,  and  dry  toast,  or 
hard  crackers,  are  excellent  to  improve  the  salivary  and  gastric  secre- 
tions. 

Water  should  be  drank  rather  freely,  on  account  of  the  tendency  to 
waste  the  serum  by  perspiration.  Exercise  should  always  be  moderate. 
Over-exertion  during  the  intermission  always  aggravates  the  subse- 
quent paroxysms.  Sailing  and  carriage-riding  are  the  most  advanta- 
geous exercises. 

SiMPTOMATic  Fever?. — ^These  are  treated  on  general  principles 
as  far  as  the  constitutiona  disturbance  is  concerned,  reference  always 
being  had  to  the  primary  affection.  As  they  depend  on  a  local  patho- 
logical condition,  they  will  be  particularly  considered  under  the  head* 
of  the  idiopathic  diseases,  of  -v^bj]!  they  constitute  the  symptoms. 


FEVERS  93 

Small-Pox — Variola. — The  small-pox  is  a  contagious  eruptive 
fever,  affecting  both  the  skin  and  mucous  membrane  of  the  mouth, 
throat,  stomach,  and  lungs.  Its  access  is  a  fever;  this  is  followed  in 
three  or  four  days  by  an  eruption,  which  is  papular  at  first,  then  ve- 
sicular, and  \^s\\y  imstular ;  the  pustules  are  pointed  at  first,  but  after- 
ward become  umhilicated.  The  eruption  terminates  in  twelve  to 
seventeen  days  in  dessication  and  scabbing,  leaving  larger  or  smaller 
iiTegular  cicatrices. 

Spedes. — This  disease  appears  in  three  forms  :  1.  Distinct  small- 
pox— variola  discrcta.  2.  Confluent  small-pox — variola  conjiuens.  3. 
Modified  small-pox — varioloid.  The  first  variety  is  the  mildest ;  the 
eruption  is  regular,  the  vesicles  distinct,  and  the  fever  of  the  inflam- 
matory type.  The  second  variety  is  the  most  severe;  the  vesicles  are 
irregular  and  mixed,  and  mature  impeifectly,  and  the  accompanying 
fever  is  typhus.  The  third  variety  is  the  small-pox  us  modified  by 
vaccination,  or  a  previous  attack. 

Stages. — The  phenomena  of  variola  Are  divided  into  four  stages :  1. 
Incubation,  or  the  latent  period ;  being  the  time  that  intervenes  between 
the  inception  of  the  virus  and  the  first  appearance  of  the  symptoms. 
This  period  varies  from  six  to  twenty  days.  2.  Invasion,  which  extends 
to  the  eruption,  usually  three  oij^four  days.  3.  Eruption,  the  vesica- 
ting and  pustulating  period,  extending  to  the  eleventh  or  twelfth  day. 
4.  Dessication,  extending  to  the  time  of  cicatrization,  usually  about 
the  seventeenth  day.  The  time  fi'om  the  iJtird  to  the  eighth  day, 
during  which  the  papulee  change  to  pustules,  is  called  the  period  of 
7naturation. 

Symptoms  oj  Distinct  Small- Pox. — The  attack  is  characterized  by 
»,he  usual  premonitory  symptoms  of  a  violent  fever,  as  chills  or  rigors, 
lassitude,  headache,  pain  and  weakness  in  the  back  and  loins,  tender- 
ness about  the  pit  of  the  stomach,  frequent  nausea  and  vomiting, 
drowsiness,  sometimes  stupor,  or  coma,  and  with  infants  convulsions 
are  frequent  occurrences.  These  symptoms  are  succeeded  by  general 
heat  of  the  body,  diy  skin,  coated  tongue,  frequent  pulse,  and  extreme 
restlessness,  which  continue  until  the  eniption  appears,  when  they 
partially  subside. 

The  eruption  appears  first  on  the  face  and  forehead,  in  the  form  of 
mmute  spots  or  papulae,  sensibly  elevated  above  the  surface  of  the  skin. 
They  are  first  noticeable  about  forty-eight  hours  after  the  occurrence 
of  the  rigors.  During  the  third  and  fourth  days  the  eruption  extends 
to  the  sides  of  the  nose,  chin,  upper  lip,  neck,  and  wrists,  then  to  the 
trunk  and  thighs,  finally  covering  the  whole  body.  About  the  fifth 
day,  little  vesicles,  depressed  in  the  :enter,  containing  a  colorless  fluid. 


94       PATHOLOGY  AND  THERAPEUTICS. 

appear,  surrounded  by  an  inflamed  circular  margin,  one  vesicle  arising 
on  the  top  of  each  little  point  or  pimple.  Usually  the  eruptive  fever 
further  abates,  or  entirely  disappears  at  this  time.  There  is  generally, 
though  not  always,  an  increased  flow  of  viscid  saliva,  some  swelling  of 
the  throat,  with  hoarseness  and  difficulty  of  swallowing,  about  the 
sixth  day. 

On  or  about  the  eighth  day,  the  pustules  are  completely  formed  and 
spherical,  terminating  in  a  point,  and  the  vesicular  fluid  becomes  puru- 
lent; the  face  and  eyelids  swell,  and  the  mouth,  nose,  and  fauces  are 
covered  with  pustules.  About  the  tenth  or  eleventh  day  from  the 
access  of  the  fever,  or  eighth  or  ninth  from  the  appearance  of  the 
eruption,  the  inflammatory  areola  surrounding  the  vesicle  subsides,  the 
contents  change  to  an  opaque  yellow,  and  a  dark  spot  appears  on  each 
pustule.  Usually  at  this  time  the  tumafactiou  of  the  face  subsides 
and  the  hands  and  feet  begin  to  swell.  After  the  eleventh  day  th^ 
pustules  become  roagh,  break,  discharge  their  contents,  which,  by 
drying  on  the  surface,  form  small  crusts.  In  a  short  time  these  crusts* 
fall  off,  leaving  the  part  of  a  dark  brown  color,  which  often  remainsi 
many  days,  and  when  the  pustules  have  been  very  large,  permanent 
indentations  of  the  skin  remain.  About  the  seventeenth  day,  the  sec- 
ondary fever,  which  comes  on  about  the  completion  of  the  pustulatiou 
difiappears,  and  the  swelling  of  the  hands  and  feet  subsides. 

Symj)toms  of  Coy^fiuent  Small-Pox. — The  eruptive  fever  is  more 
intense,  the  strength  is  greatly  prosti-ated,  coma  and  delirium  are  fi-e- 
quent,  and  profuse  diarrhea  or  salivation  is  often  present.  The  eruption 
is  preceded  by  an  erysipelatous  efflorescence  upon  the  face,  from 
which  the  pustules  emerge  on  the  second  day,  in  the  form  of  small 
red  points,  which  run  together,  and  form  clusters,  resembling  measles. 
The  pustules  are  irregularly  shaped,  and  contain  a  dark,  ichorous  mat- 
ter, instead  of  true  pus.  When  the  crusts  begin  to  form,  the  whole 
face  is  covered  with  a  general  scab,  which  falls  off  fi'om  the  fifteenth 
to  the  twentieth  day.  The  fever  does  not  cease  upon  the  appearance 
of  the  eiTjption,  but  about  the  ninth  day  suffers  a  remarkable  exacerba 
tion ;  in  very  bad  cases,  the  eniption  becomes  livid  or  black,  and  pe- 
techiae,  hemorrhages,  bloody  urine,  and  exhausting  diarrheas  occur. 
Should  recovery  take  place,  the  pits  or  scars  will  be  much  deeper  than 
in  the  preceding  form.  The  patient  frequently  dies  about  the  eleventh 
day. 

Sijmptoms  of  Modified  Small- Pox. — The  eruptive  fever,  though 
generally  severe,  usually  lasts  but  a  single  day.  On  the  following  day 
the  eruption  appears;  firet  on  the  wrist  and  about  the  nose.  Frequently 
a  pimple  on  the  ala  of  the  nose  gives  an  indication  of  the  nature  of 


FEVERS.  95 

the  malady.  The  coui'se  of  the  disease  is  shorter,  and  the  sj-mptomg 
more  irregular  than  in  the  other  forms.  Some  of  the  eruptions  pro- 
gress to  perfect  pustules ;  others  die  away  without  suppurating.  As 
soon  as  the  eruption  appears,  the  patient  is  well,  unless  it  is  sufficiently 
extensive  to  keep  up  some  degree  of  irritative  fever. 

Diagnosis. — The  diseases  with  which  small-pox  is  liable  to  be  con- 
founded, especially  in  its  early  stages,  are — Chicken-pox — varicella; 
measles — rubeola  ;  scarlet  fever — scarlatina  ;  and  erysipelas.  Variola 
may  be  distinguished  from  chicken-pox  bj  the  pimples  appearing  on 
the  back,  the  maturation  of  the  pustules  on  the  third  day,  and  the  ab- 
sence of  suppuration  and  indentation,  which  characterize  the  latter  dis- 
ease ;  from  measles,  by  the  hoarseness,  moaning,  swelled  eyelids  axv\ 
watery  eyes,  which  attend  the  attack  of  measles,  and  the  eruption 
appearing  in  crescentic  clusters,  not  rising  into  visible  pimples ;  from 
scarlet  fever,  by  the  sti-aw^beny  appearance  of  the  tongue,  and  the 
bright  scarlet  efflorescence  of  the  skin,  which  usually  appears  on  the 
second  day  in  the  latter  disease ;  and  from  erysipelas,  by  the  eruption 
or  effloresce i]ce  being  of  a  florid  red  color,  and  spreading  from  a  par- 
ticular point  over  a  large  surface,  in  the  case  of  erysipelas. 

Prognosis. — The,  result  may  be  judged  of  by  the  condition  of  the 
body  at  the  time  of  attack,  and  the  intensity  of  the  fever.  It  is 
generally  favorable  in  the  distinct  and  modified  forms,  and  generally 
unfavorable  in  the  confluent  form.  Dangerous  symptoms  are  the  pus- 
tules becoming  flattened,  livid,  and  interspersed  with  discolored  spots, 
a  sudden  disappearance  of  the  eruption,  general  pallor  of  the  skin, 
with  great  anxiety  and  extreme  prostration  of  strength,  and  complica- 
tions with  local  aflbctions. 

Post-Mortem  Appearances. — After  death,  dissection  has  shown  the 
windpipe,  bronchial  vessels,  lungs,  liver,  stomach,  and  intestines  to  be 
covered  with  pustules,  with  local  inflammations  in  various  organs  ;  the 
whole  body  runs  rapidly  into  putrefaction. 

Causes. — Variola  is  produced  by  a  specific  contagion.  Its  nature 
has  thus  far  eluded  the  recognition  of  our  senses,  and  probably  never 
will  be  detected  by  chemical  analysis.  The  virus  seems  to  act  like  a 
ferment  in  relation  to  some  one  or  more  of  the  elements  of  the  blood, 
analogous  to  the  process  of  saccharine  fermentation.  It  is  produced 
by  subjecting  the  body  to  the  effluvia  arising  ft-om  those  who  already 
labor  under  the  disease,  or  by  introducing  a  small  quantity  of  the  puru- 
lent matter  of  the  disease  into  the  system  by  inoculation.  A  doctrine  haa 
lately  been  started  that  the  changes  efl'ected  in  the  blood  by  the  conta- 
gion of  small-pox  were  a  purifying  process,  analogous  to  the  working 
of  a  barrel  of  beer.     But  the  theory  is  refuted  by  the  fact  that  all  fer 


06  PATHOLOGY    AND    THE  R,-.  PEUTICS. 

mentation  is  a  destructive  process,  absolutely  decomposing  the  saccharine 
and  other  fermented  matter,  and  resolving  it  into  its  ultimate  elements. 

Laws  of  Contagion. — It  is  communicated  by  contact,  or  through  tlie 
atmosphere,  by  pustules,  or  substances  imbued  with  the  variolous  mat- 
ter, %nd  equally  by  the  living  or  dead  body.  It  is  occasionally  epidemic. 
Sometimes,  though  rarely,  it  occurs  twice  in  the  same  pei-son. 

Mortality. — From  the  statistics  which  have  been  collected,  it  appears 
that  one  in  three  or  four  cases  are  fatal.  In  the  modified  form,  or  in 
those  who  have  been  vaccinated,  the  mortality  has  been  much  less — 
about  one  in  twenty'.  The  periods  of  life  of  its  greatest  mortality  have 
been  under  five  and  over  thii'ty  years  of  age;  the  ratio  increasing  below 
and  above  those  ages,  and  being  the  least  between  them. 

Sequelae. — Medical  books  describe  a  long  catalogue  of  diseases  as  the 
consequences  of  small-pox,  some  of  which  are  more  to  be  dreaded 
than  the  disease  itself.  Among  these  are  hoils^  abscesses,  ulcers,  gan- 
grene or  sloughing  of  the  skin,  erysipelas,  suppuration  of  the  joints, 
hip  disease,  ophthalmia,  blindness  from  opacity  of  the  cornea,  inflain- 
mation  of  the  serous  membranes  of  the  chest  and  abdomen,  tuberculated 
\ngs,  consumption,  mesenteric  disease,  and  scrofula.  Some  of  these 
sequelae  doubtless  result  from  frail  organization,  more  from  bad  habits 
ot  living,  and  still  more  from  unfortunate  medical  treatment. 

Prevention. — Physicians  are  not  at  all  agreed  as  to  the  propriety  of 
resorting  to  vaccination  as  a  protection  from  small-pox.  The  vaccine 
virus  is  the  variolous  matter  modified  by  passing  through  the  organism 
of  the  cow,  or  some  other  of  the  domestic  animals ;  hence  the  disease 
resulting  from  its  intioductiou  to  the  human  system  is  called  vaccinia 
or  vacciola,  cow-pox,  kine-pox,  and  vaccine  disease.  There  is  no  ques- 
tion tliat  it  is,  to  a  great  extent,  a  protection  from  the  violence  and 
danger  of  the  natural  small-pox ;  at  the  same  time  there  i:j  danger  of 
inoculating  the  patient  \\nth  some  loathsome  and  even  worse  disease, 
as  venereal,  or  scrofula,  from  the  impossibility  of  always  getting  a  sup- 
ply of  vaccine  matter  from  healthy  constitutions.  In  either  way  there 
is  a  risk  to  incur,  and  it  is  a  delicate  n.atter  for  a  physician  to  advise  on 
n  subject  when  both  sides  are  hazardous.  I  am  fully  convinced  that 
if  people  could  bring  up  their  children  in  strict  physiological  habits, 
the  non-vaccinating  plan  would  be  altogether  the  best;  but  in  a  city 
this  seems  next  to  impossible,  and  in  the  country  it  is  pretty  generally 
neglected.  Children  reared  healthfully  in  relation  to  food,  exercise, 
and  ventilation,  have  little  to  fear  from  any  disease,  however  contagious; 
they  may  have  this,  but  it  will  not  endanger  life,  nor  produce  much 
deformity  nor  serious  injury.  I  have  seen,  withm  the  last  year,  a  most 
horridly  loathsome  case  of  scrofulous  disease,  in  which  the   patient 


FEVERS  97 

iitemlly  rotted  alive  at  the  age  of  fifteen,  from  unhealthy  vhus  received 
wnen  he  was  but  three  years  of  age.  Parents  often  find  some  one 
of  their  children  tainted  with  morbid  humors,  unnke  aiiy  other  metu 
ber  of  the  family,  and  which  they  are  wholly  unable  to  account  for, 
except  on  the  supposition  of  foul  matter  taken  into  the  system  by 
vaccination.  My  own  practice  would  be  to  keep  children  as  healthy 
as  possible,  and  if  the  small-pox  happen  along,  let  it  have  its  natural 
course.  Those  who  have  the  means  to  do  the  same  I  would  advise  to 
act  accordingly,  while  those  who  live,  move,  eat,  and  drink  after  the 
ordinary  manner,  would  have  a  better  chance  at  chances  by  resorting 
to  vaccination. 

Treatment. — As  in  all  fevers,  whether  eruptive  or  not,  the  tempera- 
ture of  the  body  is  the  guiding  principle  in  the  treatment.  To  regulate 
the  temperature  and  equalize  the  circulation,  are  the  leading  indica- 
tions. On  the  access  of  the  febrile  symptoms,  the  bowels,  unless  en- 
tirely free,  should  be  moved  by  tepid  injections.  When  the  fever  is 
fully  developed,  if  the  heat  is  not  great,  tepid  or  cool  ablutions  to  the 
whole  body  will  moderate  it  sufficiently;  if  the  fever  is  severe,  and  the 
heat  extreme,  the  wet-sheet  pack  should  be  resorted  to,  and  resumed 
as  often  as  it  becomes  warm,  until  the  skin  becomes  soft,  and  the  tem- 
perature near  the  natural  standard.  Give  the  patient  as  much  water 
to  drink  as  the  thirst  demands.  Give  no  food  save  Indian  or  wheat- 
meal  gruel,  and  not  that  unless  the  appetite  calls  for  it.  Nursing  chil- 
dren may  take  the  breast  as  usual,  if  inclined.  From  the  second  to 
rhe  fourth  da}^  when  the  efforts  of  the  organism  are  determined  to  the 
^kin  to  produce  the  eruption,  be  cautious  in  meddling  with  the  stomach 
and  bowels.  Thousands  have  been  killed  outright  by  an  emetic  or  strong 
purgative  administered  at  this  critical  period.  At  this  time  all  the  vital 
energies  are  aroused  to  throw  the  virus  off  through  the  surface,  and 
if,  by  an  irritating  emetic  or  cathartic,  this  action  be  repressed,  and  the 
force  or  the  disease  directed  to  the  stomach  and  bowels,  death  may  be 
the  speedy  result.  The  principle  here  involved  affords  a  satisfactory 
explanation  of  the  superior  safety  of  the  homeopathic  treatment,  com- 
pared with  allopathic,  in  all  eruptive  fevers,  as  has  been  frequently 
deraonsti'ated  in  practice  in  the  management  of  scarlet  fever. 

After  the  excessive  febrile  heat  is  subdued  by  ablutions  or  packings, 
two  cool  or  tepid  ablutions  daily,  morning  and  evening,  will  generally 
be  sufficient  through  the  whole  course  of  the  disease.  Should  the  ex- 
tremities at  any  time  become  cold,  bottles  of  hot  water  should  be 
applied.  There  is  often  a  strong  determination  to  the  brain,  evinced 
by  headache,  delirium,  convulsions,  etc.,  when  cold  wet  cloths  should 
be  applied. 

11—9 


98       PATHOLOGY  AND  THERAPEUTICS 

The  secondary  fever  requires  precisely  the  same  medication  as  th» 
primary,  though  if  the  former  has  been  well  managed,  the  latter  give* 
but  little  trouble. 

Ventilation  is  specially  important;  the  patient  should  be  kept  in  a 
large,  well-aired  room,  of  even  and  rather  cool  temperature. 

Various  expedients  have  been  tried  to  mitigate  the  itching  that  often 
attends  the  dessication  of  the  pustules,  as  well  as  to  prevent  pitting  or 
scarring.  None  have,  however,  been  found  of  much  service.  Washing 
the  sores  with  cold  cream  is  as  harmless,  and  probably  as  useful,  as 
any  thing  which  has  been  suggested. 

Note. — The  symptoms  of  small-pox,  in  the  above  article,  are  stated 
as  they  occur  in  patients  who«ie  habits  of  life  pattern  after  the  usual 
feshions  of  society.  The  hydropathic  practitioner  will  often  find  them 
very  materially  modified  in  persons  w^ho  have  for  a  considerable  time 
been  accustomed  to  a  hydropathic  regimen,  especially  in  children  who 
have  been  trained  on  the  principle  of  "  eating  to  live,"  instead  of  that 
of  "living  to  eat."  Indeed,  in  such  cases  many  of  the  symptoms  laid 
down  in  medical  books  as  characteristic  may  be  entirely  wanting.  I 
have  a  case  at  this  wi'iting  under  advisement,  which  sti'ikingly  exem- 
plifies the  difference  between  an  eruptive  fever  occurring  in  a  very 
healthy  or  a  very  unhealthy  person. 

Under  judicious  water-treatment,  this  fi-ightful  disease  becomes  di 
vested  of  most  of  its  terrors,  and  there  is  little  danger,  except  in  a  per- 
son of  extremely  gross  habits  and  foul  blood,  of  the  skin  being  perma- 
nently pitted  or  scaiTed. 

Cow-Pox — KiNE-Pox — Vaccinia — Vaccine  Disease. — The  vac- 
cine matter  is  usually  inserted  'inder  the  cuticle,  by  three  or  four 
punctures,  in  one  or  both  arms.  On  the  second  day  small,  red,  hard 
spots  appear,  which  increase  sensibly  on  the  fourth,  and  on  the  Jifth. 
become  small  pearly  vesicles,  soon  after  surrounded  by  a  i)ink  or  crim- 
son flush.  On  the  seventh  or  eighth  day  the  areola  becomes  circular 
or  angular,  and  about  an  inch  in  diameter.  The  vesicle  is  uneven, 
with  a  centi'al  depression.  On  the  ninth  day  the  flush  is  increased, 
hard,  and  tumid,  often  attended  with  an  erythema  over  the  arm  or 
whole  body.  About  the  tenth  day  there  is  a  slight  febrile  pai'oxysm. 
On  the  eleventh  or  twelfth  day  the  redness  diminishes,  the  center  of 
the  vesicle  is  covered  with  a  brown  scab,  which  comes  oflf  about  the 
twentieth  day,  leaving  a  deep,  circular  indentation,  about  an  inch  in 
diameter,  with  as  many  \  its  as  there  were  cells  in  the  vesicles. 

The  vaccine-virus  is  usually  selected  from  the  fiftt  to  the  twelftl? 
day. 


FEv  ERS.  99 

This  disease  requires  no  medication,  save  what  s  due  to  personal 
cleanliness,  and  "temperance  in  all  things." 

Chicken-Pox  —  Swine-Pox — Bastard-Pox — Varice^lla. — This 
disease  is  characterized  by  slight  feverishness,  followed,  w'ihin  twenty- 
four  hours,  by  an  eruption  of  small,  reddish  pimples,  appearing  first  o» 
the  back,  very  much  resembling  the  first  appearance  of  the  eruption 
of  small-pox.  On  the  second  day,  the  pimples  become  small  vesicles 
filled  with  a  colorless  or  yellowish  fluid ;  soon  after  a  thin  scab  forms 
at  the  top,  without  pus.  About  the  ffth  day  the  eruption  disappears, 
without  leaving  any  mark  or  cicatrix. 

A  daily  wash  of  the  whole  surface  of  the  body,  with  one  or  two 
wet-sheet  packs,  should  there  be  at  any  time  accidental  feverish- 
ness, with  a  spare  vegetable  diet,  is  all  the  remedial  attention  it 
requires. 

Measles — Rubeola — Morbilli. — Nosologists  divide  this  exan- 
them  into  two  species,  the  common  and  the  malignant — rubeola  vuh 
garis  and  rubeola  maligna.  The  first  species  is  the  mild  fornj;  the 
second  is  the  violent. 

Symptoms. — The  early  symptoms  resemble  catarrli,  or  influenza — 
cough,  hoarseness,  difficulty  of  breathing,  frequent  sneezing,  itchinp- 
of  the  face,  smarting  of  the  eyes  ind  eyelids,  nausea,  thirst,  etc.  The 
eruption  first  appears  on  the  fourth  day,  consisting  of  small  red  points 
on  the  face,  thence  extending  d'^nvnw^ard  over  the  body.  These  points 
do  not  rise  into  visible  pimples,  but  are  disposed  in  crescentric  clusters, 
which  feel  a  little  prominent  to  the  touch.  On  the  ffth  or  sixth  day 
the  bright  red  color  changes  to  a  brownish  hue,  and  in  a  day  or  two 
more  disappears  entirely  with  a  mealy  or  furfuraceous  desquamation 
of  the  cuticle. 

The  fever  rather  increases  with  the  eruption,  and  is  attended  with 
pneumonic  symptoms,  as  cough,  soreness  of  the  chest,  and  oppressed 
respiration.  It  usually  abates  considerably  at  about  the  end  of  the  first 
week. 

In  the  malignant  form  the  eruption  is  earlier  and  more  irregular, 
often  receding  and  re-appearing,  and  of  a  dark  or  livid  hue.  The 
febrile  symptoms  are  more  severe,  the  abdomen  is  very  tender,  the 
head  is  delirious  or  comatose,  the  lungs  are  inflamed,  and  diarrhea  and 
convulsions  often  occur. 

Peculiarities  tf  Treatment. — The  mild  form  should  be  treated  on 
prec  sely  the  same  plan  as  simple  inflammatory  fever,  and  the  malig 
nant  form  shoxild  be  managed  exactly  like  typhus  fever  of  the  putrid 


100  PATHOLOG  V    AND   THERAPEUTICS. 

type.  Nothing  brings  out  the  eruption  so  promptly  and  effectually  aa 
the  wet-sheet  pack,  and  at  the  same  time  moderates  all  the  symptoms 
of  violent  disorder  in  the  circulating  and  nervous  sytems.  When  the 
eruption  comes  out  full  and  free,  and  the  fever  is  not  violent,  occasional 
tepid  ablutions  are  sufficient.  When  there  is  much  soreness  of  the 
throat,  several  folds  of  wet  linen  should  be  applied.  Severe  cough, 
pain  in  the  chest,  or  inflammation  of  the  lungs,  requires  the  chest- 
wrapper,  applied  very  wet,  and  well  covered  with  dry  flannel.  Diarrhea, 
when  present,  should  be  treated  with  cool  injections. 

Sequelce. — Under  allopathic  treatment,  this  disease  exhibits  an  appall- 
ing catalogue  of  consequences,  as — Pneumonia^  cynanche  trachealis^ 
bronchitis,  consumption,  chronic  diarrhea,  enlargement  of  the  mesenteric 
glands,  ophthalmia,  abscesses  in  the  ear,  ulceration  of  the  parotid  glands, 
ap)th<s  and  gangrene  of  the  mucous  membrane  of  the  mouth.  I  appre- 
hend that  these  sequelae  are  to  be  attributed,  in  the  main,  to  the  dnig- 
ging  by  which  one  poison  is  atttempted  to  be  got  out  of  the  body  by 
the  introduction  of  a  dozen  othei-s.  It  is  certain  that  measles  has 
been  extensively  treated  in  many  different  places  in  the  Water-Cure 
way;  and  I  have  never  yet  known  nor  heard  of  a  single  death,  nor 
of  one  of  these  resultant  diseases. 

Scarlet  Fever — Scarlatina. — This  exanthem  appears  in  three 
distinct  forms  or  species  :  1.  Scarlatina  siynplex — simple  scarlet  fever. 
2.  Scarlatina  anginosa.     3.  Scarlatina  maligna. 

Symptoms. — After  the  ordinary  premonitory  symptoms  of  general 
fever,  a  bright  scarlet  efflorescence  appears,  usually  on  the  second  day, 
first  on  the  face,  neck,  and  breast,  extending  downward  over  the  trunk 
and  limbs.  At  first  the  eniption  consists  of  innumerable  red  points, 
between  which  the  skin  exhibits  the  natural  color ;  these  spots  finally 
coalesce,  so  that  in  a  few  hours  the  red  flush  s  universal.  On  pressure, 
the  skin  looks  pale,  but  readily  recovers  its  redness  when  the  pressure 
is  removed.  In  one  or  two  days  more  the  eflioresceuce  again  becomes 
partial,  and  is  disposed  in  large,  irregular  patches,  which  do  not  disap- 
pear on  pressure.  The  skin  feels  rough  to  the  touch,  and  is  occasion- 
ally studded  with  small  miliary  vesicles.  About  the  fflh  day  the  rash 
begins  to  decline,  is  indistinct  on  the  sixth,  and  generally  disappears 
wholly  by  the  eighth.  Desquamation  of  the  cuticle  commences  about 
the  end  of  the  fifth  day  on  the  parts  fii-st  affected,  now  extending  over 
the  body.  On  the  trunk  and  .'imbs  the  cuticle  comes  off  in  the  form 
of  scurf,  and  from  the  hands  and  feet  in  large  scales.  At  this  time  the 
mucous  membranes  are  more  or  less  affected.  The  eyelids,  lips,  edges 
of  tlie  tongue,  nos'rils,  and  palate  exhibit  a  bright  red  color,  the  tonsils 


FEVERS.  101 


lire  enlarged,  and  tliere  is  difficulty  in  swallowing.  The  fever  disap- 
pears with  the  rash. 

Such  is  sca-rlet  fever  in  its  mild  form.  The  anginose  variety  is 
characterized  by  more  severe  general  symptoms,  dejection  of  mind, 
pain  in  the  head,  soreness  and  stiffness  of  the  muscles  of  the  neck. 
On  the  second  day,  hoarseness,  difficulty  of  swallowing,  hurried  breath- 
ing, interrupted  by  frequent  sighing,  breath  hot  and  burning  to  the  lips, 
heat  of  the  surface  very  great,  weak  and  frequent  pulse,  pungent, 
prickling  pains.  On  the  third  day  the  face,  neck,  and  breast  appear 
redder  than  usual,  or  scarlet  patches  appear  about  the  mouth  and  nose. 
The  sub-maxillary  glands  are  enlarged  ai;  1  painfiil,  the  palate,  tonsils, 
and  pharynx  are  reddened,  specks  and  collections  of  thick  mucus  are 
observed  about  the  mcuth  and  throat.  In  a  few  hours,  an  intense  red 
ness  prevails  over  the  whole  body,  which  is  perfectly  smooth  to  the 
touch.  On  the  fifth  or  sixth  day  the  deep  scarlet  is  succeeded  by  a 
brown  color,  the  skin  becomes  rough,  and  peels  off  in  small  scales. 

The  malignant  form  has  been  extensively  known  by  the  name  of 
putrid  sore  throat.  It  is  distinguished  by  intense  inflammation  of  the 
throat  at  the  outset,  soon  proceeding  to  deep  ulceration  and  extensive 
sloughing.  All  the  salivary  glands  are  much  enlarged,  the  eruption 
appears  later  in  irregular  patches,  o-ften  disappearing  suddenly.  The 
general  symptoms  are  all  indications  of  the  worst  or  putrid  form  of 
typhus  fever. 

Diagnosis. — Scarlet  fever  may  be  distinguished  from  measles,  by 
the  absence  of  cough,  sneezing,  and  catarrhal  symptoms;  by  the  throat 
affection ;  by  the  peculiar  strawberry  appearance  of  the  tongue,  and  by 
the  greater  extent  and  less  defined  form  of  the  eruption. 

SequelcE. — The  books  give  us  about  as  terrible  a  list  of  diseases  follow- 
ing on  as  the  sequelae  of  the  scarlet  fever,  as  they  do  in  the  case  of  mea- 
sles. In  the  list  are — Anasarca.,  or  general  dropsy,  enlargements  of  the 
joints,  scrofulous  affections,  discharges  from  the  ears,  ulceration  of  the 
glands  of  the  neclz,  ophthalmia,  and  inflammatory  affections  of  the  in- 
ternal viscera.  But,  as  in  the  case  of  measles,  I  regard  these  conse- 
quences as  owing  much  more  to  maltreatment  than  all  other  causes 
put  together. 

Peculiarities  of  Treatment. — The  melancholy  records  of  medita* 
science  affor(3  on  no  page  a  sti"onger  exemplification  of 

"  The  deadly  virtues  of  the  healing  art," 

than  on  that  wherein  is  written  the  management  and  fatality  of  scarlet 
fever.  O  le,  two,  three,  four,  five,  and  even  six  members  of  a  family 
are  sometimes  successively  attacked  anc  successivjply  die — whether  cuj 


102  PATHOLOGY    AND    THERAPEUTICS. 

down  by  the  disease,  or  killed  by  the  lemedies,  or  hurried  to  the  grave 
by  their  combined  power.  Some  iozen  years  ago,  I  knew  a  regular 
physician  to  tueai  his  three  children — all  he  had — with  the  ordinary 
leeching,  puking,  purging,  and  antimonializing  routine,  and  they  all 
died ;  and  I  have  not  the  least  doubt  he  has  treated  all  the  cases  he 
has  had  in  the  same  way  ever  since,  without  even  the  suspicion  that 
there  was  any  possibility  of  a  better  way.  About  fifteen  years  since 
the  disease  prevailed  epidemically  among  children  in  several  places  in 
western  New  York.  I  happened  to  be  acquainted  with  two  physicians 
residing  in  adjoining  towns,  whose  practice  was  somewhat  different. 
One  bled  freely,  and  gave  liberal  doses  of  purgative  medicines.  He 
lost  about  twenty  patients ;  in  several  instances  two,  and  in  two  in- 
stances three  dying  out  of  one  family.  The  other  bled  only  in  a  few 
of  the  milder  cases,  avoided  all  drastic  purgatives,  confining  his  treat- 
ment mostly  to  gentle  laxatives,  simple  diaphoretics,  and  astringent 
gurgles.  This  physician  lost  but  one  case,  although  he  treated  a  larger 
number  than  the  former  one.  Both  physicians  had  their  particular 
friends  and  admirers,  and  I  have  no  manner  of  doubt  the  doctor  who 
lost  twenty  patients  acquired  just  as  much  reputation  as  a  skillful  prac- 
titioner, and  enjoyed  just  as  much  of  the  confidence  of  the  people,  as 
the  doctor  who  lost  but  one  patient;  so  blindly  are  people  wedded  to  a 
routine  in  which  they  have  been  educated. 

The  mild  form  requires  very  little  ti'eatment.  Occasional  ablutions 
of  tepid  water,  or  the  wet-sheet  pack  once  or  twice  a  day,  if  the  fever 
is  high,  with  a  free  injection  of  warm  water  to  clear  the  bowels,  if  the 
abdonitjn  is  constipated,  swelled,  or  painful,  are  sufficient. 

Both  the  anginose  and  malignant  forms  require  careful  manage- 
ment. Employ  the  wet  sheet,  ablutions,  or  tepid  sponging,  according 
to  the  principles  already  stated.  The  feet  generally  incline  to  be  cold, 
and  particular  care  must  be  taken  to  have  them  warm  and  comfortable 
whenever  the  pack  or  any  general  bath  is  resorted  to.  Hot  bottles  or 
hot  foot-baths  answer  this  purpose.  The  throat  is  the  most  endangered 
part;  in  the  anginose  form,  tr.e  swelling  must  be  treated  with  the 
constant  application  of  cold  wet  linen  cloths,  well  but  loosely  covered. 
In  the  malignant,  or  imtrid  form,  the  coldest  water,  or  pounded  ice, 
should  be  frequently  applied  around  the  neck,  and  sips  of  iced-water 
or  bits  of  ice  occasionally  taken  into  the  mouth.  On  the  ^ccess  of  the 
disease  move  the  bowels  moderately  with  warm  v^-ater  injections,  aided 
by  the  drinking  of  warm  w^ater  or  gruel,  if  necessary.  Whenever 
diarrhea  attends,  employ  cold  enema.  Be  careful  and  not  disturb  the 
stomach  and  bowels  during  the  eruptive  effort.  If  there  is  then  great 
a'ckness  or  nausea  apply  very  cold  compresses  to  the  abdomen.     Ex- 


FEVERS.  i03 

cessive  restlessness,  anxiety,  delirium,  or  violent  headache  may  be  best 
relieved  by  a  hot  foot-bath,  with  a  cold  compress  to  the  head,  or,  if  the 
patient  is  able  to  sit  up,  a  warm  hip-bath. 

There  is  often  a  considerable  degree  of  blindness  and  deafness,  aa 
well  as  di.lficult  respiration,  attending  the  swelled  throat;  and  physicians 
and  friends  will  often,  for  these  particular  symptoms,  insist  on  a  little 
leeching,  or  a  mild  emetic,  or  a  smart  cathartic,  or  a  barbaroits  blister. 
They  are  all  bad,  worse,  or  worst.  There  are  states  and  stages  in  a 
severe  case  of  scarlet  fever,  in  which  a  single  dose  of  an  ordinary 
emetic  or  purgative,  or  a  single  bleeding,  would  be  inevitably  fatal;  and 
it  is  to  be  regretted  that  so  few  physicians  can  or  v/ill  understand  this 
fact.  In  scarlet  fever,  as  in  all  the  exanthemata,  there  is  a  period  when 
all  the  vital  powers  combine  in  a  general  effort  to  throw  the  morbid 
virus  and  febrile  irritation  upon  the  surface.  It  is  at  this  precise  time 
that  the  allopath  regards  the  intensity  of  the  fever  as  an  indication  for 
the  lancet,  or  a  relaxing  emetic,  or  a  depleting  purgative.  If  he  em- 
ploys either  of  them  at  this  critical  moment,  he  either  suppresses  this 
effort,  or  produces  a  revulsion  of  the  whole  force  of  the  disease  to  tlie 
internal  raucous  membrane,  resulting,  perhaps  and  probably,  in  inflam- 
mation, disorganization,  and  deatli. 

Dr.  Johnson,  in  relation  to  the  diet  for  scarlet  fever  patients,  says: 
"  If  there  be  appetite,  farinaceous  puddings  should  be  given ;  if  not, 
beef-tea,  mutton-broth,  gi'uel,  barley-water,  etc.  Should  the  eruption 
come  out  languidly,  and  symptoms  of  gi-eat  debility  and  opjiression  set 
in,  no  cold  water  should  be  allowed,  but  the  mutton-brolhs  etc.,  should 
be  given  quite  hot ;  and  ten,  fifteen,  or  twenty  drops  of  aromatic  spirit 
of  ammonia,  in  water,  twice  a  day;  and  hot  tea  should  be  administered 
while  lying  in  the  wet  sheet."  I  protest  against  this  whole  plan  of 
medication  as  being  neither  hydropathic  nor  rational.  Nothing  can  be 
more  preposterous  than  forcing  food,  especially  stimulating  animal 
slops,  into  the  stomach,  during  a  high  fever,  when  the  digestive  powers 
are  utterly  prostrated.  In  lieu  of  the  hot  tea,  hot  brotli,  and  hot  spirit 
recommended  by  Dr.  Johnson,  the  warm  foot-bath,  or  hot  fomentations 
to  the  abdomen,  will,  in  the  case  supposed,  supersede  all  necessity  of 
employing  these  slop-drug  preparations,  as  has  been  abundantly  proved 
in  the  thousands  of  cases  of  this  fever  which  have  been  successfully 
ti'eated  by  American  hydropaths,  without,  as  far  as  I  have  heard,  los- 
ing a  single  case  when  no  drugs  or  animal  slops  were  employed. 

Erysipelas — St.  Anthony's  Fire. — This  affection  has  been  di- 
vided into  idiopathic  erysipelas,  produced  by  the  general  causes  of  fever, 
and  traumatic  erysipelas,  resulting  from  wounds  and  injuries.     The 


104  PATHOLOGY    AND     THERAPEUTICS. 

latter  species  frequently  follows  surgical  operations  performed  on  per- 
sons whose  systems  are  gross,  and  whose  blood  and  secretions  are  very 
impure.    For  therapeutic  purposes  these  distinctions  are  unimportant. 

Sympto?ns. — After  the  usual  febrile  chills,  nausea,  vomiting,  etc.,  the 
patient  is  affected  v.'itl:  great  confusion  of  the  head,  amounting  often  to 
delirium  or  coma;  the  tongue  is  moist,  and  uniforndy  white ;  the  pulse 
fiiU,  frequent,  and  compressible.  About  the  second  or  third  day,  some 
portion  of  the  skin  exhibits  a  florid  reo  color,  from  which  the  elSores- 
cence  spreads  gradually,  being  bounded  by  a  distinct  margin,  slightly 
elevated.  The  efflorescence  extends  until  it  occupies  a  large  surface, 
attended  with  considerable  swelling,  and  a  peculiar  acrid  heat  of  the 
inflamed  parts.  When  the  face  is  the  part  principally  affected  by  the 
eftlorescence,  the  eyes  are  often  closed  bj'  the  swelled  eyelids,  and  the 
whole  hairy  scalp  is  more  or  less  inflamed.  The  efflorescence  termi- 
nates in  a  few  days,  the  time  varying  considerably',  in  the  formation  of 
vesicles,  or  in  desquamation  of  the  cuticle.  The  fever  has  the  usual 
daily  exacerbations  of  the  continued  t^pe,  but  rarely  manifests  any 
marked  remission  until  the  eruption  ceases  to  spread,  from  which  time, 
in  favorable  cases,  convalescence  commences. 

Special  Causes. — No  two  diseases  are  more  intimately  connected 
with  bad  dietetic  habits  than  erysipelas  and  scarlet  fever.  Both  are 
very  prevalent  where  swine-food,  greasy  sweet-cakes,  and  concentrated 
preparations  of  food  are  plentiful.  Sudden  changes  of  temperature 
operating  on  a  system  inflamed  by  gross  or  obstructed  by  constipating 
aliment,  seem  to  be  the  principal  circumstances  on  vrhich  these  forms 
of  eruptive  fever  depend. 

Occasional  Terminations. — This  disease,  medical  books  tell  us,  oil  en 
terminates  in  a  dropsical  sw^elli.ng — erysipelas  ctdemawdes ;  deep-seated 
ulceration  of  the  cellular  membrane — erysipelas  gangrenosum,  metas- 
tases to  internal  organs  ;  and  sometimes  it  suddenly  disappears  in  one 
ptu't,  and  attacks  a  distant  one — erysipelas  erraticum.  These  sequela?, 
however,  like  those  of  all  the  other  exanthemata,  are,  to  a  much 
gi'eater  extent,  attributable  to  injudicious  h'eatment,  or  drug-ti'eatment, 
than  to  all  other  causes  combined. 

Peculiarities  of  Treatment. — As  in  the  case  of  all  the  other  eruptive 
fevers,  the  general  fever  and  the  local  inflammaticn  may  exhibit  all 
degrees  of  violence  and  malignancy,  from  the  mildest  form  of  synochus, 
or  inflammatory  fever,  to  the  most  virulent  character  of  ts'phus ;  hence 
the  circumstances  already  noticed  in  relaticn  to  those  fevers  must  bo 
regarded  in  the  treatment  of  this.  Generally,  the  head  requires  rlie 
very  free  application  of  the  coldest  wet  cloths,  or  the  pouring  head- 
bath ;  and  very  frequenlH    .he  feet  are  coo   or  cold,  and  require  the 


FEVERS.  106 


warm  bath.  In  the  early  stages  of  most  cases,  two  v.r  three  wet-sheet 
packs  a  day  are  desirable ;  but  when  the  fever  is  sti'ongly  typhoid,  the 
pulse  weak,  the  circulation  low,  and  the  heat  UTegular,  it  is  better  to 
sponge  the  whole  surface  frequently  with  tepid  water.  Tepid  injections 
should  lie  employed  freely  on  the  access  of  the  disease,  but  not  resorted 
to  during  the  eruptive  stage,  on  the  second  or  third  day,  unless  there 
is  manifest  fullness  and  distension,  indicative  of  foecal  accumulations  in 
the  bowels. 

Dr.  Johnson  ad\ises,  in  this  disease,  the  wet  sheet  occasionally,  and 
a  nitrate  of  silver  wash,  or  a  coating  of  flour  to  the  skin,  a  dose  ot 
castor  oil,  and  then  quinine  and  sulphuric  acid  once  in  six  hours.  Such 
treatment  is  sufficiently  absurd,  coming,  as  \%  does,  from  the  author  of 
a  book  on  "Domestic  Hydropathy;"  but  the  absurd  becomes  the  ridic- 
ulous Avhen  we  come  to  Dr.  Johnson's  dietaiy  part  of  the  treatment, 
viz. :  Strong  l)eef-broth,  thickened  with  pearl  barley ;  yolk  of  eggs 
beaten  up  v/ith  milk,  and  a  little  wine  and  nutmeg  added  ;  sago,  with  a 
little  wine  in  it;  cold  beef-tea,  or  cold  mutton-broth,  as  common  drink." 

The  only  way  to  reconcile  Dr.  Johnson's  extreme  allopathic  treat- 
ment of  this  fever,  with  his  extravagant  encomiums  of  the  superior 
efficacy  of  water-treatment  in  all  fevers,  in  a  preceding  work,  is  by 
supposing  he  never  had  any  experience  in  treating  erysipelas  with 
water;  and  hence,  as  something  must  be  prescribed,  he  naturally  falls 
back  on  druggery.  His  reasons  for  introducing  the  drug-treatment 
here  are  completely  self-stultifying.  He  says  :  "The  weight  of  expe- 
rience is  in  favor  of  quinine,  and  I  should  not  consider  myself  justifiable 
in  rejecting  its  aid,  merely  to  gratify  the  pride  of  an  exclusive  practice. 
*  *  *  Human  life  is  too  precious  a  thing  to  be  trifled  with  merely 
to  satisfy  an  impertinent  w^him,  or  foolish  enthusiasm." 

Now,  if  the  principle  implied  in  the  above  quotation  is  correct — if  it 
be  true  that  drug-treatment  will  save  life  in  a  fever  where  water-ti'eat- 
ment  would  sacrifice  it,  the  whole  hydropathic  system  is  one  gi-and 
mistake,  and  its  practice  mere  charlatanry.  But  if  the  exact  contrary 
be  the  truth,  as  I  hold,  then  Dr.  Johnson's  druggeiy,  in  scarlet  fever 
and  erysipelas,  is  considerably  worse  than  scientific  nonsense.  Amer- 
ican water-doctors  find  the  new  system  as  all-sufficient  in  these  as  in 
all  other  forms  of  fever.  None  of  them,  however,  to  my  knowledge, 
have  ever  administered  the  execrable  slop-grog  food,  of  eggs,  wine, 
nutmeg,  mutton-water,  etc.  I  would  rather  trust  the  patient  with  no 
medication  whatever,  than  with  the  best  water  or  drug-treatment,  in 
connection  with  such  a  regimen  as  Dr.  Johnson  recommends. 

r^IiT.  ARY  Fever— Miliaria  —  I'his  disease  tak^  its  name  from  the 


J06  PATHOLOGY    AND    f  HE  K  A  PE  UTIC  S. 

resemblapce  of  its  vesicles  to  the  gi'ains  of  millet.  Some  authors  gi'oup 
a  variety  of  similar  rash-exanthems  under  the  general  term  of  miliaria. 
An  einiption  similar  to  that  of  miliary  fever  often  appears  in  the  course 
of  other  acute  diseases,  when  the  patients  have  been  kept  in  hot,  un- 
ventilated  apartments,  or  dosed  excessively  with  hot  stimulating  drinks. 
Lying-in  women  are  peculiarly  liable  to  this  miliary  eruption,  under 
the  usual  erroneous  management  of  their  medical  advisers.  This  fever 
occurs  most  frequently  in  those  females  who  use  tea  excessively ;  it 
often  attacks  children  who  have  been  accustomed  to  hot  drinks  and  ali- 
ments; and  old  persons  whose  blood  is  inflamed,  and  whose  nerves  are 
exhausted  by  acrid  stimulants  ana  narcotics — as  cider,  tobacco,  etc. — 
are  quite  liable  to  it. 

Symptoms. — With  the  ordinary  accessory  symptoms  of  fever,  there 
is  laborious  breathing,  frequent  sighing,  gi'eat  debilit}%  depression  of 
spirits,  restlessness,  wandermg  pains,  followed  sooner  or  later  by  a 
profuse  sweat,  of  a  sour,  rank  odor,  accompanied  with  a  troublesome 
itching  or  pricking  of  the  skin.  The  sweat  may  appear  in  two,  three, 
four.  Jive,  or  six  days.  At  length,  at  an  uncertain  period,  an  eruption 
appears  on  the  neck  and  breast  of  small  red  papulae,  about  the  size  of 
millet-seeds,  these  gradually  extend  downward,  over  the  ti'unk  and 
extremities.  The  pimples  do  not  become  prominent  to  the  eye,  yet 
feel  elevated  to  the  touch.  Often  their  redness  disappears,  leaving 
them  of  the  color  of  the  skin.  After  ten  or  twelve  hours,  a  small  ves 
icle  appears  upon  the  top  of  each  papula,  at  first  of  a  whey  color, 
usually  turning  gradually  white.  Sometimes  the  vesicles  remain  red, 
and  sometimes  red  and  white  vesicles  are  intermixed,  but  always  have 
a  strong,  rank,  offensive  smell.  In  two  or  three  days  more  the  vesicles 
break,  and  are  succeeded  by  small  crusts,  which  soon  fall  off  in  scales. 
The  febrile  symptoms  do  not  subside  when  the  eruption  appears,  but 
after  a  variable  interval. 

Diagnosis. — Miliary  fever  is  easily  distinguished  from  all  others  by 
the  profuse  sweating  attended  with  the  fetid  odor,  and  this  being  fol- 
lowed by  the  peculiar  eruption. 

Peculiarities  of  Treatment. — As  miliary  fever  is  attended  with  un- 
usual debility  in  it3  early  stages,  cool  or  tepid  applications  are  preferable 
to  very  cold.  Hot  or  cold  local  applications,  according  to  the  rules 
often  heretofore  adverted  to,  with  frequent  sponging  of  the  whole 
surface,  according  to  the  degree  of  general  heat,  are  usually  all  the 
bathing  appliances  required.  Unless  there  is  diarrhea,  the  bowels 
should  be  freely  moved  by  tepid  injections  at  the  outset.  Local  pains 
should  be  promptly  treated  with  the  cooling  oi  warming  wet  compress, 
as  eithei"  feels  most  agi-eeable  to  the  patient      When  this  fever  hai 


FEVERS.  107 

6een  produced  by  the  suppression  of  any  custo  «ary  discharge,  warm 
hip  and  warm  foot-baths  are  serviceable. 

Note. — Some  authors  treat  of  "gas^n'c,"  '■'-mucous,^''  and  ^'' catarrliaV^ 
fevers.  These  are  merely  complications  of  some  of  the  forms  of  fever 
already  described,  with  prominent  symptoms  of  indigestion,  or  an  in- 
creased and  excessive  secretion  of  a  slimy  or  mucous  matter,  from 
acrid  bile  or  some  other  irritant,  or  the  usual  evidences  of  what  is 
called  a  "  cold  in  the  head."  Sometimes  these  local  irritations  are 
attended  with  such  a  degree  of  constitutional  febrile  disturbance  as  to 
receive  the  above  appellations. 

Plague — Typhus  Pestis. — The  plague  was  first  known  in  English 
history  in  430,  and  lastly  in  1G79.  In  302  it  raged  over  Syria.  In 
540,  and  for  half  a  century  afterward,  it  prevailed  extensively  over 
Europe  and  Asia.  Since  1645,  when  it  last  visited  Edinburgh,  it  has 
repeatedly  ravaged  all  the  continent  of  Europe.  Marseilles  was  ravaged 
hy  it  in  1720,  and  in  the  course  of  the  seventeen  preceding  centuries, 
it  experienced  twenty-seven  visitations.  It  prevailed  at  Moscow  in 
1771  and  1772;  at  Noja,  in  1815  and  1816;  in  the  lazaretto  of  Venice 
in  1818;  at  Malta,  in  1813;  and  at  Gressemberg,  in  Silesia,  in  1819. 
Lately  it  has  been  confined  to  the  northern  parts  of  Africa,  where  it  ia 
reputed  to  have  originated. 

The  history  of  the  plague,  like  that  of  the  cholera,  is  a  tremendous 
lesson,  whose  true  moral  is  hygiene,  unfortunately,  however,  but  little 
understood,  and  still  less  heeded.  Wherever  and  whenever  it  has 
raged,  the  place  and  the  people  were  buried,  as  it  were,  in  their  own 
filrhiness,  and  rioting  in  the  grossest  sensuality.  The  narrow  streets, 
dirty  houses,  unventilated  apartments,  and  gross  food  of  the  inhabitants, 
with  drunkenness  and  debauchery,  have  ever  been  the  inviting  causes 
of  this  pestilence  in  all  the  cities  of  the  Old  World  where  it  has  ravaged 
and  desolated.  Athens,  Rome,  London,  which  were  formerly  more 
than  at  present,  the  world's  great  centers  of  luxury  and  licentiousness, 
have  been  repeatedly  scourged  with  this  prince  of  pestilences.  Since 
the  habits  of  the  civilized  world  have  become  more  cleanly,  yet  more 
debilitating,  we  have  internal  dyspepsias  instead  of  external  carbuncles, 
and  the  cholera  instead  of  the  plague. 

The  character  of  the  plague  is  that  of  a  malignant  exanthein ;  a 
typhus  fever  of  the  putrid  form,  attended  with  carbuncular  and  imper- 
fectly suppurating  tumors,  sometimes  running  into  deep  gangrenous 
ulcers,  the  patient  often  feeling  as  if  burning  up  with  internal  fire. 
The  treatment,  on  hydropathic  principles  should  be  the  same  as  for 
the  putrid  form  of  typhus  fever. 
9 


108  PATHOLOGY    AND   THERAPEUTICS. 


CHAPTER  II. 

VISCERAL   INFLAMMATION. 

In  this  chapter,  I  purpose  to  treat  ouly  of  acute  iuflammatory  affec- 
tions of  the  viscera.  They  are  all  characterized  by  a  tixed  paiu  or 
soreness,  and  sense  of  heat  in  the  organ  diseased,  with  a  change  in  its 
secretory  or  functional  action,  and  attended  by  a  constitutional  febrile 
disturbance.  The  accompanying  fever  may  be  either  of  the  inflam- 
matory or  typhoid  type.  A  visceral  inflammation  may  be  defined  a 
general  fever  with  a  disproportionate  local  affection.  This  class  of  dis- 
eases is  almost  universally  treated  by  allopathic  physicians  on  the  anti- 
plilogistic  plan — bleeding,  salts,  antimony,  and  a  reducing  regimen. 

The  gi'oup  of  disease*  naturally  associated  under  this  head  comprises 
the  following  species : 

1.  Inflammation  of  the  Brain Phrenitis. 

2.  "  Pharynx Quiusy. 

3.  "  Larynx Laryngitis. 

4.  "  Trachea Croup. 

5.  *'  Pai'otid  gland  .  .Mumps. 

6.  "  Lungs Pneumonia. 

7.  "  Heart Carditis. 

8.  "  Stomach Gastritis. 

9.  "  Bowels Enteritis. 

10.  "  Peritoneum  ...Peritonitis. 

11.  "  Liver Hepatitis. 

12.  "  Spleen Splenitis. 

13.  "  Kidneys Nephitis. 

14.  ♦'  Bladder Cystitis. 

15.  "  Uterus Hysteritis. 

16.  ♦'  Testes Orchitis. 

It  is  true  that  otitic  (acute  inflammation  of  the  ear),  oplithabniti* 
(acute  mflammation  of  the  eye),  and  dysentery  (an  acute  inflammatio« 
of  the  mucous  membrane  of  the  bowels),  belong  pathologically  to  this 
group;  but  each  possesses  so  many  peculiarities,  that  system  may  be 
advantageously  sacrificed  to  convenience  ;  hence  they  will  be  treated 
of  in  subsequent  chapters. 

Theory  of  Inflammatio.n. — Next  tc  fever  the  subject  of  inflam* 


VISCERAL    INFLA-JMATION.  109 

niatiou  has  occupied  the  attention  and  exercised  the  ingenuity  of  med- 
ical scholars.  But  still  we  have  no  satisfactory  explanation  of  the 
proximate  cause  of  its  various  phenomena.  Two  theories  are,  at  the 
present  time,  about  equally  prevalent  in  medical  schools,  one  of  which 
is,  singularly  enough,  the  exact  opposite  of  the  other.  But,  stranger 
still,  some  of  our  popular  medical  authors  who  are  diametrically  opposed 
to  each  other  in  theory  agree  exactly  in  practice ;  while  others  who 
agree  exactly  in  theory  are  diametrically  opposed  in  practice.  These 
facts  alone  are  sufficient  to  prove  the  whole  pretended  science  of  the 
popular  system  a  mere  hypothesis,  and  the  whole  drug-practice  a  mere 
experiment. 

To  illustrate :  one  theory  of  inflammation  is,  that  it  consists  essen 
tially  in  an  increased  action  of  the  capillary  vessels  of  that  part  which 
is  the  seat  of  it ;  and  the  other  is,  that  it  consists  in  a  diminished  ac- 
tion of  the  same  vessels.  Now,  it  would  seem  that  these  theories  are 
distinctive  enough  to  authorize  opposite  plans  of  treatment.  But  it 
does  not  so  happen.  Medical  reasoning  is  a  pro'cess  sui  generis.  The 
most  contradictory  conclusions  are  often  drawn  from  the  same  prem- 
ises, and  the  same  conclusion  is  often  deduced  from  the  most  opposite 
premises.  All  medical  books  extant  of  the  allopathic  school  "  agree  to 
disagree"  in  this.  They  all  recommend  hoth  stimulating  and  reducing 
treatment  for  all  forms  of  inflammation,  whichever  theory  they  adopt. 
If  a  person  has  inflammation  of  the  head,  lungs,  liver,  joints,  etc.,  with 
a  full,  strong,  hard  pulse,  they  say,  "  bleed,  because  it  reduces  the 
strength  of  the  system,  and  abates  the  force  of  arterial  action."  If  an- 
other has  inflammation  of  the  same  parts,  with  a  weak,  frequent,  op- 
pressed pulse,  they  still  say,  "  bleed,  because  it  strengthens  the  vessels 
by  taking  ofl*a  part  of  the  load  they  have  to  carry.''  So,  whether  the 
action  is  high  or  low,  strong  or  weak,  bleeding  is  the  remedy.  The 
theory  and  the  practice  have  really  nothing  to  do  with  each  other  on 
the  depleting  plan.  Nor  is  there  a  better  connection  between  theory 
and  practice  on  the  stimulating  plan.  In  many  forms  of  gout  and 
rheumatism,  in  dysenteric  inflammation,  in  burns  and  scalds,  etc.,  stim- 
ulants are  recommended  by  many  authors,  as  cayenne,  opium,  oil  tur- 
pentine, camphor,  brandy,  nitrate  of  silver,  spirits  of  nitre,  mustard, 
etc.  Why?  " Because,"  say  the  theorists  on  the  side  of  increased 
action,  "the  action  of  the  capillaries  has  been  preternaturally  aug- 
mented, and  we  must  let  the  action  down  gradually,  by  applying  stim- 
ulants of  a  less  intensity  than  the  proximate  causes  of  the  diseased 
action ;"  and  on  the  other  hand,  the  theorists  on  the  side  of  decreased 
action  say,  "  give  stimulants,  because  the  action  of  the  capillaries  has 
been  preter  laturally  diminished,  and  thus  excite  them  to  gi'eater  ac- 
10 


110  PATHOLOGY    AND    CHER APEUTICS. 


tion."  Such  is  the  confusion  in  which  the  whole  subject  of  inflamma 
tion  is  involved — a  confusion  which,  to  my  mind,  is  conclusive  that  both 
theories,  and  all  the  practices  predicated  upon  them,  are  radically 
erroneous. 

RATioiVALE  OF  IiNFLAMMATiON. — Experiments  have  amply  demon- 
strated the  fact,  that  the  vessels  in  an  inflamed  part  are  distended  with 
blood  beyond  their  normal  condition,  anj  that  the  blood  in  them  moves 
slower  than  in  health.  As  far,  then,  as  increased  or  diminished  action 
is  concerned,  the  latter  theory  seems  plausible  ;  and  all  the  conflicting 
methods  of  medication  appear  to  aim  at  producing,  directly  or  indi 
rectly,  one  single  effect,  viz.,  conti-action  of  the  coats  of  the  over-dis- 
tended vessels.  For  this  purpose  the  most  opposite  agents  and  pro- 
cesses are  resorted  to ;  the  blood  taken  out,  or  brandy  administered, 
hot  fomentations  employed  or  ice  applied,  refrigerating  nitre  or  scorch- 
ing capsicum  exhibited. 

There  is,  undoubtedly,  in  the  early  stage  of  inflammation,  an  in- 
creased contractile  effort  of  the  capillaries,  but  accumulation  and  en- 
gorgement with  relaxation  soon  become  their  permanent  condition. 
This  temporarily  increased  action  cannot,  therefore,  be  regarded  as 
the  proximate  cause  of  inflammation,  but  as  the  effort  of  nature  to 
overcome  its  cause  or  counteract  the  effects. 

Inflammation,  as  well  as  fever,  is  the  effort  of  the  vital  powers  to 
protect  the  organism  from  injurious  mechanical,  chemical,  or  vital  ir- 
ritants, or  to  expel  morbific  materials.  This  is  proved  by  the  phenom- 
ena of  a  multitude  of  morbid  conditions.  When  a  pai't  of  the  body 
becomes  gangrenous  or  dead,  the  Uving  parts,  provided  there  is  suffi- 
cient vitality  remaining  in  them,  immediately  form  a  line  of  demarka- 
tion,  and  the  dead  portion  is  soon  separated  from  the  living;  this  pro- 
cess is  called  sloughing.  When  a  chemical  or  mechanical  body  is 
imbedded  in  the  flesh  too  firmly  to  be  removed  by  absorption,  as  a  bul- 
let or  a  splinter,  purulent  matter  is  ^ormed  around  it,  and  its  further 
action  on  the  parts  is  partially  or  wholly  prevented  by  inclosing  it  in  an 
abscess.  When  a  grain  of  calomel  gets  into  the  lacteal  vessels,  the 
mesenteric  glandg,  which  may  be  regarded  as  organic  inspection  offices, 
receive  an  increased  determmation  of  blood,  swell  up,  or  inflame,  and 
thus  retard  the  conti-aband  article,  until  it  can  be  more  or  less  modified 
or  destroyed  by  the  vital  powers.  When  a  structure  is  divided,  as  by 
an  incised  wound,  coagulable  lymph  is  poured  into  the  wound,  form- 
ing,  as  it  were,  a  bed  for  the  uewl}' -formed  vessels  to  re-unite  the  part 
— a  process  called  adhesive  inflammation.  And  when  a  portion  of  the 
flesh  is  torn  away  b)'  violence,  or  decomposed  by  corrosives,  or  burned 


vikSCeral  inflammation  111 


out  with  fire,  a  covering  of  purulent  matter  is  thrown  over  the  exposed 
surfoce,  beneath  which  granulations — a  new  growth  of  substance — 
gradually  fill  up  the  cavity;  this  process  is  called  in  medical  books 
healthful  or  restorative  inflammation. 

Varieties  of  Inflammation. — Various  circumstances  conspire  to 
modify  inflammatory  affections  so  much  as  to  allow  of  their  division 
mto  several  well-marked  and  distinctive  kinds.  Peculiarity  of  consti- 
tution, the  structure  of  the  part  or  organ,  the  nature  and  violence  of 
the  predisposing  and  exciting  causes,  are  the  most  prominent  of  these 
circumstances.  Inflammation  tending  to  suppuration  in  a  defined 
limit,  as  in  the  case  of  boils,  abscesses,  etc.,  is  called  phlegmonous. 
That  form  which  is  attended  with  eruptions,  efflorescences,  rashes, 
extensive  ulcerations,  rapidly-spreading  gangi'ene,  etc.,  is  called  ery- 
sipelatous, or  erythematous.  When  it  tends  to  the  formation  of  a  pre- 
ternatural membrane  over  tlie  mucous  surface,  as  in  croup,  tubular 
diarrhea,  catarrh  of  the  bladder,  latarrh  of  the  uterus,  etc.,  it  is  called 
membranous,  or  membranijic.  When  it  affects  mainly  the  glandular 
structures  and  mucous  or  seicis  membranes,  without  febrile  symp- 
toms in  the  early  stages,  as  in  tubercular  consumption,  internal  dropsy  of 
the  head,  and  swellings  of  the  conglobate  glands,  it  is  called  strumous, 
or  scrofulous.  When  confined  mostly  to  the  structures  of  the  joints, 
as  in  gout  and  rheumatism,  it  is  called  arthritic. 

Inflammation  is  also  divided  into  acute,  subacute,  and  chronic.  The 
first  is  attended  with  general  fever ;  the  second  is  accompanied  with 
occasional  febrile  paroxysms ;  the  last  is  without  constitutional  febrile 
disturbance. 

Terminations  of  Inflammation. — All  inflammatory  affections  ter- 
minate either  in  resolution — a  gradual  subsidence  of  all  the  symptoms ; 
or  in  gangrene — the  death  of  the  inflamed  part.  But  there  are  many 
results  or  consequences  of  inflammation  which  are  usually  called 
terminations  by  medical  authors.  These  are  exudation  or  effusion, 
supjjuration,  ulceration,  induration,  and  adhesion. 

General  Treatment  of  Inflammation. — The  hydropathic  man- 
agement of  a  visceral  or  local  inflammation  is  precisely  the  same  as 
that  of  a  general  fever,  with  the  addition  of  the  local  appliances.  The 
heat,  pain,  swelling,  and  all  incidental  accompaniments,  are  to  be  treat- 
ed exactly  as  W3  would  treat  the  same  symptoms  when  present  as 
complications  of  a  simple  fever  The  regii  len  is  also,  in  all  respects, 
the  same  as  for  simple  fevers. 


112  PATHOLOGY    AND     I'll  ERAPEU  TICS. 

1nflam3iation  of  the  Br.ux — PiiREMTis — Brain  Fever. — This 
disease  is  also  sometimes  called  'phrensy.  Some  authors  distinguish  it 
into  two  forms — encephalites^  when  it  aflects  principally  the  substance 
of  the  brain  ;  and  meningitis^  when  it  affects  principally  its  investing 
membranes ;  but  as  the  disease,  whichever  structure  is  primarily  af- 
fected, soon  involves  both,  and  as  the  treatment  is  in  all  respects  the 
same,  according  to  the  viAence  of  the  symptoms,  this  distinction  has 
no  practical  utility. 

Symptoms. — Acute  or  excruciating  pain  in  the  head,  tlirobbing  of 
the  temporal  and  carotid  arteries,  flushed  face,  eyes  injected  and  bril- 
liantly reddish,  conti'acted  pupil,  and  a  wild  expression  of  countenance, 
characterize  the  disease  when  fully  formed.  These  symptoms  are 
preceded  by  various  cerebral  and  febrile  disturbances,  sometimes  vio- 
lent delirium,  at  other  times  nausea  and  vomiting,  or  general  con- 
vulsions. The  bowels  are  usually  extremely  costive.  There  is  abo 
great  intolerance  of  light  and  sound,  incessant  watchfulness,  the  skin  is 
dry  and  hot,  the  pulse  hard  and  quick,  the  tongue  is  dry  and  covered 
with  a  white  fur,  and  there  is  intense  thirst. 

Special  Causes. — Exposing  the  head  to  a  hot  vertical  sun,  violent 
exercise,  intense  study,  excessive  passion,  external  violence,  metastatic 
gout  or  rheumatism,  and  repelled  eruptions,  are  among  the  most  fre- 
quent of  the  exciting  causes. 

Diagnosis. — Inflammation  of  the  brain  resembles,  in  many  promi- 
nent symptoms,  several  other  complaints,  from  which  it  is  indispensable 
to  distinguish  it.  From  mania,  it  is  known  by  the  accompanying  fever; 
from  the  delirium  of  injiammatory  fever,  by  the  delirium  in  the  latter 
case  succeeding  instead  of  preceding  the  febrile  symptoms ;  from  the 
delirium  of  typhus,  by  the  suddenness  of  its  attack;  from  the  cerebral 
irritation  or  determination  to  the  brain  arising  from  the  effects  of  loss 
of  blood,  by  the  pallor  of  the  skin  and  countenance  in  the  latter  case ; 
and  from  delirium  tremens,  by  the  pallor  of  the  surface  and  general 
ti'emor  of  the  body  and  limbs  which  denote  the  latter. 

Peculiarities  of  Treatment. — In  most  cases,  inflammation  of  the 
Drain  is  attended  with  synochus,  or  high  fever,  and  requires  thorough 
general  and  local  cold  treatment.  The  immersion-bath  is  excellent; 
or  the  patient  may  be  enveloped  in  double  or  treble  wet  sheets,  while 
the  head  is  cooled  with  pounded  ice,  cold  cloths,  or  the  pouring-bath. 
The  extremities  must  be  carefully  watched,  and  if  the  feet  are  not  hot, 
like  the  rest  of  the  body,  they  should  be  bathed  in  warm  water.  The 
constipated  state  of  the  /.owels,  of  course,  requhes  copious  tepid  injec- 
tions. In  some  cases  where  the  whole  scalp  feels  excessively  sore  and 
Lender,  cold  water  feels  disagi-eea  ^le.  and  then  tepid  water  is  iT)or« 


VISCERAL    INFLAMMATION.  118 

soothing,  and,  by  more  rapid  evaporation,  will  cool  the  head  as  effectu- 
ally as  the  cold  water  will  in  other  cases.  If  a  single  sheet  is  employed 
for  packing,  it  wiL  require  to  be  renewed  several  times  a  day. 

Inflammation  oi  the  Throat — Quinsy. — Under  this  head  are 
included  four  distinct  forms  of  inflammation  of  the  throat,  all  of  which 
are  characterized  by  heat,  redness,  and  swelling  of  the  fauces,  with 
painful  and  difificult  deglutition. 

Symptoms. — The  first  form  of  the  disease  under  consideration  is  the 
cominon  quinsy,  or  tonsillitis  of  authors,  called  also  cynanche  or  migina 
in  medical  books.  It  consists  of  a  swelling  of  the  mucous  membrane 
of  the  fauces  and  tonsils,  by  which  the  functions  of  swallowing,  respira- 
tion, and  speech  are  performed  with  gi'eat  pain  and  difficulty;  the  ac- 
companying fever  is  violent,  and  the  disease  terminates  in  a  few  days 
by  resolution  or  suppuration.  The  second  form  is  known  as  the  malig- 
nant, or  ulcerated  sore  throat.  The  attending  fever  is  typhoid;  the 
fauces  exhibit  i  crimson  flush,  with  ulcerations  covered  with  mucus, 
and  spreading  sloughs,  of  an  ash  or  whitish  hue.  This  form  is  fre- 
quently epidemic.  In  the  third  variety,  the  redness  is  more  florid, 
and  is  most  violent  at  the  lo\ver  part  of  the  fauces ;  the  swallowing  is 
extremely  painful  and  difficult.  The  fourth  variety  has  been  called 
quinsy  of  the  oesophagus ;  the  difficulty  in  swallowing  is^felt  below  the 
pharynx,  and  the  food  is  generally  rejected  when  it  reaches  the  seat 
of  obstruction. 

Special  Causes. — All  of  these  forms  of  throat  disease  are  most  com- 
mon in  spring  and  fall,  Vv'hich  fact  shows  that  sudden  changes  of 
weather,  or  "taking  cold,"  are  their  principal  exciting  causes. 

Peculiarities  of  Treatment. — The  wet  compress,  consisting  of  several 
folds  of  linen  wet  in  cold  water,  must  be  promptly  applied  around  the 
throat,  and  frequently  renewed.  The  whole  body  must  be  well  rub- 
bed in  the  dripping  sheet,  or  tepid  half-bath,  and  then  wrapped  in  the 
dry  blanket,  so  as  to  produce  moderate  perspiration ;  or  the  general 
fever  may  be  treated  with  the  wet-sheet  pack.  In  the  malignant  form, 
small  draughts  of  iced-water  should  be  frequently  taken,  and  the  coldest 
water,  or  pounded  ice,  applied  to  the  throat  whenever  the  morbid  heat 
is  troublesome. 

Inflammation  of  the  Lar-ynx — Laryngitis. — This  disease,  in 
some  of  its  symptoms,  resembles  quinsy,  and  in  a  still  greater  number, 
the  croup.  It  consists  in  a  suppurative  inflammation  of  the  membranes 
of  the  larynx,  extending  backward  to  the  membrane  common  to  itself 
an  3  the  ,«sophagu3,  be:v^een  which  purulent  matter  is  often  formed 


!U      PATHOLOGY  AND  THERAPEUTICS. 


[t  is  a  disputed  point  wbrther  Wasliiugton,  in  his  last  illness,  was 
attacked  with  this  disease  or  common  quinsy;  but  it  is  certain  that  he 
died  of  antimony  and  the  lancet! 

Symjitoms. — After  the  ordinal  /"  symptoms  oi  fever,  the  voice  be- 
;;omes  hoarse  and  indistinct;  the  breathing  labc nous,  with  a  painful 
sense  of  constriction  in  the  throat;  the  fauces  are  swelled  and  turgid, 
Ihe  swelling  extending  to  the  face  and  eyes,  the  latter  sometimes  pro- 
truding as  in  cases  of  strangling;  the  pulse  is  frequent,  the  tongue 
furred,  and  every  attempt  to  swallow  is  attended  with  great  distress, 
the  muscles  of  deglutition  being  thrown  into  violent  spasms,  threatening 
the  patient  with  instant  death  from  sulibcation. 

Diagnosis. — It  is  distinguished  from  croup  by  the  existence  of  a  con- 
stant and  voluntaiy  ha^\*king,  rather  than  a  forcible  and  involuntaiy 
cough  ;  and  from  common  quinsy  by  the  absence  of  any  considerable 
swelling  of  the  tonsils. 

Peculiarities  of  Treatment. — There  is  no  material  difference  in  the 
therapeutic  management  required  for  this  and  the  preceding  malady, 
except  that  indicated  by  the  danger  of  immediate  suffocation.  Ice- 
water  gargles  should  be  freely  employed,  in  conjunction  with  cold  wet 
cloths  to  the  throat,  and  the  general  tepid-bath,  or  wet  sheet ;  and  if 
the  exti'eme  sense  of  suffocation  is  not  relieved  in  a  few  hours,  the 
patient  should  be  put  into  a  full  hot-bath  for  ten  or  fifteen  minutes :  if, 
however,  this  is  impmcticable,  the  hot  fomentations  to  the  abdomen 
should  be  resorted  to  occasionally,  in  connection  with  the  general  and 
local  treatment  already  mentioned. 

Inflammation  of  the  Trachea  —  Tracheitis  —  Ctnanche 
Trachealis — Bronchleivoiitis — The  Croup. — This  disease  con- 
sists of  a  peculiar  inflammation  of  the  mucous  membrane  of  the 
trachea,  or  windpipe,  attended  with  a  thick,  tenacious,  glaiiy  secretion, 
which  hardens,  if  the  disease  is  not  soon  arrested,  into  a  preternatural 
membrane,  and  produces  death  by  closing  up  the  air-passage  in  the 
larynx.  In  some  few  instances,  however,  it  has  been  expectorated.  A 
similar  membrane  is  also  sometimes  formed  in  the  bowels,  bladder,  or 
uterus,  and  cast  off  in  the  form  of  a  tube,  or  of  fragments  resembling, 
and  sometimes  mistfiken  for  portions  of  the  mucous  membrane. 

Symjitoms. — The  Jirst  stage  is  denoted  by  a  ringing  cough,  to  which 
many  children  are  subject  on  taking  cold,  attended  with  little  or  no 
change  in  the  breathing  or  voice.  This  may  be  called  the  premonitoiy 
fatage.  In  the  second  stage  there  is  a  shrill,  ringing  cough,  with  diffi- 
cult breatling;  the  voice  is  altered,  hoarse,  and  broken;  the  breathing 
is  sometimes  hiss  jg  and  a  otiier  times  creaking  or  crowing;  the  eyes 


VISCERAL    INFLAMMATION.  115 

are  heavy,  watery,  and  bloodshot,  and  many  patients  die  before  the 
disease  progresses  further.  In  the  tliird  stage  the  cough  and  voice 
are  striduious,  the  respiration  is  laborious  and  suftbcative,  and  the  case 
is  generally  regarded  as  hopeless.  The  cheeks,  eyes,  and  nails  mani- 
fest a  purple  redness ;  the  complexion  is  often  mottled,  or  the  flush  of 
the  cheek  is  circumscribed ;  the  pulse  is  very  small  and  frequent.  In 
the  fourth  stage  the  voice  is  whispering  and  low;  the  cough  less  fre- 
quent, and  scarcely  audible  across  the  room  ;  the  trachea  is  coated  with 
effusion ;  the  face  is  leaden,  the  eye  filmy,  and  the  extremities  cold, 
and  final  insensibility  is  gradually  closing  the  scene. 

Sjjecial  Causes. — The  croup  most  freq-iently  attacks  children  be- 
tween the  ages  of  one  year  and  twelve,  though  occasionally  it  occurs 
in  infants  at  the  breast ;  and  very  rarely  in  adults.  Sudden  alternations 
of  temperature,  especially  going  from  a  heated,  ill-ventilated  apartment 
to  a  humid  atmosphere,  or  vice  versa,  with  little  or  no  attention  to  bath- 
ing habits,  are  among  the  prominent  circumstances  which  co-operate 
to  produce  this  disease. 

Peculiarities  of  Treatment. — As  the  danger  from  this  disease  consists 
in  the  effusion  which  concretes  into  the  artificial  membrane,  the  ti*eat- 
ment  should  contemplate  the  arresting  of  this  secretion  at  the  earliest 
possible  moment.  The  whole  throat  must  be  instantly  enveloped  iu 
several  folds  oi  very  cold  wet  cloths,  and  these  should  be  very  frequent- 
ly changed  until  the  respiration  becomes  free.  If  the  fever  is  not  very 
high,  the  whole  body  should  be  bathed  in  tepid  water  at  about  70°,  and 
then  packed  in  the  dry  blanket,  until  the  heat  returns,  or  perspiration 
takes  place.  If  the  general  fever  and  heat  of  the  surface  are  consider- 
able, the  wet-sheet  pack  is  the  best,  to  be  renewed  occasionally,  and 
managed  in  all  respects  as  for  a  common  fever.  Attention  to  the  bow- 
els, cold  extremities,  h'regular  temperature,  etc.,  is  required,  as  in  all 
febrile  and  inflammatory  complaints. 

When  called  to  a  patient,  after  the  partial  or  complete  consolidation 
of  the  tenacious  secretion,  evinced  by  exti'emely  painful  and  suffocative 
breathing,  and  constant  but  unavailing  efforts  to  expectorate,  warm 
water  should  be  copiously  drank,  and  the  throat  tickled  with  the  finger 
or  a  feather,  so  as  to  provoke  moderate  vomiting.  Nearly  every  case 
of  croup  can  be  cured  by  a  prompt  recourse  to  these  measures  on  the 
first  attack.  But  all  treatment  may  fail  in  the  third  and  fourth  stages 
of  the  disease.  The  preternatural  membrane  has,  in  a  few  instances, 
been  expectorated  in  fragments,  and  the  patient  recovered;  but  usually 
"its  formation  is  fatal. 

Inflammation  of  the  Par  :  riD  Gland — Parotitis — Mumps. — 


IIG  PATHOLOGY    AND    THERAPEUTICS.  \ 

The  mumps  consist  of  a  painful,  unsuppurative  swelling  of  one  or  both  ' 

parotid  glands ;  it  is  contagious,  and  often  epidemic  ;  it  is  often  accom-  , 

panied  with  swelling  of  the  testes  in  males,  and  of  the  breasts  in  females,  j 

SymjJloms. — The  tumor  is  at  first  movable,  but  soon  becomes  diffused  ' 

to  a  considerable  extent ;  it  increases  till  the  fourth  day,  and  often  in-  j 

volves  the  maxillaiy  glands  in  the  inflammation.     It  is  attended  with  ' 

but  slight  febrile  disturbance,  and  gradually  dechnes  after  the  fourth  ' 
day. 

Peculiarities  of  Treatment. — Very  little  medication  is  required  in 
ordinary  cases.     Abstemious  diet,  the  wet  sheet  whenever  the  w'hole 

surface  is  affected  with  feverish  heat,  and  the  application  of  a  wet  linen  i 

cloth,  covered  with  a  dry  one.  to  the  inflamed  part,  whenever  this  is  j 

very  hot  or  painful,  constitute  the  remedial  plan.   AVhenever  metastasis  | 

occurs  to  the  testes  or  breasts,  the  full  warm-bath  should  be  employed,  j 

succeeded  by  wet  compresses  to  the  part  affected,  weU  covered,  so  as  { 

to  produce  the  fomentation  or  poultice  effect.  j 

'I 

I>'FLAMMATION     OF    THE    LuNGS PnEDMONIA P>'^EUMOMTIS  — '     i 

PERIP^'EUMo^'T — Lung  Fever — Pleurisy. — All  of  these  terms  have    | 
been  employed  to  designate  the  same  essential  disease,  which  is  an    \ 
acute  inflammatory  condition  of  some  part  or  all  of  the  substance  of  the    j 
lungs,  or  of  their  surrounding  membranes,  or  of  both.    Medical  authors   j 
apply  the  term  pleurisy  to  the  disease  when  it  primarily  attacks  the   I 
pleura;   and  the  tevui  pneumonia^  i)r  j^ncuinonitis,  \yh.en  the  primary    j 
attack  appears  to  be  in  the  parenchyma,  or  substance  of  either  or  both   j 
lungs.    The  term  peripneumonia  nolJia,  or  bastard  pneumonia,  has  been    | 
given  to  a  modification  of  the  disease,  attended  with  a  low,  typhoid   ] 
fever  of  the  nervous  tj'pe,  which  has  sometimes  prevailed  as  an  epi-    ' 
deraic.     Practicallj',  all  these  distinctions  are  useless;  for  whether  the    ; 
mflammation  first  affects  the  investing  membranes  or  the  substance  of 
the  lungs,  it  soon  involves  both ;   and  precisely  the  same  treatment  ia 
indicated  whether  we  call    it   one  or  the  other  of  these    technical 
names. 

Syynptoms. — Sometimes  the  constitutional  symptoms  appear  first,  as 
rigors,  flushed,  purplish  face,  injected  appearance  of  the  eyes,  furred 
tongue,  etc.,  and  sometimes  the  local  symptoms  precede ;  these  are 
great  heat  and  sense  of  weight  about  the  chest ;  dull,  deep-seated,  or 
acute  pain  ;  short  and  dry  cough,  with  a  slight  mucous  expectoration ; 
frequent,  short,  and  anxious  resj)iration.  In  a  day  or  two  the  expecto- 
ration becomes  viscid,  and  more  or  less  rusty-colored,  yellow,  or  bloody. 
The  pulse  is  full,  strong,  and  quick,  or  small,  weak,  and  frequent,  as 
the  fever  approximates  tlie  inflammatory  or  tj'phoid  t\-pe.     Dr.  Shew* 


VISCERAL    INFLAMMATION.  llj 

m  his  Manual,  mentions  "no  pulse"  as  among  the  synr:ptoms,  but  this  is 
most  assuredly  a  mistake. 

Teiininations. — This  disease  terminates  by  resolution,  suppuration, 
gangrene,  effusion,  or  hemorrhage.  Under  thorough  water-treatment 
from  the  outset,  it  has  always,  within  the  scope  of  my  experience  and 
observation,  terminated  very  promptly  by  resolution. 

Special  Causes. — Extreme  vicissitudes  of  temperature,  unequal  ex- 
posure of  the  body,  cold  or  wet  feet,  exposure  to  wet  or  cold  when 
the  body  is  in  a  state  of  exhaustion  from  sleeplessness  or  over-exertion, 
are  especially  conducive  to  this  disease. 

Peculiarities  of  Treatment. — If  the  general  febrile  symptoms  pre- 
cede the  local,  the  wet  sheet  is  to  be  resorted  to,  and  repeated  accoi-d- 
ing  to  the  degree  of  superficial  heat.  When  the  local  pain,  cough, 
difficulty  of  breathing,  etc.,  appear,  the  chest-wrapper  should  be  con- 
stantly worn,  covered  with  a  dry  cloth,  and  renewed  five  or  six  times 
a  day.  The  shallow  tepid-bath,  or  if  this  is  impracticable,  the  tepid 
sltz-bath,  should  be  employed  once  or  twice  in  twenty-four  hours. 
When  the  heat  is  unequally  developed,  the  pulse  low,  the  patient  ex- 
tremely prostrated,  and  the  extremities  pale  or  cold,  the  warm  sitz  and 
foot-bath  are  serviceable.  Free  tepid  injections  are  generally  advisable; 
and  when  the  expectoration  is  painfully  sticky  and  scanty,  w^irm  water- 
drinking,  to  the  point  of  slight  nausea,  or  even  moderate  vomiting,  vf  ill 
afford  speedy  relief. 

Inflammation  of  the  Heart — Carditis. — Whether  the  mus- 
cular substance  of  the  heart  is  ever  the  seat  of  an  inflammatory  affec- 
tion which  is  capable  of  distinct  recognition,  is  a  disputed  point.  But 
inflammation  of  its  investing  membranes,  though  a  rare  disease,  is  re- 
cognized in  all  standard  works ;  as  2^^'>'icarditis-  -inflammation  of  the 
heart-purse,  or  pericardium;  endocarditis — inflammation  of  the  inter- 
nal membrane  which  lines  the  cavities  of  the  heart.  For  all  practical 
purposes,  they  may  all  be  considered  as  simply  inflammation  of  the 
heart. 

Symptoms. — With  general  febrile  disturbance  there  is  more  or  less 
acute  pain  under  the  left  nipple,  toward  the  lower  extremity  of  the 
breast-bone ;  this  pain  radiates  toward  the  left  armpit,  and  sometimes 
extends  downward  to  the  elbow  or  wrist ;  the  pain  is  increased  by 
pressing  upward  against  the  diaphragm,  and  by  lying  on  either  side. 
The  pulse  may  be  full,  hard,  regular,  and  jarring,  or  small,  rapid,  un- 
equal, and  intermitting;  there  is  great  difficulty  of  breathing,  an  insup 
portable  sense  of  oppression,  frequent  sweats,  often  alternated  with 
very  dry  and  hot  skin.     The  countenance  is  pa-e,  sharp  and  mai-ked 


118  PATHOLOGY   AND   THERAPEUTICS. 

with  gi'eat  anxiety  and  ten'or:  sighing,  sobbing,  and  hiccc.igh  are  fre- 
quent, and  sometimes  delirium,  convulsions,  or  insomnolence  attend. 

Special  Causes. — Among  the  predisposing  causes  of  this  affection 
Hooper  mentions,  "  the  male  sex,  and  the  age  from  ten  to  thirty."  If 
he  had  said  that  males  between  the  ages  of  ten  and  thirty  are  most 
subject  to  the  disease,  his  talk  would  have  been  rational;  but  to  put 
down  such  circumstances  as  causes  is  flat  nonsense.  The  most  com- 
mon cause  of  heart  diseases  is  the  allopathic  treatment,  alias  mal- 
treatment of  gout  and  rheumatism,  which  produces  a  metastasis  of 
arthritic  inflammation  from  the  membranes  of  the  joints  to  those  of 
the  heart. 

Peculiarities  of  Treatment. — The  hydropathic  management  is  pre- 
cisely the  same  as  for  inflammation  of  the  lungs. 

Inflammation  of  the  Liver — Hepatitis. — Acute  inflammation 
■)f  the  liver  is,  in  this  climate,  a  rare  disease  ;  but  is  rather  frequent  in 
hot  countries,  especially  with  those  who  indulge  freely  in  flesh-eating 
and  spirit-drinking. 

Symptoms. — Pain  in  the  right  side  under  the  short  ribs,  increased 
by  a  full  inspiration,  or  by  lying  on  the  left  side  ;  dry,  husky  cough 
shortness  of  breath,  shooting  pains  about  the  chest,  sympathetic  pain 
in  the  right  shoulder,  yellow  appearance  of  the  white  of  the  eye,  and 
sometimes  yellow  skin ;  the  urine  is  high-colored,  and  there  is  either 
costiveness  or  diarrhea. 

Chronic  inflammation  of  the  liver — hepatitis  chronica  of  the  books — 
often  manifests  some  degi-ee  of  most  of  the  symptoms  above-mention- 
ed, but  is  distinguished  by  the  absence  of  general  fever. 

Peculiarities  of  Treatment. — Apply  the  wet  girdle  around  the  upper 
part  of  the  abdomen,  over  the  seat  of  the  principal  pain ;  in  all  other 
respects  manage  as  in  the  case  of  inflamed  lungs.  The  bowels  should 
be  thoroughly  cleansed  in  the  outset  with  warm  water  enemata. 

Inflammation  or  the  Spleen — Splenitis. — This  is  an  exceed- 
ingly rare  disease.  It  is  known  by  severe  pain  in  the  left  side  opposite 
the  liver,  with  a  sense  of  heat  and  weight,  and  considerable  fullness 
and  tenderness;  the  pain  is  increased  on  pressure.  The  treatment  is 
the  same  as  for  inflamed  liver. 

Inflammation  of  the  Stomach — Gastritis. — Dr.  Good  distin- 
guishes acute  inflammation  of  the  stomach  into  two  forms,  adhesive 
and  erytliematic.  In  the  former  variety  the  fever  is  high,  ^:  inflamma* 
tOry ;  in  the  latter,  low,  or  typhoid. 


VISCERVL    INFLAMMATION.  119 


Symptoms. — With  general  fever  there  is  severe  fixed  pain  and  burn- 
ing heat  at  the  pit  of  the  stomach ;  painful  deglutition  ;  the  pain  is  in- 
creased by  pressure  over  the  stomach;  frequent  vomiting,  hiccough, 
sudden  and  extreme  prostration;  hard,  wiiy,  rapid,  and  often  irregular 
and  intermitting  pulse  ;  intense  thirst ;  restlessness  and  anxiety  ;  tongue 
red,  parched,  and  of  a  glay,ed  appearance.  Frequently  the  inflamma- 
tion extends  to  the  bowels,  attended  with  diarrhea  and  great  tenderness 
of  the  abdomen,  constituting  the  gas'ro-enteriiis  of  authors. 

Special  Causes. — In  a  majority  of  cases  gastritis  is  the  effect  of  pov,-- 
erfu!  iiritants  or  chemical  poisons  taken  into  the  stomach.  It  is  some- 
times produced  by  drinking  largely  of  very  cold  water  when  the  body 
•is  excessively  heated  by  exercise,  especially  in  persons  whose  stomachs 
are  enervated  by  spirituous  liquors.  Unripe  fruits,  decayed  vegetables, 
and  putrid  animal  food,  sometimes  excite  it. 

Peculiarities  of  Treatment. — Apply  wet  cloths  freely  to  the  wholo 
abdomen,  of  the  teinperature  which  feels  most  agreeable  and  soothing 
to  the  patient.  Generally  quite  cold  water  answers  the  best.  Small 
quantities  of  ice  or  iced-water  may  be  frequently  taken.  Drink  ad 
lihitum  of  water  of  a  moderate  temperature — 60°  to  70^.  Tepid  in- 
jections are  generally  necessary ;  when  diarrhea  attends  they  may  be 
used  cold.  The  entire  wet  sheet  envelopment  should  be  employed 
two  or  three  times  a  day  "when  the  febrile  heat  is  general  and  excessive. 

Inflammation  of  the  B'owels — Enteritis. — This  disease,  like 
gastritis,  is  divided  into  the  adhesive  and  erythematic  varieties,  by  Dr. 
Good.  The  former  variety  is  attended  with  obstinate  constipation  ;  the 
latter  with  diarrhea. 

Symptoms. — With  more  or  less  of  general  fever  there  is  acute  pain 
in  some  part  of  the  abdomen,  gradually  extending  over  the  whole ;  the 
pain  is  increased  by  pressure,  and  accompanied  with  tension  and  swell- 
ing. The  patient  lies  on  the  back  with  the  knees  drawn  up,  and  can 
scarcely  suffer  the  weight  of  the  bed-clothes.  The  bowels  are  usually 
obstinately  constipated,  but  sometimes  diarrhea  attends ;  and  there  is 
co.^stant  nausea,  ard  more  or  less  vomiting  of  bilious  and  sometimes  of 
highly  offensive  foecal  matter.  The  pulse  is  frequent,  hard,  and  con- 
tracted. 

Special  Causes. — Long-retained  and  hardened  foeces ;  constipating 
ibod  ;  iiTitant  poisons  ;  impure  aliments. 

Diagnosis. — Enteritis  is  distinguished  from  colic  by  the  presence  of 
fever.     In  colic  the  pain  is  diminished  by  pressure. 

Peculiarities  of  Treatment. — The  constipated  state  of  the  bowels 
requires  the  free  employment  of  copious  tepid  injections;  in  all  othei 


120      PATHOLOGY  AND  THERAPEUTICS. 

respects  the  treatment  is  the  same  as  for  gastritis.  It  is  not  advisable, 
however,  to  resort  to  the  injections  until  the  heat  and  tenderness  of  the 
abdomen  has  been  somewhat  reduced  by  the  external  applications. 
When  severe  diarrhea  occurs,  the  wai*m  sitz-bath  and  cool  injections 
may  be  occasionally  employed  to  advantage. 

Inflammation  of  the  Peritoneum — Peritonitis. — Authors  dis- 
tinguish three  varieties  of  acute  peritoneal  inflammation ;  peritonitis 
jnoj^er,  when  the  lining  serous  membrane  of  the  abdomen  is  generally 
affected ;  omentalis,  when  the  omentum  is  the  principal  seat  of  dis- 
ease ;  and  mesenterica,  when  the  inflammation  aftects  principally  that 
portion  called  the  mesentery. 

Symptoms. — The  usual  accessory  symptoms  of  general  fev^r  are 
eucceeded  by  a  sense  of  heat  and  pain  in  the  abdomen,  usually  confined 
to  one  part,  but  gradually  becoming  diffused.  There  is  great  teuder- 
uess  or  soreness  of  the  belly,  without  inclination  to  go  to  stool,  and  a 
considerable  degree  of  tension  and  swelling  comes  on,  which  ordinarily 
increases  for  several  days ;  the  patient  finding  most  relief  when  lying 
motionless  on  the  back,  with  the  knees  somewhat  elevated.  The 
tongue  is  not  much  altered  at  first ;  the  pulse  is  small,  weak,  and  very 
frequent.  This  disease  frequently  attends  as  a  symptom  of  puerperal 
fever,  which  fever  is  generally  the  result  of  bad  management  during 
the  period  of  childbirth. 

Diagnosis. — It  is  distinguished  from  colic  by  the  pain  being  increased 
on  pressure,  and  frequency  of  the  pulse.     It  is  not  so  easily  distinguish 
ed  from  enteritis;  but  this  is  of  no  consequence,  as  the  treatment  i&    "^ 
all  respects  precisely  the  same. 

Inflammation  of  the  Kidney — Nephritis. — Symptoms. — Gene- 
ral fever,  pain  in  the  region  of  the  kidney,  extending  to  the  groin  and 
along  the  ureter  to  the  neck  of  the  bladder.  The  pain  is  deep-seated, 
often  dull  and  obscure,  but  always  sncreased  by  the  erect  posture,  hy 
coughing  or  sneezing,  or  by  firm  pressure.  It  is  also  increased  by 
straightening  the  leg  of  the  affected  side.  To  avoid  this  the  patient 
instinctively  reclines  on  the  aflfected  side,  and  bends  the  limb  so  as  to 
relax  the  muscles  of  the  gi'oin.  There  is  frequent  desire  to  urinate, 
with  great  difficulty  or  inability^  to  expel  the  contents  of  the  bladder. 
The  urine  is  generally  bk)ody  at  first.  The  tongue  is  white,  the  pulse 
is  hard  and  frequent,  the  bowels  are  constipated,  the  abdomen  is  tym- 
panitic, with  wandering  pains,  and  the  patient  labors  under  great  de- 
pression of  spirits. 

Special  Causes. — Acrid  diuretics,  hard  water,  gravel,  violent  exer 
cise  of  the  muscles  of  the  back,  hardened  foeces  in  the  colon. 


VISCERAL    INFLAMMATION  121 

Diagnosis, — It  may  oe  distinguished  from  lumbago  by  the  pain 
following  the  com'se  of  the  m"eter,  and  by  the  difficulty  of  urination. 

Peculiarities  of  Treatment. — If  the  fever  is  not  violent,  and  the 
heat  of  the  surface  is  irregular,  the  warm  hip-bath  will  alleviate  the 
pain.  If  the  heat  of  the  surface  is  great  and  uniform,  the  cold  hip- 
bath will  produce  the  greatest  relief.  One  or  the  other  should  be  fre- 
quently emploj'^ed,  with  general  and  topical  treatment,  as  in  other 
'isceral  inflammations. 

Inflammation  of  the  Bladder — Cystitis. — Idiopathic  inflamma- 
tion of  the  bladder  does  not  often  occur.  It  does,  however,  sometimes 
result  from  the  common  causes  of  inflammation,  but  is  more  frequently 
the  consequence  of  gravel,  stone,  long  retention  of  urine,  maltreated 
gonorrhea,  and  such  drug-irritants  as  cantharides,  ardent  spirits,  tur- 
pentine, and  various  essences  and  balsams. 

Symjptoms. — General  fever ;  acute  pain,  swelling,  and  tension  in  the 
region  of  the  bladder ;  pain  and  soreness  increased  by  pressure  above 
the  pubes,  or  in  the  perineum ;  vomiting ;  tenesmus ;  frequent  mic- 
turition, with  great  difficulty  in  discharging  the  urine  ;  heat  and  smart 
ing  in  the  urethra;  great  general  irritation,  restlessness,  and  anxiety. 

Peculiarities  of  Treatmeiit. — On  account  of  the  structure  of  the 
urethral  passage,  the  warm  hip-bath  should  be  at  first  employed  for 
half  an  hour,  or  until  sensible  relief  is  experienced.  This  should  be 
succeeded  by  the  cold  compress,  which  should  be  worn  constantly  and 
very  frequently  renewed,  occasionally  alternating  with  the  warm  hip- 
bath. The  febrile  symptoms  are  to  be  trea.ted  with  the  wet-sheet 
pack,  followed  by  the  dripping  sheet  or  tepid  half  bath,  as  often  and 
whenever  they  are  indicated  by  the  general  heat.  The  vomiting  may 
be  relieved  by  warm  water-drinking,  followed  by  sips  of  cold  water  or 
bits  of  ice.  The  tenesmus  requires  copious  injections  of  warm  water, 
followed,  after  the  bowels  have  acted  freely,  by  the  injection  of  as 
much  cold  water  as  the  bowels  can  conveniently  receive.  The  warm 
foot-bath  is  useful  when  there  is  the  least  tendency  to  cold  extremities. 

Inflammation  of  the  Uterus — Hysteritis — Metritis. — This 
disease  has  been  divided  into  two  varieties — simple,  when  occurring  in 
the  unimpregnated  organ ;  and  puerperal,  when  attacking  the  womb 
soon  after  delivery. 

Symptoms. — Nearly  every  symptom  characterizing  inflammation  of 
the  bladder  attends  also  inflammation  of  the  uterus ;  in  the  disease  un- 
der consideration  there  are  the  additional  symptoms  of  pain  extending 
with  great  severity  to  the  loins,  and  shooting  down  the  thiglis,  and  ao 
Il-r 


122  PATHOLOGY    ANE    THERAPEUTICS. 

increase  of  pain  in  the  hypogastric  region  on  the  patient's  making  a 
deep  inspiration.  There  is  also  a  sense  of  weight  and  bearing  down, 
with  a  frequent,  small,  and  wiry  pulse. 

Special  Causes. — Suppressed  mensti'uation,  exti'aordinary  mental 
emotion,  astringent  or  irritating  injections. 

Peculiarities  of  Treatment. — The  ti'eatment  for  the  preceding  dis- 
ease is  equally  applicable  to  this. 

Inflammation  of  the  Testes — Orchitis. — This  affection  is  read- 
ily known  by  the  pain,  heat,  redness,  and  swelling  of  the  pait  affected ; 
it  is  attended  with  more  or  less  general  fever.  It  only  requires  the 
constant  application  of  water,  either  by  compresses  or  the  hip-bath,  of 
such  temperature  as  is  most  soothing  to  tiie  pain ;  and  the  wet-sheet 
pack  or  tepid  full-bath,  according  to  the  degree  of  general  heat. 


CHAPTER   III. 

ARTHRITIS. 

Arthritic  inflammation  comprehends  the  various  forms  of  gout  and 
rheumatism.  The  peculiarity  of  this  kind  of  inflammation  consists  in 
its  being  confined  mainly  to  the  fibrous  tissues — the  muscles,  and  struc- 
tures around  the  joints.  Its  character  is  also  eiTatic,  often  shifting  its 
seat  of  morbid  action  from  shght  causes.  The  diseases  included  under 
the  present  head  may  be  gi'ouped  as  in  the  following  arrangement : 


Gout. 


Regular, 
Atonic, 
Re  cedent, 
Misplaced. 


Rheumatism.  < 


Inflammatory, 

Articular, 

Lumbago, 

Sciatica, 

Muscular, 

Chronic. 


Gout — Podagra. — Dr.  Good  tells  «s  (Study  of  Medicine)  "that 
the  predisposing  cause  of  a  gouty  diathesis,  when  it  first  forms  itself  in 
an  individual,  is  plethora,  or  the  state  of  the  system  produced  by  full 
living  and  indolence."  Strangely  inconsistent  with  this  remark  the 
same  author  observes:  "There  is  no  disease  to  which  the  human 
frame  is  subject  that  has  lei  to  such  a  variety  of  opinions  both  in  the- 


AETHRITIS.  128 


ory  and  practice,  many  of  them  directly  contradictory  to  each  othei",  as 
the  gout ;  and  I  may  add,  there  is  no  disease  concerning  the  nature 
and  treatment  of  which  physicians  are  so  little  agi'eed."  Nothing  can 
be  more  conclusive  of  the  absurdity  of  the  whole  philosophy  of  the 
popular  system,  and  the  empiricism  of  its  whole  practice,  than  this 
general  agreement  about  the  producing  cause  of  a  disease,  and  this 
general  d4sagreement  about  its  nature  and  treatment ! 

Symptoms. — Regular  gout  is  characterized  by  a  violent  inflamma- 
tion and  swelling  of  the  joints,  enduring  for  several  days,  and  grad- 
ually subsiding  with  itching  and  desquamation  of  the  cuticle.  It  usually 
comes  on  an  hour  or  two  after  midnight,  with  excruciating  pain  in  the 
joints  of  the  great  toe,  which  grows  worse  as  the  day  advances,  grad- 
ually ceasing  toward  evening,  to  return  with  more  or  less  violence  the 
next  morning ;  and  so  on  for  several  days.  The  attack  is  preceded  b}- 
various  symptoms  of  digestive  derangement,  and  with  coldness,  numb- 
ness, and  cramps  of  the  extremities.  The  atofiic  or  disguised  form  is 
attended  with  greater  general  debility  and  worse  dyspeptic  symptoms, 
while  the  aflection  of  the  joints  is  but  slightly  painful  and  inflammator}'. 
The  local  affection  often  alternates  with  the  symptoms  of  indigestion, 
when  pain  in  the  stomach,  nausea,  vomiting,  eructations,  etc.,  occur, 
and  the  patient  is  dejected  and  hypochondriac.  Cramps  in  the  trunk 
and  extremities  are  common,  and  there  may  be  either  obstinate  cos- 
tiveness  or  diarrhea.  Sometimes  the  affection  of  the  joints  alternates 
with  a  disturbance  of  the  viscera  of  the  chest,  producing  palpitation, 
syncope,  or  asthma ;  at  other  times  with  the  head,  which  is  affected 
with  vertigo,  cephalalgia,  and  sometimes  even  with  palsy  or  apoplexy 
The  recedent  or  retrograde  form  is  marked  by  a  sudden  subsidence  of 
the  inflammatory  state  of  the  joints,  succeeded  immediately  by  an  af- 
fection of  some  internal  part,  where  is  thenceforth  the  seat  of  the 
morbid  manifestations.  The  head,  heart,  or  lungs  may  be  affected, 
producing  the  results  named  in  the  preceding  remark.  The  mis- 
jplaced  variety  is  denoted  by  an  inflammatory  affection  of  some  inter- 
nal part  or  organ  in  a  gouty  diathesis,  whether  preceded  or  not  by  an 
inflammatory  affection  of  the  smaller  joints,  which,  however,  always 
very  soon  disappears. 

Diagnosis. — Gout  may  be  distinguished  from  rheumatism  by  its 
commencement  in  the  small  instead  of  the  large  joints ;  also  by  the 
peculiar  manner  of  attack.  When  the  gouty  diathesis  is  strongly  mark- 
ed, the  joints  of  the  toes,  and  sometimes  those  of  the  fingers,  are  per  • 
manently  enlarged  and  disfigured. 

Causes. — The  gout  is  emphatically  tlie  disease  of  the  gourmand  and 
the    epicure.      Wherever   this    diathesis   prevails,   there   has   nature 


124  PaTHOLOGF    and   THE  a  APEU  TIC  S. 

stamped,  ia  painfully  legible  characters,  the  penalty-  of  riotous  living. 
A  vegetable-eater  and  water-drinker  has  never,  probably,  been  afflicted 
\vith  any  "joint-racking  rheums"  like  unto  this  malady,  since  the  cre- 
ation, unless  inherited.  It  is  said,  indeed,  not  to  be  exclusively  confined 
to  "  high  life,"  as  it  is  occasionally  known  among  the  poor  and  laboring 
classes.  No  doubt  the  indigent  and  hard-working  can  eat  and  drink  iu 
such  a  way  as  to  produce  it.  Yet  we  know  this  is  very  uncommon ; 
and  we  must  regai-d  the  disease  as,  in  a  general  sense,  the  legitiraato 
fruit  of  fashionable  yet  unnatural  luxury.  Flesh  and  wine  represent 
the  nature  of  its  predisposing  causes.  The  free  indulgence  in  animal 
food  of  any  sort,  and  the  free  use  of  fermented  liquors  of  any  kind, 
aiJ«  among  its  prominent  causes ;  and  when  to  these  are  added  con- 
centrated and  constipating  fo^d,  with  sedentary  or  indolent  habits,  we 
have  the  general  condition  which  produces  the  gouty  diathesis  in  its 
greatest  intensity.  The  diathesis  sometimes  exists  in  those  who  eat 
intemperately  and  drink  temperately,  or  vice  versa. 

In  gouty  subjects,  the  functions  of  alimentation  so  frequently  overact 
those  of  elimination,  that  the  surplus  materials  obstruct  the  capillaries, 
and  the  retained  morbific  matters  so  change  the  secoruent  action,  that 
chnlky  concretions  are  formed  in  and  around  the  cavities  of  the  joints, 
iu  the  ligaments,  tendons,  and  membranes,  in  the  little  mucous  bags — 
hurscE  7nucosa — which  surround  the  joints,  in  the  cellular  substance, 
and  even  iu  the  pores  of  the  skin.  The  joints  of  the  fingers  and  toes, 
more  especially  the  latter,  are  fiequently  enlarged,  hai"d,  and  tender, 
ocCfisionally  ulcei'ate,  and  sometimes  form  fistulous  openings,  through 
which  oozes  a  whitish  earthy  matter,  consisting  mainly  of  urate  of  soda. 

Treatment, — The  indications  are  :  1.  To  relieve  the  paroxysm.  2. 
To  prevent  its  return.  These  mean,  in  other  words,  to  mitigate  the 
pain,  and  restore  general  health.  Cold  or  very  cold  wet  cloths  should 
be  constantly  applied  to  the  affected  parts  until  the  pain  subsides ;  or 
the  feet  or  hands,  when  inflamed,  may  be  held  in  cold  water  until  the 
preternatural  heat  is  subdued.  There  is  no  danger  whatever  of  pro- 
ducing metastases  to  the  internal  organs — as  bleeding,  blistering,  drastic 
purging,  etc.,  do  produce — by  the  application  of  cold  water  io  the  in- 
flamed joints,  provided  the  application  is  not  continued  beyond  the 
point  of  reducing  the  temperature  to  the  natural  standard.  The  gen- 
eral feverishness  attending  the  paroxysm  requires  the  wet-sheet  pack, 
so  managed  as  to  produce  moderate  perspiration,  followed  by  the  shal- 
low tepid-bath.  Water-drinking  should  be  as  copious  as  the  stomach 
can  bear  without  painful  distension,  and  the  diet  should  be  of  the 
"hunger-cure"  kind. 

To  overcome  the  gouty  diathesis  requu'es  a  systematic  employment 


ARTHRITIS.  125 

of  the  water  processes,  with  the  sti-ictest  general  regimen.  A  daily- 
pack  for  an  hour,  followed  by  a  plunge,  dripping  sheet,  or  half-bath,  a 
daily  tepid  shallow-bath  for  ten  minutes,  with  the  pail  douche  over  the 
shouldei's,  a  daily  hip-bath  at  about  65°  for  fifteen  minutes,  a  daily 
foot-bath  at  about  the  same  temperature  for  ten  minutes,  constitute  the 
average  number  and  strength  of  the  bathing  part  of  the  regular  ti-eat- 
ment.  In  addition  to  all  this,  the  douche  may  be  applied  to  the  affected 
part  with  as  much  force  as  can  be  borne  without  much  pain,  and  mod- 
erately along  the  spine,  two  or  three  times  a  week.  With  these  pro- 
cesses the  patient  should  exercise  all  that  his  strength  will  admit  of, 
short  of  absolute  exhaustion,  and  drink  all  the  water  the  stomach  can 
endure  without  pain.  The  diet  must  be  plain  and  unconcentrated, 
consisting  mainly  of  vegetables,  ripe  fruits,  and  unbolted  farinaceous 
preparations.  Nearly  all  medical  authors  agree  that  gouty  subjects 
ought  to  be  put  upon  an  abstemious  vegetable  diet.  Even  many  writers 
who  insist  that  man  is  naturally  omnivorous,  and  cannot  subsist  on  an 
exclusively  vegetable  diet,  seem  to  forget  their  darling  theory,  and 
prescribe  for  this  disease  what  they  specially  interdict  in  almost  every 
other. 

The  bathing  part  of  the  treatment  may  be  managed  in  various  ways, 
according  to  convenience,  with  equal  efficacy.  The  following  plan, 
with  such  modifications  as  circumstances  will  naturally  suggest,  is 
adapted  to  all  ordinary  cases :  In  summer,  a  plunge-bath  on  rising  in 
the  morning,  followed  by  a  long  walk;  at  ten  a.m.,  the  pack  and  douche ; 
at  four  to  five  p.m.,  half-bath  and  pail  douche;  at  half-past  eight  p.m., 
sitz-bath.  A  foot-bath  may  be  taken  at  either  nine  a.m.,  five  to  six 
P.M.,  or  evening,  or  at  ail  of  those  times.  In  winter,  a  pack  and  half- 
bath  in  the  morning,;  douche  at  ten  a.m.;  half-bath  at  four  to  five  p.m.; 
sitz  in  the  evening ;  foot-haths  as  above. 

Gouty  patients  who  have  been  drugged  extensively,  their  nerves 
enfeebled  and  their  constitutions  shattered  with  opium,  colchicum, 
veratrum,  elaterium,  antimony,  etc.,  must  be  managed  w4th  more  care 
and  tenderness.  They  will  not  bear  as  cold  nor  as  vigorous  treatment. 
For  such,  the  pack  and  dripping  sheet,  the  tepid  shallow-bath,  and  oc- 
casionally, when  they  become  unusually  tender  and  irritable,  the  full 
warm-bath,  followed  by  the  tepid  pail-douche,  are  the  best  leading 
water  appliances. 

Ciises  in  Gout. — While  under  ti'eatment,  gouty  patients  are  liable 
to  critical  disturbances  in  the  form  of  boils,  diarrhea,  and  particularly 
to  a  general  feverishness,  during  which  all  the  affected  parts,  and 
sometimes  the  whole  body,  becomes  highly  and  suddenly  inflammatory 
and  painful.    The  full  warm-bath,  or  the  moderately  hot  bath,  is  usefuJ 


126  PATHOLOGY    AND    THEK  APE  UTICS. 

once  or  twice  during  the  latter  form  of  critical  distui'bance,  which 
usually  lasts  several  days.  Diarrhea,  if  severe,  requires  the  warm 
sitz-bath  and  cool  injections ;  boils  need  nothing  but  wet  compresses. 
Whenever  the  crisis  is  sev(  re,  all  active  treatment  should  be  suspended; 
wet  cloths,  or  cold  water  in  any  convenient  way,  may,  however,  be 
applied  to  swelled  and  pamful  parts  during  the  crisis  the  same  as  at 
other  times 

Rhkumatism. — Like  gout,  rheumatic  affections  are  almost  invariably 
connected  with  derangements  of  the  digestive  apparatus,  and  generally 
preceded  by  unusual  disturbance  in  the  functions  of  the  primary  nutri- 
tive organs.  Some  authors,  indeed,  maintain  that  gout  and  rheumatism 
are  convertible  maladies,  often  blending  together,  or  running  into  each 
other,  in  their  varied  local  manifestations.  In  fact,  rheumatism  might 
very  well  be  defined  as  gout  of  the  larger  joints ;  while  the  stiffness, 
lameness,  and  rigidity  of  the  muscles,  and  the  thickening  and  swelling 
of  the  structures  in  and  around  the  joints,  are  about  as  common  to 
either  manifestation  of  the  arthritic  diathesis. 

Symptoms. — Injiammaiory  rheumatism  presents  all  the  essential 
sj-mptems  of  inflammatory  fever,  or  synochus,  with  the  addition  of  ex- 
treme soreness  and  tenderness  over  the  whole  surface  of  the  body,  and 
also  acute  pain  in  some  one  or  more  of  the  larger  joints,  or  in  the  small 
of  the  back,  rendering  all  motion  of  the  body  and  limbs  extremely  diffi- 
cult and  painful  The  patient  is  often  unable  to  get  on  or  off  the  bed 
without  assistance,  and  then  the  effort  is  attended  with  gi-eat  suffering. 
The  articular  variety  has  been  called  rheumatic  fever,  or  acute  rheu- 
matism. It  differs  from  the  former  in  being  attended  with  much  less 
general  pain  and  soreness,  and  a  much  greater  inflammatory  action 
and  swelling  of  some  one  or  more  of  the  large  joints  and  surrounding 
muscles,  generally  the  hip,  knee,  elbow,  or  shoulder.  Lumbago  is  the 
variety  in  which  the  pain  is  felt  chiefly  in  the  loins,  usually  shooting 
upward.  In  the  form  called  sciatica,  or  coxalgia,  the  pain  is  felt  mostly 
in  the  hip-joint,  the  disease  also  being  attended  with  an  emaciation  of 
the  nates  or  buttock  of  the  affected  side,  or  an  elongation  of  the  limb. 
In  the  variety  called  muscular,  the  pain  is  experienced  mainly  in  the 
muscles  of  the  diaphragm,  or  in  the  intercostal  muscles  between  the 
ribs,  when  the  pain  is  gi-eatly  increased  by  a  full  inspiration.  This 
form  has  been  called  plcurodyne,  pleuralgia,  and  sjyurious  jjleurisy  by 
authors;  and  not  unfrequently  mistaken  for  real  pleurisy,  and  the  patient 
bled,  leeched,  and  blistered  not  a  little  to  his  disadvantage.  CJironie 
rheumatism  is  characterized  by  pain,  rigidity,  and  weakness  of  the 
lai'ger  joints  and  surrounding  muscles,  acco*upanied  with  no  regular 


ARTHRITIS.  127 

fever,  and  but  slight  occasional  febrile  paroxysms,  and  with  very  little 
perceptible  swelling.  This  form  of  rheumatism  is  almost  always  re- 
lieved temporarily  by  warmth,  hot  applications,  stimulating  liniments, 
etc.,  while  all  the  other  forms  are  frequently  aggravated  by  them. 

The  fever  attending  rheumatic  attacks  is  peculiarly  accompanied 
with  frequent  and  irregular  sweats,  which,  however,  do  not  prove  iu 
any  sense  critical,  nor  exert  anj''  marked  influence  upon  the  course  of 
the  disease. 

Causes. — Unusual  exposures  to  wet  and  cold  while  the  body  is  in  a 
state  of  exhaustion  or  obstruction,  seem  to  be  the  general  producing 
causes  of  all  forms  of  rheumatic  affections. 

Treatment. — The  proper  management  of  the  first,  or  inflammatory 
variety,  is  alm.ost  identical  with  that  of  inflammatory  fever.  In  some 
cases  where  the  joint  or  joints  most  affected  nre  so  tender  that  the 
least  motion  produces  excruciating  pain,  a  combination  of  relaxant  and 
cooling  processes  will  give  prompt  relief,  as  the  warm  fomentation,  or 
warm  douche,  followed  by  the  coldest  wet  cloths  or  pounded  ice.  The 
articular  form  requires  a  less  vigorous  application  of  the  wet  sheet,  or 
other  general  cold  treatment,  but  a  more  persevering  application  of  cold 
compresses  to  the  affected  joints.  Lumbago  and  sciatica,  and  that  form 
called  musculai',  in  addition  to  moderate  general  treatment,  are  relieved 
with  the  greatest  facility  by  the  hot  fomentation  to  the  parts  affbcted 
with  pain,  stiflness,  and  rigidity,  followed  by  the  cold  covered  compress, 
or,  what  is  better  still,  the  warm  douche  followed  by  the  cold,  the  tem- 
perature and  force  of  the  stream  to  be  regulated  in  some  degree  by 
the  patient's  feelings.  Chronic  rheumatism,  in  whatever  form  mani- 
fested, requires  the  same  general  management  as  gout,  the  leading 
curative  indicati-on  being  to  restore  the  general  health.  As  constipation 
is  an  almost  universal  concomitant  or  antecedent  circumstance,  especial 
attention  must  be  given  to  the  state  of  the  bowels,  which  should  be 
kept  free  by  means  of  injections,  and  an  opening,  plain  diet. 

So  long  as  the  mercurial  mania  rages  among  the  medical  gentlemen 
of  the  allopathic  school,  so  long  will  the  hydropathic  phyician  be 
continually  called  upon  to  treat  manj'-  anomalous  varieties  of  chronic 
rheumatism,  made  such  by  the  mercury  with  which  the  patient  has 
been  dosed  in  the  treatment  of  some  acute  disease.  Such  patients  are 
peculiarly  sensitive  to  vicissitudes  of  weather,  and  do  not  bear  as  cold 
treatment  as  those  whose  systems  have  never  been  mercurialized. 
The  wet-sheet  pack,  followed  by  the  tepid  half-bath,  once  a  day,  the 
tepid  half-bath  followed  by  the  pail  douche,  and  the  occasional  employ- 
ment of  the  warm-bath,  followed  by  the  pail  douche  or  shower,  consti- 
oite  the  best  general  plan  of  managing  mercurial  rheumatism.     Some- 


128  PATHOLOGY   AND  THERAPEUTICS. 

times  the  ti-eatment  will  set  the  remains  of  the  mineral,  which  has  long 
lain  dormant,  as  it  were,  in  the  system,  in  motion,  and  reproduce  sali- 
vation, spongy  gums,  fetid  breath,  metallic  taste,  or  other  evidences  of 
mercurial  action.  During  this  mercurial  excitement,  no  very  active 
cold  treatment  should  be  employed.  The  tepid  sponge-bath,  or  half- 
bath,  with  such  local  applications  as  the  local  pains  demand,  the  temper- 
ature being  such  as  feeis  most  agreeable  to  the  part  affected,  may  h« 
employed  until  the  manifestations  of  movcurial  action  subside,  when 
the  regular  ti-eatment  may  be  resumed.  When  the  whole  surface 
becomes  extremely  susceptible  and  sore,  the  hot-bath,  followed  by  the 
tepid  wash  or  pail  douche,  should  be  employed. 

The  general  regimen  applicable  to  gout  is  equally  so  to  rheumatism. 


CHAPTER   IV. 

INDIGESTION. 


Wherkver  the  refinements  of  civilization  and  the  luxury  of  plen- 
teousness  exist,  dyspepsia,  in  some  of  its  protean  shapes,  seems  to  be  the 
general  condition  of  the  inhabitants.  I  do  not  agree  with  Dr.  E.  John- 
son (Results  of  Ilydrojjathy)  that  "constipation  is  not  a  disease  of  the 
bowels ;"  nor  do  I  coincide  in  his  notion  that  mental  excitement  is  the 
sole  cause  of  indigestion.  I  admit,  however,  it  is  one  among  several 
very  efficient  causes  of  that  extensive  train  of  morbid  maladies  which 
we  call  dyspepsia. 

Nosologists  have  enumerated  more  than  one  hundred  distinct  dis- 
eases, to  which  they  have  assigned  specific  characters,  and  which  they 
have  scattered  through  various  and  dissimilar  genera,  orders,  and  class- 
es ;  yet  each  is  nothing  but  a  mere  circumstance  of  deficient  or  imper- 
fect performance  of  the  digestive  function.  Thus  Dr.  Good,  in  his 
elaborate  system  of  pathology,  ejevates  such  symptoms  of  digestive 
derangement  as  heartburn,  water-brash,  flatulence,  depraved  appetite, 
colic,  constipation,  teething,  etc.,  to  the  rank  of  idiopathic  maladies.  I 
shall  undertake  to  associate  ail  these  manifestations  of  one  general 
morbid  condition  into  a  more  natural  arrangement,  and  treat  of  them  in 
the  present  chapter.  The  propriety  of  thus  gi'ouping  together  several 
classes  of  diseases  which  have  been  usually  considered  not  only  as  idio- 
pathically  distinctive  H:t  as  demanding:  ^^idely  different  and  even  oppo- 


INDIGESTION. 


129 


site  methods  of  treatment,  is  enhanced  by  the  fact  that  they  are  all 
really  cured  by  the  same  general  plan  of  hydropathic  medication 


Diseases  of  Indigestion. 


Dyspef.fc'ia 


'  Morbid  Appetite, 
Morbid  Tliirst, 
Heartburn, 
Flatulence, 
Constipation, 

I  Sick  Headache, 

r  Chronic  Hepatitis, 
Liver       )  Jaundice, 
Complaint)  Gall-Stones, 

t  Duodenitis. 

r  Toothache, 
Misdentition-I  Tartar  of  the  Teeth, 

l  Excrescent  Gums. 
Iliac  Passion, 
Painter's  Colic, 
Wind  Colic, 
Surfeit, 
Constipated  Colic, 

I  Constrictive  Colic. 


(  Bilious, 

1  Flatulent, 
Spasmodic, 
Infantum. 
r  Feculent, 
Bilious, 

j  Mucous, 
Diarrhea  <;^^ij.y_ 

Serous, 


Intestinal 


Colic  < 


.  Tubula" 
j-Bezoar, 

I  Calculus, 
Concretions  I  g^y^^^j^^,_ 

/-Alvine  Worms, 
Worms  <j  Anal  Worms, 

I  Erratic  Worms, 
r  Blind  Piles, 
Hemorrhoids  J  Bleeding  Piles. 
I  White  Piles, 
[  Caruncular  Piles. 


That  the  majority  of  the  diseases  named  in  the  above  table  are 
symptomatic  of  indigestion  all  will  allow ;  but  those  who  are  accustom- 
ed to  regard  worms  as  natural  to  the  alimentary  canal,  and  those  who 
consider  the  piles  as  a  local  affection,  will  object  to  the  tabular  arrange- 
ment. But  I  will  venture  to  assure  every  physician  who  will  carefully 
investigate  the  subject,  that  he  will  find  the  stomachs  and  bowels  of 
children  or  adults  infested  with  vermin  in  very  nearly  the  ratio  that 
foul  secretions  and  crude  ingesta  evince  disordered  digestion ;  and  if 
he  will  attentively  study  the  history  of  hemorrhoidal  affections,  he  will 
find  them,  in  some  form,  almost  as  general  %s,  and  almost  invariably 
preceded  by,  constipated  bowels.  Still  gi'eater  will  be  the  dissent  of 
those  who  have  imagined  epidemic  or  spasmodic  cholera  to  depend  on 
specific  contagion,  ozone,  electrical  or  magnetic  states  of  the  atmos 
phere,  or  planetary  or  other  unearthly  influences,  to  the  idea  that  all 
the  choleras  of  medical  books  are  dyspeptic  affections.  But,  whatever 
may  be  their  predisposing  or  exciting  causes,  it  is  sufficiently  apparent 
that  the  actual  condition  of  the  disease  is  that  of  extreme  derangement 
nnd  intense  irritation  of  all  the  organs  auxiliary  to  dijrpstion. 

Dystepsia. — Depraved  appetite,  unnatural  thirst,  flatulence,  acrid 
eru 'Nations,  heartburn,  or  water-brash,  irregular  bowels,  and  sick  head- 


130  PATHOLOGY    AXD    THERAPEUTICS. 

flche,  are  among  the  multitudinous  symptoms  of  dyspepsia ;  yet  the 
disease  may  exist  with  the  absence  of  either  one  or  the  majority  of 
vhem. 

Symptoms. — Fastidious  or  iiTcj^ular  appetite,  constipation,  or  diar- 
rhea, or  those  states  alternating,  sense  of  weight  or  other  feeling  of 
distress  after  eating,  food  digested  with  difficulty,  depressed  spirits, 
disturbed  sleep,  occasional  pain  or  tenderness  in  the  epigastrium,  a 
feeling  of  languor,  which  is  relieved  by  taking  food,  aversion  to  exer- 
cise of  body  or  mind,  are  symptoms  which,  variously  combined,  desig- 
nate the  disease.  Usually  there  is  occasional  palpitation  or  throbbing 
of  the  heart,  furred  tongue,  and  slow,  irrfegular,  or  intermittent  pulse. 

Doctor  Gully  and  some  other  authors  distinguish  dyspepsia  into  the 
nervous  and  mucous  varieties.  The  term,  nervous,  is  applied  to  the 
disease  when  occurring  in  persons  of  iiTitable  temperaments,  with  a 
large  development  of  the  brain  and  nervous  system;  and  the  term, 
mucous,  is  applied  to  the  disease  as  it  appears  in  persons  of  more  tor- 
pid or  phlegmatic  temperaments.  The  former  generally  results  from 
nental  shocks,  excessive  emotions,  intense  study,  violent  passions,  and 
is  attended  with  great  pain  or  uneasiness  in  the  stomach,  spasms,  gnaw- 
ing or  sinking  sensations,  capricious  appetite,  etc.  The  latter  results 
more  especially  from  sedentary  habits  and  excesses  in  eating  and  drink- 
ing, and  is  attended  with  torpid  bowels,  and  but  little  actuaj  pain  in  the 
digestive  organs. 

Treatment. — No  other  disease  presents  itself  under  so  great  a  va- 
riety of  complications ;  and  although  the  principles  which  regulate  its 
ti'eatment  are  very  simple,  there  is  an  unlimited  opportunity  for  the 
exercise  of  skill  and  tact  in  the  management  of  a  dyspeptic  invalid. 
Usually  we  have  to  deal  with  fickle  tempers,  despondent  minds,  strong 
morbid  appetites  with  weak  resolutions,  all  of  which  circumstances  are 
aggravated  by  the  patient  having  previously  doctored  with  all  sorts  of 
doctors,  and  swallowed  everything  he  could  read  of  in  the  newspapers 
in  the  shape  of  nostrums. 

All  the  resources  of  hygiene  must  be  drawn  upon,  and  adapted  to 
the  circumstances  of  each  particular  case.  The  nervous,  feeble,  rest- 
less individual,  who  is  all  activity  with  little  stiength,  who  has  a  con- 
stant disposition  to  move  with  no  power  to  endure,  must  take  moderate 
water-treatment,  exercise  gently,  prefer  sailing,  riding,  etc.,  to  active 
walking,  and  sleep  all  that  he  is  inclined  to,  even  though  it  be  late  in 
the  morning,  or  at  other  times  of  day,  while  the  torpid,  quiet,  but 
more  enduring  person  should  employ  more  powerful  water  processes 
rise  etu'ly,  walk  much,  and  practice  gj-mnastics  for  amusement,  unless 
lie  can  fin    amusement  in  some  light  ki  'd  of  manual  or  mechanical  labor 


INDIGESTION.  131 


The  diet  should  be  more  plain  and  simple  as  the  disease  is  more  ad- 
vanced and  serious.  Regularity  in  the  alvine  dejections  is  of  first  im- 
portance. The  patient  should,  if  possible,  go  to  stool  at  the  same  time 
of  each  day,  and  if  the  diet  does  not,  in  a  very  few  days,  produce 
regularity  in  the  discharges,  cool  or  cold  injections  should  be  employed 
daily,  soon  after  rising.  As  a  tonic  effect  is  always  desirable,  cool  or 
cold  water  should  be  employed,  whether  the  bowels  are  loose  or  con- 
stipated, except  when  affected  with  coli.  or  griping.  The  sitz-bath 
and  the  abdominal  compress  are  the  important  and  ever-necessary  local 
baths.  The  former  may  be  resorted  to  two  or  three  times  a  daj',  for 
ten  or  fifteen  minutes,  the  temperature  as  cold  as  the  patient  can  bear 
without  producing  a  permanent  chill,  or  disagreeable  feeling  of  weak- 
ness and  stiffness.  The  crash  towel  bandage  is  the  best ;  the  wet  part 
should  pass  round  the  body,  when  it  can  be  worn  without  unpleasant 
irritation  or  chilliness  of  the  back ;  otherwise  it  should  onl}'-  extend 
across  the  abdomen  from  one  side  to  the  other.  Foot-baths  should  not 
be  neglected  when  there  is  a  tendency  to  cold  extremities.  The  most 
important  general  baths  are  the  partial  or  complete  wet-sheet  pack, 
according  to  the  general  heat  and  reactive  power,  and  the  tepid  half 
or  shallow-bath.  The  plunge  or  douche  may  be  employed  under  the 
restrictions  heretofore  specified  ;  the  dripping  sheet  is  a  good  substitute 
for  either  of  the  other  general  baths  when  it  is  impracticable. 

The  hot  fomentation  to  the  abdomen  is  serviceable  whenever  indi- 
cated by  severe  headache,  spasms,  general  restlessness,  nausea,  vomit- 
ing ;  and  sick  headache  is  relieved  by  drinking  warm  water,  followed 
by  sips  of  cold,  and,  in  severe  cases,  the  abdominal  fomentation.  When 
sick  headache  occurs  periodically,  warm  water  should  be  copiously 
drank  on  its  first  attack,  to  dilute  and  wash  away  the  offending  bile  or 
other  acrid  fluids  as  soon  as  possible. 

A  good  combination  of  baths  for  full  or  active  treatment  in  an  ordi- 
nary case,  would  be  the  following  daily  :  Tepid  half-bath  five  minutes 
and  pail  douche  ;  wet-sheet  pack,  followed  by  moderate  douche,  plunge, 
or  dripping  sheet ;  sitz-bath  at  60°,  ten  minutes,  followed,  after  an  hour's 
interval,  by  a  foot-bath  at  72°,  five  minutes  ;  the  first  to  be  taken  on  ris- 
ing ;  the  second  from  ten  to  eleven  a.m.  ;  the  third  at  four  to  five  p.m., 
and  again  in  the  evening.  The  wet  girdle  should  be  wet  and  reapplied 
after  each  bath,  and  again  at  bedtime.  In  protracted  cases  requiring 
long  course  of  treatment,  it  is  advisable  to  omit  the  wet  bandage  occa- 
sio^ially  for  a  few  days,  and  then  resume  it  again. 

In  many  cases  of  dyspepsia  there  is  a  weak  and  relaxed,  or  a  rigid 
and  contracted  state  of  the  external  abdominal  muscles,  especially  fre- 
quent in  those  who  have  been  addicted  to  crooked  bodily  positions,  in- 


132  PATHOLOGY    AND    THERAPEUTICS. 


tense  mental  excitement,  sexual  abuses,  or  the  use  of  narcotic  stimu- 
lants, as  tobacco  and  alcohol.  The  fi-ee  indulgence  in  tea  and  coffee 
also  conduces  to  it ;  and  fine,  constipated  food  is  among  its  producing 
causes.  These  cases  require  local  manipulations,  as  kneading,  pound- 
ing, rubi-ing,  etc.,  the  lower  pait  and  external  muscles  of  the  abdomen, 
not  with  sufficient  violence,  however,  to  cause  pain.  A  trotting  horse 
afibrds  a  good  exercise.  Climbing  mountains,  and  walking  rather  fast 
over  an  uneven  surface,  are  also  peculiarly  beneficial  exercises. 

Liver  Complai>t. — A  morbid  condition  of  the  liver  is  as  constant 
and  as  necessary  a  concomitant  of  indigestion  as  is  a  morbid  condition 
of  the  stomach.  In  some  forms  of  deranged  digestion  the  stomach 
and  bowels  appear  to  be  the  seat  of  the  more  prominent  morbid  phe- 
nomena, and  in  others  the  liver  presents  evidences  of  being  dispro- 
portionately affected.  Its  pathological  conditions  are  various,  but  its 
ftinctional  derangements  may  all  be  comprehended  under  the  general 
term  of  liver  complaint. 

Syjnjjioms. — Chronic  hepatitis  is  a  state  of  passive  or  chronic  inflam- 
mation of  the  organ.  In  addition  to  a  variety  of  dyspeptic  symptoms, 
there  is  sense  of  weight,  fullness,  or  other  pain  in  the  region  of  the 
liver,  which  is  increased  by  deep  pressure  ;  sometimes  the  pain  is  re- 
ferred to  the  left  side  ;  at  other  times  to  the  right  shoulder,  or  between 
the  shoulder-blades ;  there  is  frequently  darting,  irregular,  and  fugitive 
pains  along  the  breast-bone  and  through  the  chest ;  some  degree  of 
enlargement  or  hai'doess  is  usually  obvious  to  the  touch  under  the 
short  ribs  of  the  right  side ;  the  countenance  is  sallow ;  the  bowels  are 
costive ;  the  stools  ai'e  clay-colored ;  the  patient  is  torpid,  inactive,  and 
desponding,  and  there  are  occasional  attacks  of  jaundice.  Dropsy  fi-e- 
quently  follows  this  form  of  diseased  liver.  It  is  also  generally  attended 
with  a  diy,  husky  cough,  and  a  slight  hawking,  or  spitting  of  a  thick, 
tenacious  mucus,  especially  in  the  morning,  when  the  sputa  appears 
dark  and  cai'bonaceous,  as  though  charcoal-dust  had  been  diffused 
through  it.  The  cough  is  immediately  caused  by  the  engorged  or 
swelled  liver  pressing  upon  the  diaphragm,  and  the  viscid  secretion  of 
the  mouth  or  throat  is  owing  to  the  irritation  of  congested  and  acrid 
bile.  This  cough  and  expectoration  may  be  distinguished  from  that 
which  has  its  seat  in  the  lungs  or  their  appendages,  by  the  sloio  puhe^ 
and  the  prominent  hepatic  or  dyspeptic  symptoms. 

Jaundice — the  icterus  of  tlye  books — has  been  commonly  distinguished 
into  the  yeJlaw  and  black,  or  green,  according  to  the  discoloration  of  the 
skin  from  impacted  and  partiallj-  pmtrescent  bile,  to  which  some  authors 
have  added  the  subvar'«>ties  of  hiliary — p  ■^duced  by  a  resorption  of 


INDIGESTION.  133 


bile;  gall-stone — resulting  from  obsti-uction  of  the  bile-ducts  from  in- 
spissated bile;  spasmodic — produced  by  spasmodic  stricture  of  the  bile 
ducts;  hepatic — resulting  from  schirrus  or  induration  of  the  liver;  in 
fan  tile — occurring  in  infants  ;  and  black  vomit — the  regurgitation  of 
morbid  bile  into  the  stomach,  and  its  ejection,  mixed  with  dark,  gru- 
mous  blood.  Jaundice,  in  a  general  sense,  is  known  by  debility,  languor, 
inactivity,  heat  and  pricking  of  the  skin,  bitter,  nauseous,  or  acrid  taste 
in  the  mouth,  yellowness  of  the  conjunctiva  of  the  eye,  and  subse- 
quently of  the  whole  surface  of  the  body ;  the  bowels  are  irregular, 
the  urine  high-colored  and  yellowish,  the  pulse  is  usually  slow  and 
weak,  the  mind  is  downcast  and  gloomy,  or  listless,  wandering,  and 
irritable,  and  there  is  feverish  heat  and  dryness  of  the  skin.  When 
the  disease  is  proti'acted,  the  skin  turns  greenish,  brown,  livid  or  lead 
en,  blotches  appear  in  difterent  parts,  and  the  discharges  from  the 
bowels  are  dark,  pitchy,  and  bloody.  Tlie  special  or  immediate  cause 
of  jaundice  is  torpor  or  inactivity  of  the  liver,  by  which  the  viscid  par- 
ticles which  should  be  secreted  in  the  liver,  and  passed  off  in  the  for?Ti 
of  bile,  are  left  in  the  blood. 

The  existence  of  gall-stones  is  known  by  the  acute  and  sometimes 
excruciating  pain  they  occasion  when  passing  through  the  common 
bile-duct  from  the  liver  into  the  duodenum;  this  pain  is  felt  in  the 
epigastrium,  extending  to  the  right  side  and  back,  and  occurs  in  severe 
paroxysms,  with  intervals  of  comparative  ease.  The  pain  suddenly 
remits  when  the  calculus  reaches  the  intestine. 

Duodenitis  is  an  inflammatoiy  state  of  the  mucous  membrane  of  the 
duodenum,  at  the  point  where  the  bile  enters  this  portion  of  the  intes- 
tinal tract ;  it  is  occasioned  by  the  contact  of  acrid  and  hritating  bile, 
and  known  by  a  sickening,  sinking,  gnawing  sensation  just  below  the 
pit  of  the  stomach,  with  tenderness  to  external  pressure,  often  so  gi'eat 
as  to  make  the  weight  of  the  hand  or  of  the  bedclothes  painful. 

Treatment. — All  that  has  been  said  in  relation  to  the  treatment  of 
dyspepsia,  applies  with  equal  force  here.  There  are,  however,  some 
modifications  of  the  general  plan  of  management  required  in  some 
forms  and  stages  of  the  disease,  or  rather  group  of  diseases  under  con- 
sideration. The  state  or  condition  of  liver  disease  described  as  chronic 
hepatitis,  in  which  the  bile  is  still  imperfectly  secreted,  but  its  quality 
exceedingly  vitiated,  requires  more  especial  attention  to  the  stomach 
and  bowels.  Wai"m  water  emetics  are  serviceable  to  deterge  the  biliary 
ducts,  whenever  nausea,  bitterness  in  the  mouth,  and  unusual  sense  of 
fullness  in  tl^  right  side  indicate  obstruction ;  and  if  the  bowels  are 
costive,  with  general  fullness  and  tenderness,  tepid  injections  should  be 


184  PATHOLOGY    AND   THERAPEUTICS. 


freely  emploj-ed  until  these  symptoms  are  removed,  when  cool  or  cold 
'ues  should  be  substituted. 

Jaundice  presents  many  complicated  varieties  of  morbid  phenomena, 
all  of  which  are  usually  denominated  "  nervous  debility ;"  a  term  not 
entirely  inappropriate,  since  the  thick  viscid  blood,  consequent  on  the 
retained  matter  of  bile,  being  unable  to  peneti-ate  freely  the  minute 
capillary  vessels,  where  nutrition  of  the  nervous,  as  well  as  the  other 
structures,  is  effected,  the  nei-ves  are  really  impoverished  for  want  of 
sustenance.  In  this  form  of  diseased  liver,  too,  the  skin  is  dry  and 
feverish,  or  clammy  and  cold,  in  either  case  weak,  obstructed,  and  bil- 
ious, yet  bloodless.  Reaction,  though  sometimes  active  and  prompt,  is 
always  feeble  and  ti^ansient ;  hence  we  are  to  begin  the  general  treat- 
ment with  the  gentler  processes,  employing  water  of  a  mild  temper- 
ature, gradually  intensifying  the  force  and  lowering  the  temperature 
of  the  bnths,  as  the  superficiiil  circulation  of  the  patient  improves. 
The  half-bath  may  be  commenced  at  about  85°  or  90°,  and  gradually 
reduced  to  75°  or  70°;  the  sitz  may  be  employed  at  first  at  75°,  and  by 
degrees  lowered  to  60°;  the  cold  sheet  half-pack,  or  entire  warm  sheet 
pack,  is  advisable  at  fii"st,  gradually  proceeding  to  the  ordinary  wet- 
sheet  envelopment  as  the  skin  becomes  invigorated.  In  some  case?, 
where  there  is  considerable  tendency  to  feverishness,  the  whole  body 
will  readily  warm  up  in  the  wet  sheet,  and  the  glow  increase  for 
twenty  or  thirty  minutes,  when  it  will  begin  to  decline,  in  spite  of  any 
amount  of  extra  bedding.  Such  patients  should  be  taken  out  of  the  pack 
as  near  the  height  of  the  reaction  as  possible,  and  bottles  of  hot  water 
should  be  applied  to  the  feet,  and  in  extreme  cases  to  the  armpits  also,  to 
enable  them  to  remain  still  longer  enveloped.  The  dripping  rub-sheet 
is  one  of  the  best  appliances  in  cases  of  extreme  torpor  and  bloodless- 
ness  of  the  surface,  the  temperature  not  being  so  cold  as  to  leave  a 
permanent  chill. 

It  should  6e  particu'tirly  borne  in  mind,  that  no  patients  in  the  con- 
dition of  "  nervous  debility"  under  consideration,  will  tolerate  extremes 
of  treatment,  be  they  hot  or  cold.  There  is  not  sufficient  blood  in  the 
superficial  capillaries  to  react  against  very  cold  impressions,  and  for  the 
same  reason  steam  or  vapor-bathing,  or  the  ordinary  hot-bath,  has  a 
peculiarly  relaxing  and  debilitating  effect,  a  vigorous  capillary  circulation 
being  just  as  necessary  to  defend  the  body  against  one  extreme  of  tem- 
perature as  another. 

The  existence  of  gall-stones  only  requires  the  hot  fomentation  and 
warm  sitz-bath,  with  copious  warm  water  drinking,  to  facilitate  their 
passage,  and  mitigate  the  pain. 

As  duodenitis  is  caused  directly  by  morbid  and  acrid  bile  it  will  dli 


INDIGESTION.  135 


appear  whenever  the  healthful  secretion  of  the  liver  is  restored.  Some- 
times it  disappears  when  the  condition  of  the  liver  changes  from  chronic 
inflammation  to  jaundice — from  morbid  action  to  no  action.  Occasion- 
ally ulceration  takes  place  from  the  long-continued  corrosive  effect  of 
putrid  bile,  resulting  in  death  suddenly  and  unexpectedly. 

MiSDENTiTiON. — Teething,  tooth-edge,  toothlessness,  and  deformity 
of  the  teeth,  are  placed  by  Dr.  Good  in  the  catalogue  of  diseases  be- 
longing to  the  genus  before  us.  Teething,  it  seems  to  me,  is  rather  2 
natural  than  a  morbid  process ;  and,  although  often  accompanied  withx 
much  pain  and  suffering,  and  various  diseases,  these  are  all  owing  to 
some  obstruction  or  irritation  in  the  digestive  organs,  producing  a  gen- 
eral feverishness  of  the  system  and  an  inflammatory  state  of  the  gums. 
Tooth-edge  is  the  peculiar  tingling  or  uneasy  sensation  experienced  in 
the  teeth  from  some  kinds  of  gratino;  or  jarring  noises,  or  from  certain 
acids  and  acrid  substances.  Toothlessness  results  from  constitutional 
defect,  external  violence,  internal  drug-medicines,  decay,  or  old  age. 
Deformity  of  the  teeth  is  generally  an  unfortunate  inheritance,  for  which 
the  child  is  indebted  to  the  bad  dietetic  or  other  habits,  or  infirmities, 
of  one  or  both  parents ;  a  great  degree  of  deformity,  however,  may 
be  produced  by  bad  habits  in  the  dietetic  and  medical  management  of 
the  child  itself. 

The  diseases  properly  coming  under  the  present  head  are,  toothache, 
tartarous  teeth,  and  excrescent  gums,  all  specially  connected  with  or 
dependent  on  depraved  or  impaired  digestion.  The  history  of  all  the 
animal  creation,  and  of  the  whole  human  race,  shows  that  there  is  a 
most  intimate  relation  between  sound,  clean,  symmetrical  teeth  and 
healthy,  fine,  vigorous  gums,  and  correct  dietetic  habits.  The  uni- 
formly healthy  condition  of  the  teeth  of  wild  animals,  and  the  general 
rotting  state  of  those  of  domesticated  animals  illustrates  this  fact  suf- 
ficiently. 

The  exciting  cause  of  toothache  is  usually  "taking  cold."  It  may 
exist  in  connection  with  caries  or  ulceration  of  the  teeth,  or  with  eX' 
treme  irritability  of  the  dental  neiTe  without  structural  decay.  The 
cure  may  be  found  in  holding  tepid  or  cool  water  in  the  mouth,  renew- 
ing it  as  often  as  it  becomes  quite  w^arm,  rubbing  the  fiice  and  neck 
with  the  hands  dipped  in  cold  water,  the  shallow  foot-bath,  and  absolute 
fasting  until  the  pain  abates.  Very  few  toothaches  can  hold  out  against 
a  fast  of  twenty-four  hours,  even  if  no  other  medication  is  resorted  to. 
Rubbing  the  teeth  and  gums  smartly  with  a  brush  dipped  in  cold  water, 
even  until  the  gums  bleed  freely,  often  relieves  toothache  promptly. 

Tartar  of  the  teeth  consists  :yf  concrete  saliva  hardened  by  the  earthj^ 


136  PATHOLOGY     VND    THERAPEUTICS. 

materials  which  it  secretes.  The  remote  cause  is  undoubtedly  the 
excessive  amount  of  earthy  oi  extraneous  ingredients  taken  into  the 
system  with  the  food  and  drink,  more  especially  derived  from  hard  wa- 
ter ;  and  the  immediate  cause  is  deficient  mastication,  the  food  being  soft 
and  sloppy,  and  not  demanding  sufficient  exercise  of  the  teeth  to  keep 
them  clean.  In  many  instances  the  mouth  is  most  foully  disfigured  by 
tartarous  concretions  which  have  destroyed  the  gums  and  alveolar 
sockets.  The  tooth-brush,  aided  by  some  mild  dentifrice,  is  the  best 
palliative  we  can  employ.  To  effect  a  cure,  the  teeth  must  be  cleaned 
by  a  careful  dentist,  and  then  the  dietetic  habits  must  be  placed  under 
physiological  law. 

Excrescent  gums  may  be  either  soft,  spongy,  or  fungous,  or  in  the 
form  of  firm,  unyielding  lumps  or  jiardened  knobs ;  they  are  always 
symptomatic  of  scurvy,  or  some  disorder  of  the  digestive  organs.  They 
can  only  be  cured  by  attention  to  the  general  health.  Sometimes  the 
excrescences,  when  considerably  protuberant,  have  been  extirpated 
with  caustic,  ligature,  or  the  knife ;  but  unless  general  health  is  re- 
stored, they  will  soon  grow  again. 

Colic. — All  those  diseases  comprised  under  the  generic  head  of 
cholic,  or  belly-ache,  are  characterized  by  griping  pain  in  the  bowels, 
mostly  in  the  region  of  the  umbilicus,  and  attendea  with  vomiting  and 
costiveness.  ^ 

Symptoms. — The  species  called  iliac  passion  is  accompanied  with 
painful  retraction  or  drawing  in  of  the  navel,  and  spasms  of  the  muscles 
of  the  belly  ;  the  vomiting  is  exceedingly  violent,  ejecting  bile  from  the 
duodenum,  and  often  stercoraceous  matter  from  the  bowels;  and  even 

some  cases  the  injections  inti-oduced  into  the  rectum  have  been 
ejected  by  the  mouth.  This  is  the  disease  called  introsusception  or  in- 
tuS'Susception  in  medical  books,  and  so  denominated  from  the  circum- 
stance that  one  portion  of  the  affected  intestine,  constringed  and  les- 
sened in  diameter,  has  fallen  into  another. 

Paintefs  colic — known  also  as  Devonshire  colic,  colica  poictou,  and 
colica  rachialgia — is  so  termed  from  the  remote  cause  being  the  in- 
troduction of  lead  into  the  system,  and  hence  mostly  confined  to  paint- 
ers. In  the  neighborhood  of  smelting  furnaces,  pigs,  poultiy,  and  other 
animals  are  said  to  be  affected  with  this  complaint.  It  is  evinced  by 
a  pain  at  the  pit  of  the  stomach,  at  first  dull  and  remitting,  but  grad- 
ually becoming  more  violent  and  continued,  and,  as  it  increases,  ex- 
tending upward  to  the  arms,  and  downwai-d  to  the  navel,  back,  loins, 
rectum,  and  bladder,  and  frequently  extending  to  the  thighs  and  legs. 
From  the  navel  it  sometimes  shoots  with  so  much  violence  to  e-ach  sid© 


INDIGESTION.  187 


that  the  oatient  feels  as  if  some  person  were  cutting  him  in  two.  Tho 
external  muscles  are  extremely  sore  and  tender,  and  can  scarcely 
bear  the  slightest  touch.  Momentary  relief  is  occasionally  experienced 
after  the  vomiting  of  acrid  bile  and  slime,  but  the  pain  soon  returns. 
Tn  about  a  week  or  less,  if  recovery  takes  place,  relieving  sweats 
appeal-,  and  the  bowels  discharge  large  quantities  of  excrement,  con- 
sisting of  hard  lumps,  or  scybala,  mixed  with  blood  and  dirt-colored 
mucus,  afier  which  the  patient  is  Ctjnvalescent.  Paralysis  of  the  fingers, 
hand,  and  arm  comes  on  after  several  attacks. 

It  may  be  poor  consolation  to  wine-bibbers  to  know  that  litharge,  and 
other  preparations  of  lead,  are  extensively  employed  in  the  manufac- 
ture of  sweet  and  sub-acid  wines,  and  that  where  such  wines  are  freely 
drunk,  this  kind  of  colic  is  very  prevalent;  nevertheless,  such  is  the 
fact. 

Dr.  Samuel  Cooper,  author  of  a  surgical  dictionary,  remarks  :  "  Dur- 
ing the  sixteenth  and  seventeenth  centuries,  when  preparations  of  lead 
used  to  be  given  in  large  doses  medicinally,  the  colica  pictonum  and 
paralysis,  in  their  severest  forms,  appear  to  have  been  very  frequent." 

Wind-colic — colica  Jlatulenti a — is  evinced  by  acute  pain  extending  to 
the  pit  of  the  stomach,  accompanied  with  great  fullness  and  flatulence, 
often  impeding  respiration;  it  is  relieved  by  pressure,  expulsion  of 
wind,  or  bending  the  body  forward.  It  is  chiefly  produced  by  crude 
or  unripe  fruits,  long  fasting,  grief,  fear,  etc.,  and  is  a  fi-equent  attend 
Hnt  of  dyspepsia  and  chronic  diarrhea. 

Surfeit — colica  cibaria — is  usually  produced  by  loading  the  stomach 
with  an  excessive  quantity  or  indigestible  quality  of  food.  Occasionally 
it  results  from  poisonous  vegetables  or  animals  taken  into  the  stomach. 
Various  kinds  of  shellfishes,  and  several  species  of  other  fishes,  are 
known  to  have  been  followed  by  an  attack.  It  is  characterized  by  pain, 
nausea,  and  dizziness,  until  vomiting  takes  place,  terminating  afterward 
in  a  griping  looseness.  There  is  also,  in  some  cases,  an  eruption  of  the 
skin,  with  constriction  in  the  throat,  an  intolerable  sense  of  suflbcation, 
swollen  eyes,  extreme  thirst,  and  a  burning  heat  over  the  whole  surface. 

Constipated  colic — colica  constipata — is  caused  by  indurated  foeces, 
or  other  intestinal  concretions,  and  is  known  by  severe  griping  pain, 
obstinate  costiveness,  gi-eat  tension  with  little  flatulence ;  the  vomiting 
sometimes  accompanied  with  foeces ;  the  costiveness  is  attended  with 
bloody  strainings,  terminating,  when  not  fatal,  in  a  free  discharge  of  the 
infarcted  matter. 

The  constrictive  species — colica  constricta — results  from  a  permanent 
Btricturft  existing  in  some  pait  of  the  aliraentq^y  canal.  Its  symptoms 
are — a  sense  of  striclure  ;  a  fee  mg  of  flatalenci*  gradually  passing  off 


138  PATHOLOGY    AND    THERAPEUTICS. 

by  the  stricture;  the  bow'jls  taidy,  and  discharging  with  difficulty 
sinull  liquid  stools.  In  the  early  stage  of  the  disease  there  are  colic 
pains  and  costiveness,  alternating  with  bilious  diarrhea ;  after  the  dis- 
ease has  existed  some  time,  solid  foeces  are  rarely  passed,  and  only 
after  a  gi*eat  effort,  and  they  are  of  an  extremely  slender  caliber.  Pa- 
tients have  I)een  known  to  subsist  more  than  thirty  days  without  any 
evacuation  from  the  bowels. 

Treatment. — The  general  mauageraeni  of  colic  consists  mainly  in 
the  employment  of  copious  warm  water  injections,  to  free  the  aliment- 
ary canal  of  its  accumulated  contents,  conjoined  with  frequent  hip  or 
half-baths,  which  may  be  either  hot  or  cold,  according  to  ch'cumstances, 
to  quiet  pain,  and  overcome  whatever  inflammatory  or  spasmodic  con- 
dition may  exist.  In  some  cases,  hot  water  proves  the  best  sedative, 
and  in  other  cases,  very  cold  water  is  most  efficient.  It  is  fortunate 
that  in  almost  all  cases,  and  probably  in  every  case,  when  warm  water 
fails  in  giving  relief,  cold  water  promptly  succeeds.  The  desirable 
temperature  can  generally  be  very  readily  determined  by  the  febrile 
or  non-febrile  character  of  the  symptoms.  If  there  is  considerable 
heat  and  fixed  soreness  about  the  abdomen,  with  a  general  feverishness 
of  the  whole  body,  cold  or  very  cold  water  is  most  appropriate  ;  and 
when  the  whole  body  is  inclined  to  coldness  and  torpor,  and  the  ab- 
dominal pains  are  griping  and  periodica],  hot  water  is  indicated.  In 
mild  cases,  the  hot  fomentation,  followed  by  the  cold  compress,  will 
remove  all  local  distress.  Wherever  the  hip  or  half-bath  is  employed, 
the  abdomen  and  back  of  the  patient  should  be  thoroughly  rubbed  dur- 
ing its  administration.  The  moderate  drinking  of  water,  or  tepid  water, 
assists  the  relaxant  effects  of  the  other  processes. 

In  the  first-named  variety — colica  ileus — the  stricture  of  the  intestine 
is  sometimes  so  great  as  to  produce  a  degree  of  strangulation,  liable  to 
be  followed  by  inflammation  and  gangrene,  especially  if  drastic  or  irri- 
tating purgatives  are  resorted  to,  as  they  generally  are  in  old-school 
practice.  The  faeces  in  tliis,  as  in  the  other  forms  of  colic,  may  be  so 
hardened  as  to  require  the  handle  of  a  spoon,  or  some  similar  contriv- 
ance, to  remove  them  from  the  rectum.  For  these  reasons,  as  large  a 
quantity  of  water  as  the  bowels  can  well  receive  should  be  injected, 
and  the  process  frequently  repeated.  The  warm  stream  douche,  fol- 
lowed by  the  cold  dash,  is  excellent  as  a  local  application. 

The  second  variety — painter's  colic — demands,  in  addition  to  all  the 
treatment  required  for  the  ileus  form,  thorough  detersive  and  invigora- 
ting nvanagement.  The  wet-sheet  pack,  cold  or  warm,  according  to 
the  external  lieat  or  colc'oess  of  the  patient,  followed  by  the  dripping 
wet-sln;et  or  towe -wasb   and  this  by  the  dry  sheet  and  dry  hand  rub- 


INDIGESTION.  189 


bing,  will  best  accomplish  the  cleansing  and  strengthening  part  of  the 
remedial  plan. 

The  thii'd  variety — wind,  or  flatulent  colic — the  hot  fomentation  and 
a  single  mjeccion  are  usually  sufficient  to  remove.  If  it  resist  these 
means,  the  warm. douche  to  the  abdomen,  followed  by  the  dash  of  a 
pail  of  cold  water  to  the  belly  and  legs,  will  effectually  disperse  it. 

The  fourth  variety — surfeit — requires  a  thorough  warm  water  emetic, 
a  free  injection,  and  a  rigidly-abstemious  diet,  or  absolute  abstinence, 
for  a  few  days. 

The  fifth  and  sixth — constipative  and  constrictive — ^forms,  are  cured 
by  a  frequent  and  persevering  employment  of  tepid  injections  and 
sitz-baths,  as  leading  processes,  assisted  by  hot  fomentations,  the  wet- 
sheet  pack,  and  other  appliances,  as  the  general  symptoms  indicate, 
Especial  attention  should  be  given  to  rubbing,  kneading,  gently  pound- 
ing, or  otherwise  exercising  the  muscles  of  the  loins  and  abdomen. 
The  diet  should  be  of  the  coarsest  kind — cracked-wheat,  rye-mush, 
Indian  gruel,  hard  wheat-meal  biscuits,  good  fresh  ripe  fruits,  etc. 

Cholera. — The  gi-oup  of  diseases  comprehended  under  this  generic 
term,  is  characterized  by  vomiting  and  purging,  gripings  in  the  bowels 
spasms  in  the  arms  and  legs,  often  flatulent  eructations  and  dejections, 
with  great  anxiety  and  prostration.  The  usual  succession  of  symptoms 
is — Vomiting,  purging,  spasms,  prostration,  and  collapse.  In  the  spas- 
modic cholera,  however,  the  vomiting  is  generally  preceded  for  hours 
or  days  with  looseness  or  diarrhea.  Cholera  is  distinguished  from  colic 
by  the  presence  of  purging,  and  from  diarrhea  by  the  absence  of  vom- 
iting in  the  latter  disease. 

In  the  bilious  variety — commonly  knov/n  as  cholera  mothus — the 
vomiting  and  purging  are  copious  and  frequent,  with  a  redundancy  of 
bile.  In  the  severest  cases  the  vomiting  is  vehement,  the  dejections 
very  painful,  the  spasms  violent,  and  the  agony  intense.  In  the  worst 
cases  the  extremities  are  cold,  the  pulse  is  small,  frequent,  and  un- 
equal, and  the  patient  sometimes  dies  within  twenty-four  hours  from 
the  first  attack.  The  exciting  causes  are  usually  a  surfeit,  acrid  bile, 
indigestible  articles  of  food,  drastic  purges,  emetic  drugs,  especially 
tartar  emetic,  etc. 

Tlie  flatulent  form — wind  cholera — is  particularly  characterized  by 
the  absence  of  bile  in  the  discharges ;  the  vomiting  and  purging  are 
rare  ;  but  in  their  stead  there  is  great  and  oppressive  flatulence  and 
retching,  with  windy  eructations  and  dejections.  This  form  of  the  dis- 
ease is  rather  peculiar  to  dyspeptics. 

Spn^'"wdic  cholera — called  also  malignant,  epidemic,  Asiatic,  Indian, 


140  PATHOLOGY    AND    THERAPEUTICS.  \ 

blue,  and  pestilential  cholera — is  generally  epidemic,  though  not  con-    ; 
tagious.     The  first  symptoms  are  usually  experienced  during  the  night,    ■ 
sometimes  commencing  with  a  slight  general  uneasiness  and  moderate    i 
diarrhea ;  at  other  times  the  symptoms  come  on  violently,  and  follow    ; 
each  other  rapidly.     In  fatal  cases  death  usually  occurs  at  some  period    : 
between  six  and  twenty-four  hours ;  in  a  few  fatal  cases  the  patient   j 
lingers  two  or  three  days.     The  ordinaiy  course  of  symptoms  is,  more    , 
or  less  diari-hea ;  the  discharges  at  firet  feu^^ent,  but  soon  presenting   j 
the  appearance  of  rice-water  or  gruel ;  there  ai*e  flying  pains,  or  sense   \ 
of  coldness  in  the  abdomen,  as  if  purgative  medicine  were  about  to   I 
operate ;  the  countenance  is  pale ;  there  is  nausea,  vomiting,  prosti'a- 
tion  of  muscular  power,  and  nervous  agitation ;  cramps  in  the  legs,    ; 
arms,  loins,  and  abdominal  muscles,  more  or  less  severe ;  small  weak 
pulse,  intense  thirst,  and  urgent  desire  for  cold  wnt.er ;  in  most  cases   { 
cold,  clammy  skin ;  all  these  symptoms  may  appear  successively  or  al     i 
most  simultaneously.     In  some  cases  the  premonitory  symptoms  exist  ' 
for  eight  or  ten  days  ;  and  sometimes  the  patient  is  prostrated  at  once.   ' 
When  the  disease  comes  on  suddenly,  the  cramps  usually  commence 
in  the  fingers  and  toes,  rapidly  extending  to  the  trunk ;  the  eyes  are 
sunken,  and  surrounded  by  a  dark  circle  ;  there  is  vomiting  and  purg-   j 
ing  of  white  matters  mixed  w^ith  flocculi ;  the  features  are  sharp  and 
contracted ;  the  expression  of  countenance  wild  and  confused.     The  i 
face,  extremities,  and  often  the  whole  surface  of  the  body,  manifest  a  \ 
varying  intensity  of  a  leaden,  bluish,  or  purplish  hue  ;  the  extremities  [ 
are  shrunk,  the  nails  blue,  the  pulse  thready  or  wholly  imperceptible  j 
at  the  wrist,  arm,  axilla,  temple,  or  neck ;  there  is  gi*eat  restlessness,   ; 
incessant  jactitation,  severe  pain  in  the  epigasti'ium,  loud  moaning  or 
groaning,  difficult  and  oppressed  breathing;  difficult  inspiration,  with 
short  and  convulsive  expiration ;  voice  hoarse,  whispering,  or  nearly  , 
suppressed  and  plaintive  ;  the  tongue  is  white,  cold,  and  flabby,  and  the  i 
external  temperature  often  sinks  below  80°  ;  convulsions  recur  at  short  ; 
intervals,  or  a  constant  tremor  exists.     The  secretions  of  bile,  saliva,  ] 
tears,  and  urine  are  entirely  suppressed,  and  a  cadaverous  odor  exhales  ; 
from  the  body.     The  patient  retains  his  faculties  to  the  last.  i 

Either  of  the  alcove  symptoms  may  be  disproportionately  severe,  or  j 
it  may  be  entirely  absent.     Those  usually  regarded  as  pathognomonic 
are,  watery  dejections,  blue  appearance  of  the  countenance  or  sur-  i 
face,  thirst,  coldness  of  the  tongue,  and  pulselessness  at  the  wrist. 

The  fourth  variety — cholera  infantum — is  peculiar  to  infants,  and  j 
prevails  extensively  during  the  warm  season  in  nearly  all  of  our  cities,  j 
In  ordinary  cases  the  diarrhea  precedes  the  vomiting  for  several  days; 
but  in  severe  ones  vomiting  also  occurs  from  the  beginning.     The  dl*-  ■ 


INDIGESTION.  141 


charges  at  Jirst  aro  composed  of  ordinary  foecal  matters;  but,  as  the 
disease  progresses,  they  become  watery  and  variously  colored,  from  a 
dirty  white  to  a  brownish,  and  sometimes  greenish  hue.  Sometimes 
those  discharges  are  frothy,  like  yeast,  and  mixed  with  the  food,  which 
})asses  the  bowels  almost  unaltered  ;  in  some  cases  the  discharges  are 
bloody,  as  in  dysentery.  There  is  raging  thirst,  the  tongue  is  dry,  but 
scarcely  furred ;  the  febrile  heat  is  very  irregular ;  the  body  emaci- 
ated ;  the  skin  grows  dry  and  ash-colored ;  the  abdomen  is  very  much 
heated  toward  the  termination  of  the  disease ;  the  pulse  is  small, 
weak,  and  frequent  throughout.  It  usually  runs  its  course  in  about 
three  weeks. 

Treatment. — Bilious  cholera  ii:  its  early  stage  requires  copious  warm 
water  injections,  and  free  warm  water-drinking,  to  cleanse  the  whole 
alimentary  canal  as  promptly  as  possible.  When  the  discharges  liave 
existed  for  a  considerable  time,  and  the  patient  is  greatly  exhausted,  or 
after  the  employment  of  the  cleansing  processes  above  named,  frequent 
sips  of  cold  water  should  be  taken,  and  moderate  cool  injections  em- 
ployed after  each  dejection.  The  cold  compress  should  be  applied  to 
the  abdomen,  and  very  frequently  changed.  When  the  griping  is  ex- 
treme, the  hot  hip-bath  should  be  resorted  to;  and  the  cold  hip-bath 
when  there  is  much  external  heat  and  tenderness  of  the  abdomen 
The  wet-sheet  pack  and  the  pouring  head-bath  are  appropriate  and 
very  efficacious,  and  often  magically  soothing  processes,  after  the 
stomach  and  bowels  are  freed  of  their  irritating  contents. 

The  Jlatulcnt  form  may  be  relieved  by  hot  fomentations  or  hip-baths, 
and  moderately  cool  injections. 

In  indicating  the  appropriate  hydropathic  treatment  for  spasmodic 
cholera — the  most  frightful,  yet  not  the  most  fatal  pestilence  of  mod- 
ern times — I  feel  no  small  degree  of  embarrassment ;  not  that  I  regard 
the  Water-Cure,  which  I  claim  to  be  a  sufficient  system  in  all  other 
functional  diseases,  as  an  exceptional  failure  in  this,  but  because  it  has 
no  power  to  reclaim  the  dead  ;  and  in  many  cases  an  attack  of  this 
disease  is  a  death-stroke.  Persons  of  gi'oss  habits,  the  intemperate, 
the  debauchee,  the  riotous  liver,  and  those  whose  dietetic  habits  have 
been  peculiarly  enervating  and  constipating,  are  especially  and  almost 
exclusively  the  subjects  and  the  victims  of  this  penal  scourge.  The 
nature  of  the  disease  is  an  intensely  irritated  or  peculiarly  inflamma- 
tory state  of  the  mucous  membrane  of  the  stomach  and  bowels ;  the 
diarrhea,  which  the  drag-physicians  regard  and  treat  as  though  it  were 
the  essential  disease,  being  a  mere  indicent,  eifect,  or  symptom  of  this 
general  morbid  condition.  That  debility  and  obsti'uction  in  the  primary 
nutritive  functions  constitute  the  essential  condition,  wliile  inflammatory 


142  PATHOLOGY    AND    THERAPEUTICS 


uction  and  serous  discharges  constitute  the  leading  manifestations  of  the 
disease,  is  rendered  probable,  if  not  proved,  by  the  fact,  that  no  indi- 
vidual of  correct  dietetic  habits — such  habits  as  are  advocated  in  this 
work — ever  yet  had  the  disease.  This  is  certainly  true  of  the  Gra- 
hamites  and  Vegetarians  of  New  York,  in  all  the  seasons — 1832-34  and 
1849 — that  it  has  prevailed  epidemically ;  and  as  far  as  T  can  leai-n — 
and  I  have  taken  no  little  pains  to  ascertain  the  fact — throughout  the 
wide  world. 

When  I  say  that  dietetic  enors  are  prominent  among  the  producing 
causes  of  malignant  cholera,  I  do  not  mean  exclusively  habits  of  glut- 
tony and  intemperance.  Many  persons,  intending  to  diet  preventively, 
have  dieted  in  exactly  the  way  to  produce  it.  Medical  councils,  boards 
of  health,  and  sanatory  committees  have  g*>nerally  given  authoritatively 
more  bad  than  good  advice,  both  as  respects  avoiding  the  disease  and 
curing  it.  The  preventive  measures  officially  recommended  in  New 
York  in  the  hot  season  of  1849,  consisted  mainly  of  "flannel  next  the 
skin,  tlie  warm  bath  occasionally,  a  gi'eater  proportion  of  animal  food, 
and  fine,  constipating,  fai'inaceous  food."  Under  the  delusion  that  "the 
diarrhea  was  the  cause  of  all  the  symptoms  which  followed,  and  that 
if  the  diarrhea  could  be  prevented,  no  cholei'a  could  occur,"  rice, 
dried  beef,  bakers'  fine  bread,  with  animal  food  two  or  three  times  a 
day,  and  the  almost  entire  prohibition  of  fi-uits  and  vegetables  of  all 
kinds,  became  substantially  the  preventive  plan  of  living — a  plan  which 
was  faithfully  followed,  even  unto  death,  by  many  persons  and  several 
physicians  in  this  city.  The  ti'ue  preventive  plan  is  exactly  the  oppo- 
site in  every  respect. 

The  drug-treatment  of  cholera  would  be  amusing  for  its  inconsisten- 
cies, did  its  consequences  not  border  so  closely  on  the  ti-agical.  A 
great  variety  of  plans  of  medication,  dti'ectly  opposite  to  each  other, 
have  been  ti-ied  with  equal  success,  which  fact  ought  to  be  conclusive 
with  every  unprejudiced  mind  that  the  whole  is  purely  empirical.  Let 
us  place  a  few  of  the  opposite  plans  of  treatment  recommended  to  us 
on  high  authority  in  juxtaposition  :  Bleeding  and  antimony — opium  and 
brandy;  copious  libations  of  cold  water — powerful  internal  stimulants, 
as  capsicum  and  cajeput  oil ;  3metics  of  mustard,  ipecac,  antimony, 
and  blue  vitriol — iced-water,  or  bits  of  ico,  to  allay  sickness  at  the 
stomach;  cathai'tics,  as  calomel,  castor-oil,  colocy nth,  jalap,  colchicum, 
and  croton  oil — astringents,  as  sugar  of  lead,  lime-water,  and  nitric 
acid  ;  hot  water,  fomentations,  dry  heat,  wine,  and  alcohol — cold  water, 
solutions  of  potash,  soda  water,  and  eflfervescing  draughts ;  mustard 
plasters  and  blisters  to  the  stomach,  caustics  to  the  spine — large  doses 
of  opium  and  stiychnine  ;  inhalation  of  oxygen  gas — injections  of  saline 


INDIGESTION.  lU 


solutions  into  the  veins ;  galvanism  and  mercuria  frictions — x.ibacco, 
and  the  exhausted  air-bath,  etc.,  etc. 

In  the  early  stage  of  the  disease,  a  free  injection  of  tepid  or  rather 
warm  water  should  be  administered  frequently;  meanwhile  the  thirst 
should  be  assuaged,  and  the  heat  of  the  stomach  mitigated  with  frequent 
but  moderate  draughts  of  cold  water,  or  bits  of  ice,  and  the  cold  com- 
press to  the  abdomen,  well  covered  with  dry,  soft  flannel.  Before  the 
surface  becomes  very  cold,  or  the  patient  sinks  into  collapse,  the  drip- 
ping wet  sheet,  followed  by  the  dry  sheet,  and  both  accompanied  with 
active  and  persevering  friction,  should  be  employed ;  the  wet-sheet 
pack  also  works  admirably  in  the  early  stages.  If  the  patient  is  too 
weak  to  bear  these  processes,  and  in  the  later  or  collapsed  stage,  the 
surliice  should  be  well  rubbed  with  a  cold  wet  towt>\  and  this  succeeded 
by  active  friction  with  dry  soft  flannel  or  the  dry  hand;  the  injections 
should  then  be  frequently  employed,  but  of  cool  water,  and  moderate 
in  quantity.  In  the  very  outset  of  the  disease,  provided  there  is  much 
nausea  and  retching,  I  would  employ  a  brisk  warm  water  emetic,  and 
follow  it  with  sips  of  cold  water  according  to  the  degi'ee  of  thirst ;  the 
cool  or  cold  hip-bath  is  also  a  valuable  assistant  in  any  stage  of  the  dis- 
ease preceding  the  collapse.  When  the  spasms  are  violent,  the 
external  friction  should  be  proportionally  vigorous.  In  bad  cases,  two 
or  three  stout,  active  attendants  ought  to  work  upon  the  patient  by 
means  of  wet  and  dry  rubbing  alternately,  so  as  to  promote  the  super- 
ficial circulation  as  much  as  possible,  and  thereby  relieve  the  internal 
congestion. 

Cholera  infantuyn  is  generally  easily  cured  by  cool  injections,  the 
abdominal  compress,  and  the  tepid  towel- bath  or  ablution,  as  often  as 
the  surface  manifests  any  considerable  feverish  heat.  The  patient 
may  drink  of  pure  water  according  to  thirst.  When  the  evacuations 
from  the  bowels  are  mixed  with  blood,  the  injections  should  be  quite 
cold.  In  protracted  cases,  the  child  should  be  placed,  once  a  day, 
when  the  fever  is  highest,  in  a  tepid  half-bath  and  the  abdomen,  back, 
chest,  and  even  extremities  well  rubbed  with  the  bare  hand.  The 
food  must  be  exceedingly  simp  re.  Wheat- meal  mush  and  rice,  seasoned 
with  a  little  sugar  or  milk,  are  the  best  articles. 

Diarrhea. — The  gi-oup  of  diseases  properly  arranged  under  this 
head  are  characterized  by  frequent  and  copious  discharges  by  stooi, 
with  a  sense  of  weight  and  uneasiness  in  the  lower  belly,  and  without 
severe  griping  or  tenesmus ;  nausea  and  vomiting  are  occasional,  but 
riot  usual  incidents.  All  forms  of  diarrhea  may  become  chronic,  in 
wh.ich  event  tliere  is  great  emaciation. 


144  PATHOLOGY    AND    THERAPEUTICS. 


In  the  feculent  variety — diarrhea  fusd—ttie  faeces  are  of  common 
pality,  but  simph'  loose  and  copious. 

The  bilious  variety — diarrhea  hiliosa — is  only  distinguished  from  the 
former  by  the  bright  yellow  color  of  the  discharges. 

In  the  mucous  form — diarrhea  mucosa — the  dejections  consist  mainly 
of,  or  contain  a  large  quantity  of  mucus.  This  affection  has  sometimes 
been  called  catarrhal  diarrhea. 

The  white  looseness — diarrhea  alba — is  characterized  by  dejections 
of  a  milky  color,  resembling  a  mixture  of  water  and  lime,  with  a  frothy 
scum.  This  hfis  been  called  chylous  diarrhea  by  some  authors,  on  the 
mistaken  supposition  that  the  non-absorption  of  chyle  was  its  imme- 
diate cause.  It  is  chiefly  found  in  persons  whose  digestive  powers 
have  been  shattered  by  severe  fevers  ana  severer  drugs,  and  by  ex- 
cessive indulgence  in  stimulating  food  or  drink,  or  narcotic  irritants,  as 
alcohol  and  tobacco. 

In  the  fourth  variety — called  lientery — the  dejections  consist  princi- 
pally of  undigested  aliment,  which  passes  rapidly  through  the  aliment- 
ary canal,  with  but  little  change. 

In  the  serous  variety — diarrhea  aguosa — the  discharges  are  almost 
entirely  limpid  and  water}'. 

Tubular  diarrhea  is  known  by  dischai'ges  consisting  more  or  less  of 
membrane-like  tubes,  or  fragments  of  membranous  tubes,  which  are 
whitish,  viscous,  and  inodorous.  This  membranous  secretion  is  of  the 
same  nature  as  that  which  takes  place  in  the  mucous  surface  of  the 
tracliea  in  cases  of  croup.  Its  ex})ulsion  from  the  bowels  often  alarms 
the  patient,  who  mistakes  it  for  a  portion  of  the  bowel  itself.  In  some 
instances,  membranous  tubes  half  a  j'ard  in  length  have  been  evac- 
uated. 

Treatment. — In  a  genei-al  sense,  the  treatment  of  diarrhea,  when 
protracted  or  chronic,  is  essentially  the  same  as  for  dyspepsia,  of  which 
it  IS  mostly  symptomatic.  The  feculent  form,  being  occasioned  by  ex- 
cess in  quantity,  or  an  irritating  quality  of  food,  requires  no  medication 
save  the  negative  remedy — fasting.  Bilious  looseness  is  readily  relieved 
for  the  time  by  one  or  two  copious  tepid  injections.  All  the  other 
forms  must  be  ti'eated  on  general  principles ;  the  local  iiritation  may 
be  relieved  by  sitz-baths,  cold  injections,  cold  compresses,  hot  foment- 
ations, etc.,  as  either  may  be  indicated,  while  the  cure  must  be  found 
in  a  restoration  of  the  general  health,  for  which  purpose  all  the  means 
recommended  for  the  treatment  of  dyspepsia  must  be  had  recourse  to. 
In  all  forms  of  chronic  diarrhea  the  diet  must  be  carefully  attended 
to ;  it  cannot  well  be  too  bland  and  simple  and  the  whole  I'egimeu  I9« 
ill  all  respects,  the  same  as  for  dyspepsia. 


INDIGESTION.  145 

Intestinal  Concretions. — There  are  three  kinds  of  stony  con- 
cretions found  in  the  stomach  or  intestinal  canal,  all  of  which  are  the 
result  of  indigestion  connected  with  constipation.  One  kind,  called 
bezoar  or  hezoardus,  is  frequently  found  in  the  stomachs  of  ruminating 
animfils,  especially  the  goat,  but  very  rarely  in  the  human  stomach.  It 
consists  of  a  central  nucleus  of  gravel,  straw,  glass,  seeds  of  plants, 
etc.,  around  which  a  vegetable  mattei;|Or  animal  secretion  is  closely 
agglutinated,  having  a  glossy  whito  or  i^^bright  metallic  luster.  -These 
concretions  w^ere  formerly  regarded  gssi  febrifuge  by  physicians,  and 
worn  as  amulets  by  the  superstitious. 

Another  kind — intestinal  calculus — more  frequently  found  in  the 
human  stomach,  is  composed  of  the  same  earthy  and  sandy  matters  as 
are  found  in  the  bladder  in  calculous  affections  of  that  viscus,  and  are 
of  various  sizes,  from  a  pea  to  a  hen's  egg.  The  long-continued  use 
of  chalk,  magnesia,  etc.,  so  generally  prescribed  for  acidity  of  the 
stomach,  is  a  frequent  cause  of  these  concretions ;  hence  dyspeptics 
are  peculiarly  liable  to  them.  Preparations  of  iron,  , - itrticularly  the 
carbonate,  when  administered  medicinally,  have  been  known  to  accu- 
mulate in  the  bowels  and  form  concretions. 

The  third  kind — scybalum — consisting  of  indurated  mucus  or  oily  mat- 
ter mixed  with  hardened  foeces,  results  from  constipation,  by  which  the 
excrementitious  matter  remains  too  long  in  the  cells  of  the  colon,  or 
some  other  part  of  the  alimentary  tract.  The  discharges  are  usually 
in  the  form  of  hard  roundish  balls,  from  the  size  of  a  pea  to  that  of  a 
walnut.  The  substance  called  auihergrls,  found  in  the  larger  intestines 
of  the  cachalot,  or  spermaceti-whale,  is  supposed  to  consist  of  the  hard- 
ened foeces  of  the  whale,  and  to  be  the  result  of  constipation ;  hence 
the  more  sickly  the  animal  when  harpooned,  the  more  productive  and 
valuable  is  its  yield  of  ambergris. 

It  is  generally  difficult  to  recognize  these  affections  by  the  symp- 
toms, save  wiien  their  character  is  revealed  by  the  appearance  of  the 
concreted  matters  in  the  ejections  or  dejections.  Usually,  however, 
there  is  more  or  less  pain  or  uneasiness  at  a  particular  point  in  the 
abdomen,  and  occasionally  a  hard,  lumpy  tumor,  which  either  produces 
an  external  uneasiness  or  swelling,  or  may  be  distinctly  felt  on  pressure 
by  the  fingers. 

Treatment. — All  we  have  to  do  in  the  way  of  medication  is  to  get 
rid  of  the  morbid  accumulations  by  copious  warm  injections,  and  piiv 
the  patient  on  plain,  unconstipati  :g,  healthful  fiTiit  and  farinaceous  diet 

Worms. — Pathologists  are  not  all  yet  agreed  whether  invermina- 
tion — worms,  or  the  lai'vje  of  insects  inhabiting  the  stomach  or  intes- 

ir-13 


146      PATHOLOGY  AND  THERAPEUT  CS. 


tines — is  natural  or  abnormal.  It  is  not  very  long  since  a  Kind  of 
worm-mania  prevailed  in  the  medical  profession,  by  which  a  multitude 
of  diseases  were  ascribed  to  vermination.  Dysentery,  plague,  mea- 
sles, small-pox,  hydrophobia,  itch,  syphilis,  piles,  cholera,  and  even 
toothache,  have  been  imputed  to  various  kinds  of  animalculae,  vermin, 
or  insects. 

There  is  no  manner  of  d  ubt  that  worms  are  suspected,  by  physi- 
ciansjflnd  nurses,  to  occasion  VtHous  ailments  of  children  much  oftener 
than  they  really  exist :  but  it  is  -equa'ily  true  that  they  do  occasionally 
eftect  a  lodgment,  and  become  developed  in  the  alimentary  canal,  pro- 
ducing a  variety  of  symptoms  indicative  of  gastric  and  intestinal  irrita- 
tion. Their  origin  is  not  so  clear.  In  some  instances  it  is  quite  ob- 
vious that  the  young  or  ova  of  some  species  of  worms  is  taken  into  the 
stomach  with  the  ingesta ;  generally  when  drinking  of  stagnant  or 
marshy  waters,  or  when  eating  decayed  or  infected  fruits  and  vegeta- 
bles, or  partially  decomposed  and  putrescent  animal  food.  It  is  also 
highly  probable,  at  least,  that  the  minute  eggs,  or  ovulu,  of  various  ani-* 
malculae  floatii.^  in  the  atmosphere,  and  collecting,  especially  in  damp 
places,  on  the  alimentary  materials,  get  an  entrance  into  the  digestive 
cavit}^  and,  providing  they  find  in  foul  secretions,  retained  excrernenti- 
tious  matters,  or  impurities  of  any  kind,  a  proper  nest,  quicken  into 
life,  grow,  and  become  finally  so  strong  and  vigorous  as  to  resist  the 
ordinary  solvent  property'  of  the  vital  fluids,  and  the  expulsive  efforts 
of  the  unaided  vis  medicatrix  naturce.  This  idea  makes  the  existence 
of  worms  depend  on  a  morbid  condition,  which  I  believe  to  be  the 
fact ;  for  I  have  never  yet  known  any  kind  of  vermin  to  trouble  chil- 
dren who  have  been  fed  and  reai-ed  healthfully.  Dr.  S.  Cooper  and 
many  other  medical  writers  of  credit  assert  that  worms  are  most  prev- 
alent among  the  poor,  dirty,  ill-fed  classes  of  society,  and  particularly  in 
persons  who  reside  in  damp,  marshy  countries. 

Alvine  worms  are  those  which  exist  and  find  a  proper  nidus  in  the 
stomach  or  alvine  canal ;  they  are  mostly  found  in  children  and  sickiy 
adults,  producing  emaciation,  a  swelled,  hard  belly,  gnawing  or  pungent 
pain  in  the  stomach,  pale  countenance,  fetid  breath,  and  irritation  of 
the  nostrils.  These  worms  have  been  arranged  into  five  varieties,  viz., 
the  long  round-worm,  long  th'-iad-icornt,  long  taj)e-worm,  broad  tape- 
worm, and  JluJce.  The  first  and  second  varieties  ai'e  much  more  com- 
mon than  the  others.  The  latter  is  rarely  founi  in  man,  *^^hough  the 
most  common  to  domestic  animals. 

Anal  worms  exist  in  or  near  tbe  rectum  or  lower  bowel.  They 
excite  a  troublesome  itching  or  iiTitation  of  the  part,  often  preventing 
sleep,  and  sometimes  occasioning  pair,  or  faintcebs  in  the  stomach. 


INDIGEtoTION.  147 

The  varieties  found  in  this  locality  are  tte  ascarides,  called  also 
iliread-ivorm,  and  maw-worvi,  the  beetle-grubs,  and  the  60/5.  The 
first  variety  is  most  common,  and  is  somewhat  migratory,  being  occa- 
sionally found  in  the  stomach  and  bladder.  The  last  two  kinds  are 
very  rare  in  the  human  animal. 

The  erratic  worms,  which  are  occasionally  though  not  frequently 
found  in  the  alimentary  canal,  are  the  hair-worm,  the  erratic  leech,  and 
the  maggot.  These  are  called  erratic,  because  they  do  not  find  a 
proper  habitation  in  the  stomach  or  intestines  ;  they  produce  spasmodic 
colic,  with  severe  gripings ;  and  sometimes  vomiting,  or  dejection  of 
blood.  The  first  and  second  varieties  are  chiefly  found  where  the 
stagnant,  muddy,  and  putrid  waters  of  marshes,  pools,  and  ditches  is 
drank.  They  sometimes,  when  accidentally  introduced  into  the  hu- 
man stomach,  attain  an  enormous  size,  and  deviate  so  much  from  their 
ordinary  shape  as  to  be  with  difficulty  recognized.  Dr.  Good  says 
(Study  of  Medicine)  :  "  It  is  highly  probable,  however,  that  they  can 
only  live  in  dyspeptic  patients,  or  persons  whose  digestive  powers  are 
infirm  ;  for  there  are  few  or  no  animals  capable  of  resisting  the  solv- 
ent pow^er  of  the  gastric  juice  when  secreted  in  full  health  and  vigor." 
The  third  variety  find  their  way  into  the  stomach  in  the  condition  of 
eggs  or  hoppers,  which  are  deposited  in  various  articles  of  food,  par- 
ticularly in  all  strong  and  stale  meats,  cheese,  bacon,  etc. 

Diagnosis. — Dr.  Heberden  has  most  clearly  presented  the  general 
train  of  symptoms  which  determine  the  existence  of  worms;  "Head- 
ache, vertigo,  torpor,  disturbed  dreams,  sleep  broken  off  by  fright, 
screaming  fits,  convulsions,  feverishness,  thirst,  pallid  hue,  bad  taste  in 
the  mouth,  offensive  breath,  cough,  difficult  breathing,  itching  of  the 
nosti'ils,  pains  in  the  stomach,  nausea,  squeamishness,  voracity,  lean- 
ness, tenesmus,  itchings  at  the  anus  toward  night,  at  length  dejection 
of  films  and  mucus.  The  broad  tape-worms  produce  the  severest 
mischiefs  on  the  body ;  the  teretes  and  ascarides  (round  and  thread- 
worms) sometimes  lurk  scarcely  suspected,  unless  there  is  itching  of 
the  anus,  or  they  are  traced  in  the  foeces."  All  of  these  symptoms, 
however,  may  arise  from  any  continued  irritation  in  the  fii-st  passages  ; 
hence,  in  forming  our  diagnosis,  we  must  take  the  greater  number  of 
the  above  symptoms  in  connection  with  the  absence  of  any  other  re- 
cognizable malady  to  which  they  can  reasonably  be  attributed.  "  In  ail 
obscure  diseases,"  says  Swediaur,  "attended  with  symptoms  that  are 
chiefly  anomalous,  the  suspicions  of  the  physician  should  be  directed 
to  intestinal  worms." 

Treatment. — It  is  obvious  tliat  the  radical  cure  of  worms  must  de- 
pend upon  removing  the  morbid  conditi:-^  which  renders  the  ahment- 


U8  PATHOLOGY   AND   THERAPEl  TICS. 

ary  canal  thoir  habitable  abode  ;  this  implies  a  restoration  of  vigorous 
functional  actions,  and  pure  secretions ;  and  to  effect  this  we  must 
again  resort  to  all  the  medication  suited  to  dyspepsia.  Some  exti'a 
management,  however,  is  necessary  to  dislodge  the  intruders  from  their 
slimy  beds,  and  loosen  their  hold  upon  the  mucous  membrane.  This 
can  be  best  accomplished  by  copious  injections  of  cold  water  occasion- 
ally, and  rigidly  simple  and  uuconcentrated  food.  A  perfect  "ver- 
mifuge" diet  may  be  found  in  two  articles — the  crusts  of  good,  sweet 
wheat-meal  bread,  and  good,  ripe,  uncooked  apples.  It  is  important 
tjiat  most  of  the  food  be  hard,  so  that  it  be  well  masticated,  and  that  it 
be  eaten  slowly,  so  that  the  stomach  be  not  overloaded.  Dry  toasted 
brown  bread  is  also  admissible  ;  and  cracked  wheat  may  be  used  mod- 
erately by  way  of  variety.  All  slop  food  is  especially  objectionable 
Those  mothers  who  have  pampered  their  little  ones  on  fine  sweet-cake 
until  it  has  produced  worms,  may  find  it  somewhat  difficult  to  restrict 
them  to  the  coarse  bread  whicVi  will  cure  them.  Still,  they  can  do  it, 
and  should. 

HEM0RP..H0IDS. — Di".  Good  limits  the  definition  of  the  varieties  of 
the  diseases  comprehended  under  this  generic  term  to  "livid  and  pain- 
ful tubercles  or  excrescences  on  the  verge  of  the  anus,  usually  with  a 
discharge  of  mucus  or  blood."  This  definition  excludes  those  swell- 
ings of  the  veins  near  the  anus  and  within  the  rectum,  which  are 
termed  hemorrhoidal  varices^  and  which  almost  all  persons  who  are 
habitually  costive  are  more  or  less  troubled  with,  evinced  by  pain  and 
-difficulty  in  passing  the  foeces,  which  are  slightly  streaked  with  blood. 
Dr.  S.  Cooper,  and,  indeed,  nearly  all  medical  authors,  regard  the  va- 
rious forms  as  originally  mere  swellings  of  the  veins. 

Description. — In  their  simplest  state  piles  consist  of  varicose  tumoi"9 
of  the  anal  veins,  covered  with  a  slight  thickening  of  the  mucous 
membrane  of  the  rectum.  They  are  first  noticed  in  the  form  of 
small  fleshy  tubercles,  generally  of  a  brownish  or  pale  red  color  and 
either  situated  within  the  anus,  or  descending  from  the  rectum.  They 
have  rather  a  solid  and  spongy  feel,  and  when  quite  external  are  pale, 
and  more  elastic  and  ti-ansparent ;  they  frequently  appear  and  disap- 
pea]'  very  rapidly.  Piles  often  contain  a  centi-al  cavity,  filled  with  flu  d 
or  coagulated  blood  ;  and  by  repeated  attacks  of  nflammation  the  swe'.J 
ings  gradually  enlarge  into  caruncular  excrescences  about  the  verge  of 
the  anus,  either  within  or  without,  of  various  shapes  and  forms,  from 
pea-sized  to  fig-sizod.  and  are  frequently  so  painful  as  to  prevent 
either  sitting  or  walking.  When  these  caruncles  are  hard,  florid,  in- 
compressible, without  discharge,  and  intolerably  sore  ic  the  touch,  the 


INDIGESTION.  149 


affection  is  called  blind  piles.  When  the  irritation  accompanying  them 
induces  a  discharge  of  whitish  mucus  from  the  neighboring  glands,  it 
s  called  ichlte  piles.  When  the  hemorrhoidal  vessels,  which  form  or 
suppoit  the  growing  tumors,  are  so  distended  as  to  burst  and  bleed 
freely,  it  is  denominated  bleeding  piles.  And  when  warty  excres- 
cences spread  about  the  perinfEum,  or  within  the  verge  of  the  anus,  it 
is  called  caruncular  piles.  Usually  pile  tumors  become  larger  and 
firmer  with  every  reappearance ;  and  when  they  have  been  strangu- 
lated for  some  time  by  the  pressure  o-f  the  sphincter,  repeatedly 
gorged  with  fluids,  or  of  very  long  standing,  they  become  fixed  and 
permanent  in  size,  and  acquire  a  greater  degree  of  solidity ;  they  are 
then  a  source  of  almost  constant  pain  and  trouble  from  protrusion, 
inflammation,  or  ulceration,  and  often  occasion  a  most  distressing  pro- 
lapsus of  the  lower  bowel. 

Special  Causes. — Among  the  causes  assigned  in  medical  books,  we 
find  "  local  irritation  produced  by  indurated  and  retained  fceces  ;  purga- 
tive stimulants,  especially  aloetic  purgatives."  This  may  all  be  resolved 
into  constipation,  and  the  medicine  given  to  cure  constipation.  Prob- 
ably more  than  half  the  adult  population  of  the  United  States  are  suf- 
ferers, to  a  gi-eater  or  less  extent,  from  piles  in  some  form.  For  eight 
or  ten  years  past,  during  which  time  my  attention  has  been  especially 
called  to  this  subject,  I  have  found  a  great  majority  of  invalids  who 
have  applied  for  water-treatment,  whatever  might  have  been  the  char- 
acter of  their  leading  malady,  to  be  also  afflicted  with  this.  Its  special 
and  almost  exclusive  cause  is  concentrated  food,  inducing  constipated 
bowels ;  but  it  is  almost  always  greatly  aggravated  by  the  purgatives 
which  have  been  given,  by  regular  and  irregular  quacks,  on  account  of 
the  constipation.  Most  of  the  patent  pills,  from  which  newspapers 
derive  so  'm'ge  a  revenue,  and  the  people  so  many  shattered  constitu- 
tions, are  s4rongly  aloetic,  and  hence  peculiarly  calculated  to  inflame 
and  relax  the  vessels  of  the  recturii,  already  irritated  and  engorged  by 
their  hardened  contents.  Many  frightful  cases  of  external  protrusion, 
or  falling  down  of  the  anus,  have  come  under  my  observation  in  the 
persons  of  habitual  pill-takers*  In  some  cases  the  bowel  has  prolapsed 
thi'ee  and  four  inches. 

Dr.  Good  names  "  peculiarity  of  constitution"  as  one  of  the  causes 
of  pile  tumors ;  and  Dr.  Copland  (author  of  a  Medical  Dictionary) 
"conceives  that  piles  are  most  common  in  persons  who  possess  a  very 
strong  action  of  the  sphincter  ani,  and  are  hence  habitually  predis- 
posed to  a  spasmodic  stricture  of  the  rectum."  These  remarks,  from 
tliese  eminent  auth'Ors.  I  consider  eminently  nonsensical.  Nothing  but 
tlie  false  philosophy    :1  a  false  system  could  ever  induce  such  erudite 


150  PATHOLOGY    AND    THERAPEUTICS. 


and  critical  scholars  to  perpetrate  such  absurdities.  According  to  my 
experience,  nine  oui  of  every  ten  of  relaxed,  debilitated  females,  who 
must  of  necessity  possess  a  very  weak  instead  of  very  strong  action  of 
the  sphincter,  as  weli  as  of  all  the  other  muscles,  are  affected  with  pile 
tumors. 

Treatment. — Piles  may  be  promptly  relieved  by  local  appliances  ;  but 
the  cure  depends  on  restoring  the  integrity  of  the  digestive  functions. 
The  general  management  is  essentially  the«same  as  for  dyspepsia.  When 
the  tumors  are  inflamed  and  painful,  very  frequent  sitz-baths,  of  a  low 
temperature,  60°  to  50°,  with  oft-repeated  injections  of  a  small  quantity 
of  cold  water,  should  be  employed,  until  relief  is  obtained;  after  which 
about  four  to  six  ounces  of  very  cold  water  should  be  thrown  into  the 
rectum  every  morning  previous  to  the  expected  action  of  the  bowels. 
When  the  bowel  is  prolapsed,  the  patient  should  keep  the  horizontal 
position  mostly,  and  apply  the  coldest  wet  cloths  to  the  fundament. 
Sometimes  an  excessively  irritable  or  highly  inflammatory  condition  of 
hemorrhoidal  tumors,  occasions  a  severe  and  protracted  diarrhea,  the 
discharges  occurring  as  often  as  once  an  hour,  or  every  half  hour,  con- 
sisting mainly  of  small  quantities  of  bloody  mucus,  or  slimy  matter 
tinged  with  blood,  and  accompanied  with  considerable  tenesmus,  gi'ip- 
ing,  or  bearing  down  sensation.  Such  attacks  usually  last  a  week,  and 
not  unfrequently  two  or  three  weeks ;  the  patient  generally,  and  the 
doctor  sometimes,  mistake  the  case  for  dysentery.  Here  injections 
do  but  little  service  ;  the  wet-sheet  pack,  two  or  three  times  a  day,  and 
the  wet  abdominal  bandage  very  frequently  changed,  are  our  most  ad- 
vantageous resources. 

The  dietary  part  of  the  management  is  of  first  importance.  In 
some  few  cases  the  mucous  surfiice  of  the  lower  bowel  is  so  tender 
and  irritable,  that  almost  all  food  seems  to  act  as  a  mechanical  irritant; 
the  patient,  however,  at  such  times  needs  but  very  little  of  any  kind, 
and  this  may  be  boiled  rice,  farina,  Graham  flour  mush,  tapioca,  etc. 
But  generally  the  unbolted  and  unconcentrated  forms  of  farinaceous 
food  are  prefemble,  as  in  all  other  forms  of  indigestion. 

Hard  warty  excrescences  around  thef  anus,  or  scattered  over  the 
perina^um,  may  be  removed  with  entire  safety  and  facil'fty  by  the  liga- 
ture, or  knife,  or  clipped  off"  with  a  pair  of  scissors.  Removal  by  ex- 
cision and  by  ligature  hfis  often  been  practiced  in  the  other  kinds  of 
he-morrhoidal  tumors,  but  there  is  always  danger  to  be  apprehended 
from  hemorrhage  in  the  one  case,  and  from  sympathetic  inflammation 
in  the  other;  moreover,  if  all  the  resources  of  hydropathy  and  hygiene 
are  judiciously  drawn  l  )on,  there  is  not  the  least  necessity  for  these 
Burgica  operations. 


FLUXES.  161 

CHAPTER  V. 

FLUXES. 

I  ADOPT  tliis  generic  term,  not  because  it  is  clearly  appropriate  or 
distinctive,  but  because  it  is  familiar.  The  only  species  strictly  per- 
taining to  this  genus  are  catarrh  and  dysentery,  both  essentially  febrile 
diseases,  and  each  consisting  of  a  peculiar  inflammation  of  some  portion 
of  the  general  mucus  membrane ;  each  exhibits  two  varieties,  thus : 

r^  ^      1   S  Common,  t\         ^        S  Acute, 

Catarrh  {  Dysentery  < 

(  Epidemic.  (  Chronic. 

Catarrh. — This  is  an  inflammatory  affection  of  the  mucous  mem- 
brane of  the  fauces,  often  extending  to  the  frontal  sinuses  or  bronchia, 
or  both;  it  is  attended  with  sneezing,  obstruction  of  the  nostril,  and 
more  or  less  mucous  expectoration,  or  discharge  from  the  nose. 

Symptoms. — In  comynon  catarrh — cold  in  the  head  or  chest — the  fever 
is  slight ;  there  is  a  sense  of  weight  over  the  eyes,  and  fullness  in  the 
head,  and  the  nostrils  pour  forth  a  thick,  acrimonious  ichor,  which  ex- 
coriates the  skin ;  the  voice  is  hoarse,  and  more  or  less  cough  attends. 
In  the  epidemic  form — injiuenza — the  attack  is  sudden,  and  the  fever 
severe  and  strikingly  depressive  ;  there  is  great  heaviness  over  the 
eyes,  extreme  languor,  anxiety,  and  oppression  at  the  praecordia,  with 
frequent  sighing,  sickness,  and  violent  headache.  The  pulse  is  very 
frequent,  and  peculiarly  irregular;  the  skin  is  moist,  with  a  tendency 
to  profuse  sweating,  but  the  heat  of  the  body  is  seldom  considerable ; 
the  tongue  is  white  or  yellowish,  but  moist;  sometimes  there  are  severe 
general  or  local  muscular  pains,  and  at  other  times  erysipelatous  patches 
appear  in  different  parts  of  the  body.  The  danger  of  this  disease  is 
not  in  proportion  to  the  violence  of  the  symptoms,  as  compared  with 
all  other  febrile  diseases,  for  usually  the  symptoms  are  extremely  vio- 
lent for  one  or  two  days,  and  then  as  rapidly  subside;  great  debility, 
however,  frequently  exists  for  weeks  or  months  after  convalescence  is 
established.  Often  severe  pains  attack  the  chest,  and  in  such  cases 
physicians,  regarding  them  as  indicative  of  pleurisy,  have  endangered 
the  patient's  life  by  venesection. 

Special  Causes. — Common  catarrh  is  usually  traceable  to  taking 
cold.  Influenza,  like  Asiatic  cholera,  is  usually  epidemic,  and  has 
prevailed  at  all  seasons  of  the  year,  in  every  state  of  the  barometer, 
thernometer,  and  hydrometer.     Dr.  Good  very  cautiously  imputes  its 


152  PATHOLOGY    AND    THERAPEUTICS. 

specific  cause  to  some  "atmospheric  iotemperaraent;"  Dr.  Weber  has 
suspected  "negative  electricity"  of  the  mischief;  but  none  of  the 
modern  theories  are  any  improvement  on  that  of  Hippocrates,  which 
was  "  providential  interposition  ;"  nor  the  very  modest  suggestion  of 
Sydenham,  who  was  rather  disposed  to  ascribe  it  to  '■'■some  oecult  and 
inexplicable  changes  wrought  ir  the  bowels  of  the  earth  itself,  by 
which  the  atmosphere  becomes  contaminated  with  certain  effluvia, 
which  predisposes  the  bodies  of  men  to  some  form  or  other  of  disease." 
I  ofluenza  is  the  most  widely-spreading  epidemic  known,  having  some 
times  exteuvfed  over  all  Europe  and  a  part  of  America  in  the  same 
season. 

Treatment. — This  is  exceedingly  simple.  Practically,  common  ca- 
tarrh may  be  regarded  as  a  high  fever^  and  influenza  as  a  loiv  fever 
In  the  former  affection,  the  wet-sheet  pack  is  specially  indicated  as  the 
leading  measure,  repeated  according  to  the  general  feverishness ;  and 
in  the  latter,  the  tepid  ablution,  frequently  repeated,  and  followed  by 
the  drj--blanket  envelop  when  the  body  feels  chilly  after  the  bath,  with 
the  chest-wrapper,  well  covered  when  the  lungs  are  troublesomely 
affected,  and  warm  hip  and  foot-baths  when  the  abdominal  viscera  are 
disproportionately  disturbed.  Generally  the  bowels  require  to  be  moved 
by  free  tepid  injections  at  the  outset;  and  when  there  is  considerable 
nausea  and  retching,  the  vrarm  water  emetic  should  be  administered. 
The  general  regimen  is  the  same  as  for  simple  fever. 

Dysentery. — This  iisease  was  called  bloody  fiux  by  the  old  authors. 
It  is  an  inflammatory  affection  of  the  mucous  coat  of  the  larger  intes- 
tines, accompanied  with  griping  and  tenesmus  ;  the  dejections  are 
frequent  and  bloody,  and  the  foeces  are  discharged  irregularly. 

Symptoms. — In  the  acute  variety,  the  abdomen  is  painful  or  tender ; 
the  fceces  are  discharged  with  difficulty;  mucous  and  bloody  dejections 
alternate,  or  are  variously  diversified  iu  color  and  consistence  ;  the  at- 
tending febrile  disturbance  is  considerabie,  and  may  be  of  the  high  or 
low  character — the  syncchus  or  typhoid  type. 

What  is  called  chronic  dysentery  is  sometimes  a  milder  and  more 
disguised  form  of  the  disense,  but  more  generally  it  is  common  diarrhea 
modified  by  local  circumstances,  or  a  sequel  of  maltreated  acute  dysen- 
tery. In  plainer  English,  it  is  frequently  a  drug-disease.  This  remark 
need  not  excite  surprise  v/heti  the  formidable  array  of  diug-poisong 
which  modern  medical  science  has  brought  to  bear  upon  this  disease, 
and  upon  the  patients'  constitutions,  too — calomel,  corrosive  subli.nate, 
sugar  of  lead,  antimony,  nitrate  of  si  vor,  opium,  capsicum,  oil  of  tui*- 
pentine.  mineral  acid^.  etc. — is  taken  'uto  account.    Chronic  dj^sentery 


FLUXES  153 

is  attended  Wjth  but  slight  fever,  and  that  usually  of  the  hectic  type. 
Either  vai'iety  may  be  attended  with  ulceration  of  the  bowels,  and  puru- 
lent, sanious,  or  membranous  evacuations,  or  discharges  of  pure,  un- 
mixed blood. 

Special  Causes. — Dietetic  errors  of  all  kinds  are  the  principal  pre- 
disposing, and  undue  exposure  to  cold,  damp,  sudden  alternations  of 
temperature,  etc.,  the  chief  exciting  causes.  Bad  water  and  marsh 
effluvia  sometimes  occasion  the  worst  forms  of  the  disease. 

Treatment. — Medical  books  are  as  discordant  in  relation  to  the 
treatment  of  dysenter}^,  as  they  are  in  the  case  of  cholera.  In  treating 
the  disease  hydropathically  we  must  ever  keep  in  view  the  character  or 
type  of  the  fever,  which  is  in  reality  as  much  a  part  of  the  disease  as 
is  the  local  inflammation  of  the  colon,  or  other  large  intestines.  When 
the  general  fever  is  violent,  the  wet-sheet  pack  or  half-bath  should  be 
employed,  according  to  the  degree  of  heat.  Moderate  draughts  of 
cold  w^ater  should  be  frequently  administered,  and  the  whole  abdomen 
constantly  covered  with  the  wet  compress,  which  should  be  very  often 
changed,  until  the  pain,  heat,  tension,  etc.,  subside.  In  the  early  stage 
one  or  two  copious  tepid  injections  are  advisable,  to  clear  the  aliment- 
ary canal  of  its  irritating  crudities,  after  w^hich  moderate  cool  injections 
are  to  be  employed  occasionally.  Sometimes  very  cold  or  iced  water 
has  a  more  soothing  effect  upon  the  griping  and  tenesmus  than  any 
other  temperature,  and  reference  should  always  be  had  to  the  patient's 
feelings  in  regulating  the  temperature  of  the  water. 

Hip-baths,  the  temperature  low  in  the  ratio  that  the  general  fever 
or  heat  of  the  abdomen  is  high,  may  be  advantageously  employed  once 
m  two  or  three  hours.  I  have  seldom  found  any  difficulty  in  curing 
this  complaint  in  children,  in  a  very  few  daj^s,  by  two  or  three  daily 
tepid  w^ashings  of  the  whole  surface,  the  constant  application  of  the 
wet  compress  to  the  abdomen  whenever  and  as  long  as  the  heat  was 
above  the  natural  standard,  the  free  use  of  cool  or  cold  water  as  a  drink, 
and  one  or  two  tepid  injections  at  the  outset.  The  diet  should  be: 
entire  abstinence  until  the  violence  of  the  fever  and  local  inflammation 
are  both  sensibly  abated,  and  then  as  bland  as  possible — boiled  rice,  rice 
gruel,  wheat-meal  mush  or  gruel,  toasted  brown  bread,  etc.  When 
ulceration  takes  place  in  the  intestines,  and  the  discharges  exhibit  pus, 
puti'id  sanies,  or  black,  grumous,  fetid  blood  and  slime,  the  diet  may 
be  wnth  propriety  restricted,  for  a  week  or  two,  to  rice  or  arrow-root. 

I  have  never  known  relapses,  or  "sequelae,"  which  are  so  common 
an  I  so  formidable  after  an  attack  of  this  disease  and  a  course  of  drug- 
treatment,  occu  in  %  patient  who  was  treated  hydropathically  from 
f^r:'t  to  last. 


164 


PATHOLOGY   AND   THERAPEUTICS. 


CHAPTER  VI. 


CACHEXIES, 


Literally,  tJie  term  cachexia  means  bad  habit  of  body,  a  condition 
which  exists  more  or  less  in  all  diseases.  But  there  is  a  class  of  dis- 
eases pre-eminently  distinguished  as  being  caused  by  or  attended  with 
universal  depravity  of  the  organization,  or  general  derangement  of  all 
the  bodily  functions,  constituting,  in  fact,  a  constitutional  taint  or  mal- 
conformation,  which  may  be  transmuted  through  many  generations, 
with  either  increasing  or  decreasing  intensity,  as  the  voluntary  habits 
of  each  successive  generation  are  more  or  less  in  conformity  with 
physiological  laws ;  and  this  group  of  diseases  may  be  appropriately 
considered  in  the  present  chapter,  as  expressed  in  a  tabular  arrange- 
ment: 


Consumption  < 


''  Tubercular. 
Catarrhal, 
Apostematous, 
Laryngeal, 
Hemorrhagic, 

^  Dyspeptic. 
Atrophy, 
Anhaemia, 
Climactenc, 

I.  Tabes. 

r  Arabian 
Elephantiasis  -^  Italian, 

I  Asturian. 


Hemorrhage  < 


Marasmus  < 


''  Epistaxis, 
Haemoptysis, 
Haematamesis, 
Haematuria, 
Uterine, 

^  Anal. 

(  Simple  Scurvy, 
Scurvy  i  Land  Scurvy, 
I  Sea  Scurv^'. 

Plethora  \  Sanguine, 
(  Serous. 

Scrofula,     Melanosis, 
Cancer,       Catacausis. 


Most  of  the  above  diseases,  and  several  which  1  have  thought  proper 
to  consider  under  other  heads,  are  included  in  the  order  dysthetica,  in 
Dr.  Good's  nosologj-,  a  term  which  signifies  "  an  ill-conditioned  habit.*' 

Consumption — Pulmonary  Consumption — Phthisis  Pulmon- 
ALis. — Consumption  of  the  lungs  is  the  most  general  evidence  and 
the  most  fatal  result  of  the  artificial  and  enervating  habits  of  civilized 
society.  In  the  city  of  New  York,  about  2000  die  annually  of  this 
disease    and  in  Boston,  Philadelphia   Baitimore,  and  a  majority  of  tho 


CACHEXIES.  156 


other  cities  of  the  United  States,  the  mortality  from  this  source  bears 
nearly  the  same  ^lation  to  the  population.  In  most  other  countrief 
in  which  civilization  has  made  equal  progress,  the  disease  has  commit- 
ted equal  ravages.  Dr.  Young  has  calculated  that  it  destroys,  prema- 
turely, one  fourth  of  the  inhabitants  of  Europe.  Females,  from  their 
more  sedentary,  indoor,  and  relaxing  habits,  are  rather  more  liable  t^ 
this  malady  than  males.  The  period  of  life  between  puberty  and 
middle  age — fourteen  to  forty — is  more  especially  favorable  to  the 
operation  of  the  causes  of  this  disease,  ant  the  greatest  ratio  of  mor- 
tality occurs  between  the  ages  of  thirty  anc  forty.  The  greatest  num- 
ber of  deaths,  in  this  latitude,  takes  place  in  the  coldest  months  of  the 
year.  This  fact,  however,  does  not  prove  that  the  cold  season  is  more 
conducive  to  the  development  or  causation  of  consumption,  but  that 
consumptives  are  more  liable  to  sink  at  that  particular  period. 

Symptoms. —  Tubercular  consumption  is  by  far  the  most  frequent 
and  most  intractable  form ;  and,  indeed,  some  authors  regard  the 
existence  of  tubercles  in  the  lungs  as  essential  to  the  character  of  true 
phthisis.  It  is  usually  connected  with  a  stronglj^-marked  scrofulous 
diathesis,  is  more  insidious  in  its  approach,  and  more  delusive  in  its 
progi-ess  than  either  of  the  other  varieties.  Man}-  persons  are  born 
with  such  a  malformation  of  the  chest,  and  so  great  a  predisposition  to 
tubercles,  that  the  slightest  aberrations  in  the  manner  of  life  suffice  to 
induce  that  condition  of  engorgement,  mal-assimilation,  and  morbid 
deposition  which  eventuates  in  general  tuberculation  of  the  pulmonary 
structures.  The  special  symptoms  are,  short  and  tickling  cough  ;  the 
pain  in  the  chest  is  slight ;  there  is  either  a  sense  of  tenderness  or 
weight  experienced  at  the  upper  part  of  the  lungs ;  the  breathing  is  ha- 
bitually short,  and  a  full  inspiration  is  impracticable,  the  attempt  increasing 
the  sense  of  weight,  soreness,  or  aggravating  the  cough;  the  expecto- 
ration is  generally  scanty  and  small  in  ""uantit}^  in  the  early  stages,  and 
in  many  cases  it  is  very  trifling  throughout ;  the  matter  expectorated 
is  a  watery,  whey-like  sanies,  sometimes  tinged  with  blood,  and  as  the 
disease  progresses,  thick,  tenacious,  curdy,  or  cheesy  particles  are  ex- 
creted. Sometimes  small,  irregular  stony  concretions  are  formed  by 
the  deposition  of  earthy  matters — mainly  carbonate  of  lime — in  the 
substance  of  the  tubercles,  and  expectorated  as  the  process  of  ulcera- 
tion releases  them  from  their  inclosures.  Emaciation  does  not  become 
6ti-ikingly  apparent  until  the  diseas--  has  made  severe  inroads  upon  the 
constitution,  and  not  unfrequently  e  body  maintains  its  ordinary  full- 
ness until  the  gi-eater  portion  of  the  ungs  is  fiitally  occupied  by  tuber- 
cular formations.  In  those  cases  att^  ided  with  but  trifling  expectora- 
tion, there  is,  of  course,  but  little  ul>   -ation  ;  yet  generally  some  \<\T^ 


156  PATHOLOGY    AND    THEll  A  P  EUTICS. 


tious  of  the  tubercles  are  ulcerating,  and  forming  open,  irregular  cavi- 
ties in  the  substance  of  the  lungs,  while  in  other  parts  of  the  pulmonary 
sti'uctures.  the  process  of  tuberculation  is  going  on.  As  the  functional 
powers  of  the  lungs  become  impairec,  the  pulse  becomes  frequent  and 
feeble,  the  breathing  gi'ows  shorter,  ineguliir  chills  come  on,  succeeded 
«by  some  degree  of  feverish  heat;  and  in  the  last  stages,  night  sweats, 
diaiThea,  swellings  of  the  limbs,  etc.,  denote  the  ra})idh'  approaching 
fat«l  termination.  In  this  form  of  consumption,  the  hope  of  recovery 
often  attends  the  patient  almost  to  the  dying  hour,  and  schemes  of 
business  or  pleasure,  or  new  projects  for  recovery,  occupy  his  thoughts 
until  within  a  few  days  or  hours  of  death. 

There  has  been  much  controversy  among  medical  theorists  whether 
tubercles  are  the  product  of  inflammatory  action,  or  of  irritative  action, 
or  of  an  action  to  which  some  other  technical  term  should  be  applied. 
The  discussion  is  entirely  unprofitable.  It  is  enough  to  know  that  the 
general  condition  of  the  body  is  one  of  debility;  that  the  local  condition 
of  the  part  diseased  is  one  of  engorgement,  and  its  secretions  changed 
from  a  healthy  to  a  morbid  charactei*.  It  is  also  a  disputed  point 
whether  tubercles  in  the  lungs  are  curable  in  any  case,  some  eminent 
authors  taking  the  position  of  their  absolute  and  unconditional  tatality, 
while  others,  equally  respectable  as  practitioners  and  pathologists,  con- 
tend that  cures  havs  resulted  in  a  few  instances. 

Dr.  Good,  in  allusion  to  a  remark  of  Dr.  Woolcombe,  that  55,000 
victims  annually  die  of  consumption  in  Great  Britain,  makes  the  follow 
ing  very  singular  observation  :  "During  the  last  half-century,  it  is  said 
to  have  been  considerably  on  the  increase  ;  but  this  is  perhaps  chiefly 
owing  to  the  gi-eater  number  of  infants  of  delicate  health  who  are 
saved  from  an  early  grave  by  the  introduction  of  a  better  system  of 
nursing  than  was  formerly  practiced,  yet  who  only  escape  from  a  dis- 
ease of  infant  life  to  fall  before  one  of  adolescence  or  adult  years. 
And,  for  the  same  reason,  savages  rarely  suffer  from  consumption,  as 
they  only  rear  a  healthy  race,  and  lose  the  sickly  soon  after  birth."  1 
think  a  better  explanation  can  be  found  in  another  way.  Much  of  the 
increasing  mortality  is  justly  atti'ibu table,  in  my  opinion,  to  the  intro- 
duction of  a  worse  system  of  nursing  infants  than  formerly  prevailed, 
to  wit :  close  rooms,  hot  slops,  tight  clothing,  nick-nack  food,  apothecary 
drugs,  etc.,  by  which  the  bodies  of  the  infants  become  sickly,  stunted, 
feeble,  and  susceptible  before  they  emerge  from  their  cradles.  The 
reason  that  the  savages  seldom  have  consumption  is  because  they  are 
comparatively  exempt  from  the  peculiar  debilitating  customs  of  our 
"better  system."  Thr  statement  that  they  lose  all  their  sickly  children 
is  wholly  gratuitous. 


CACHEXIES.  157 


In  tlie  catarrhal  form  the  cough  is  frequent  and  violent,  with  a 
copious  expectoration  of  a  thin  muco-purulent  matter,  rather  mixed 
with  blood,  but  generally  offensive  to  the  smell.  There  is  considerable 
soreness  of  the  chest,  and  transient  pains  shifting  from  side  to  side. 
It  comes  on  after  repeated  colds,  or  a  protracted  catarrhal  affection. 

The  aposicmatous  variety  is  known  by  a  diy  cough,  which  returns 
fitfully ;  fixed,  circumscribed,  obtuse  pain  in  the  chest,  which  is  some- 
times throbbing  or  pulsatory ;  the  patient  experiences  great  difficulty 
in  lying  on  one  side.  The  cough  at  length  terminates  in  a  sudden  and 
copious  expectoration  of  purulent  matter,  which  sometimes  threc:*"en3 
suffocation.  These  symptoms  are  immediately  owing  to  the  formation 
of  an  aposteme  or  abscess  in  the  lungs.  When  the  collection  of  matter 
is  considerable,  the  patient  often  experiences  severe  rigors  or  chills, 
and  manifests  a  iiigh  degree  of  irritative  fever.  After  the  discharge 
of  the  matter,  the  patient  is  sometimes  permanently  relieved ;  but 
usually  the  relief  is  temporary,  and  all  the  symptoms  recur  repeatedly 
at  longer  or  shorter  intervals,  as  new  abscesses  form  and  discliarge 
their  contents.  In  some  few  instances  no  expectoration  takes  place, 
the  patient  dying  before  the  abscess  breaks. 

Laryngeal  phthisis  is  that  modification  of  the  disease  in  which  ul- 
ceration commences  in  the  larynx  before  any  extensive  morbid  altera- 
tions have  occurred  in  the  lungs.  It  is  distinguished  by  excessive  irri- 
tation and  tickling  in  the  larynx,  with  a  cough  dry  and  husky  at  first, 
but  soon  attended  with  a  slight  discharge  of  purulent  mucus,  frequentl}' 
streaked  with  blood ;  there  is  also  remarkable  hoarseness,  which  occa- 
fuonally  goes  and  returns  without  any  assignable  cause,  and  a  sense  of 
soreness  or  tenderness  about  the  upper  part  of  the  throat ;  often  there 
is  some  degree  of  actual  hemorrhage  from  the  diseased  part. 

All  these  symptoms  may  occur  in  the  last  stage,  or  near  the  fatal 
termination  of  either  of  the  other  forms  of  consumption,  more  espe- 
cially the  tubercular ;  and  also  in  the  worst  cases  of  bronchitis ;  they 
can,  therefore,  only  be  properly  regarded  as  a  distinct  variety  of  phthi- 
sis when  they  take  the  lead  in  the  morbid  manifestations.  When  the 
ulceration  of  the  larynx,  instead  of  preceding  disorganization  in  the 
lungs,  comes  on  after  ulceration  in  the  lungs  has  long  existed,  the  pa- 
tient complains  more  particularly  of  a  sore,  oppressive  sensation  in  the 
throat,  as  if  some  foreign  mass  were  lodged  in  the  larynx ;  and  this 
sensation  is  generally  accompanied  by  more  or  less  difficulty  of  swal- 
lowing; it  is,  too,  usually  accompanied  with  a  peculiar  hoarseness,  or, 
rather,  roughness  in  the  voice.  In  most  cases  it  is  a  fatal  omen,  occui-- 
ring  only  a  few  days,  or  at  most  a  few  weeks,  before  death. 

The  hemorrhagic  variety  is  churacferizol  by  repeated  attacks  of 
i4 


!58      PATHOLOGY  AND  THERAPEUTICS. 


hcTmopfysis,  or  bleeding  at  the  Jungs.  The  coughing  or  expectoration 
of  a  large  quantity  of  blood,  may  indeed  be,  and  usually  is,  an  acci- 
dental occurrence  in  a'l  the  other  form=  of  the  disease,  especially  the 
tubercular  and  the  dyspeptic  vai-ieties  :  nevertheless,  it  sometimes  takes 
place  without  evidences  of  any  considerable  organic  change  either  in  the 
lungs  or  digestive  organs,  and  recurs  with  such  frequency  and  violence 
as  to  exhaust  the  patient,  producing  all  the  train  of  constitutional  symp- 
toms which  marks  the  progress  of  the  other  vai'ieties  of  consumption. 
It  is  intimately  connected  with  the  next  variety — dyspeptic  phthisis — 
and  usually  depends  immediately  on  an  excessively  engorged  condition 
and  relaxation  of  the  pulmonary  vessels,  this  condition  being  chiefly 
owing  to  a  shriveled,  bloodless  state  of  the  superficial  capillaries,  or  to 
an  enlarged  liver,  or,  which  is  more  common  still,  to  both  of  these  cir- 
cumstances combined. 

Dyspeptic  phthisis  is  that  form  of  pulmonary  consumption  which  is 
preceded  by  protracted  disease  of  the  digestive  organs ;  the  lungs  are 
atlected  sympathetically,  or,  rather,  the  morbid  condition  is  extended 
from  the  abdominal  viscera  to  the  lungs ;  the  liver  being  usually  the 
organ  most  concerned  in  the  primary  malady.  This  variety  of  con- 
sumption is  niore  common  than  is  generally  supposed,  constituting,  in 
fact,  a  majority  of  the  cases  we  meet  with.  It  is  seldom  correctly 
dingnosticated,  from  the  fact  that,  when  the  lungs  become  promi- 
nently the  seat  of  the  morbid  phenomena,  the  prior  evidences  of 
digestive  derangement,  or  disease  of  the  liver,  are  overlooked ;  very 
often  the  latter  are  so  obscure  as  to  be  wholly  disregarded,  unless 
the  physician  discovers  their  relation  to  the  affected  lungs  by  a  careful 
investigation  of  the  history  of  the  patient,  from  the  first  appearance 
of  ill-health.  Dr.  Wilson  Phillip  says  that  drunkards,  whose  digest- 
ive powers  have  been  broken  down  by  ardent  spirits,  frequently  fall  a 
sacrifice  to  this  disease ;  and  he  regards  those  who  have  suffered  se- 
vere attacks  of  dyspepsia,  and  what  are  called  bilious  complaints,  as 
peculiarly  liable  to  dyspeptic  consumption. 

Diagnosis. — As  it  is  only  in  the  incipient  stage  of  all  forms  of  con- 
sumption that  we  can  have  any  reasonable  assurance  of  effecting  a 
radical  cure,  it  becomes  exceedingly  important  to  detect  the  malady 
before  it  has  made  irremediable  advances.  It  is  impossible  to  give  a 
list  of  symptoms  which  may  be  relied  upon  as  pathognomonic.  When- 
over  the  imfient  experiences  habitual  cough,  be  it  ever  so  slight,  and 
habitual  expectoration,  of  whatever  character,  with  shortness  of  breath, 
a  sense  of  i)ain,  fullness,  weight,  or  uneasiness  in  the  chest,  with  an 
increasing  feeling  of  general  languor  or  debilty,  the  case  is  probably 
consumpt/on,  and  should  thencefath  receive  the  closest  scinitiny.     If 


CACHEXIES.  169 


these  symptoms  have  been  preceded  by  dyspeptic  indications,  or  evi- 
dences of  disordered  or  torpid  liver,  the  danger  is  greater ;  and  if  the 
constitution  is  manifestly  scrofulous,  stUl  gi-eater  apprehension  may  be 
entertained.  In  the  early  stage  of  the  dyspeptic  variety,  tlie  cough 
and  expectoration  occui  chiefly  in  the  morning,  and  are  hardly  noticed 
during  the  remainder  of  the  day;  the  expectoration  consists  of  a  small 
quantify'  of  tenacious  mucus  or  muco-purulent  matter,  generally  dis- 
colored in  the  morning  by  a  carbonaceous,  dark-colored  stain,  as  though 
charcoal  dust  had  been  diftused  through  it. 

The  early  symptoms  in  all  forms  of  consumption  are  obscure  and 
insidious ;  and  those  which  attend  its  progress  and  mark  its  several 
stfiges  ai-e  subject  to  very  great  diversity*.  But  the  general  progress 
of  the  symptoms  may  be  enumei'ated  as  follows :  The  patient  first  be- 
comes sensible  of  unusual  languor,  and  breathes  with  less  than  usual 
freedom ;  his  respirations  are  shorter  in  duration  and  more  frequent 
in  number.  He  coughs  occasionally,  but  does  not  complain  of  its 
being  troublesome,  and  he  very  rarely  expectorates  when  coughing. 
Some  degree  of  pain,  soreness,  weight,  or  uneasiness,  will  be  at  this 
time  experienced  in  some  part  of  the  chest  whenever  the  patient 
makes  a  deep  and  prolonged  inspiration.  As  these  symptoms  increase, 
the  pulse  becomes  more  frequent  and  weaker,  particularly  in  the  after 
part  of  the  day.  After  the  disease  has  made  a  little  further  progress, 
there  is  feverish  feeling  or  hectic  flush  toward  evening,  a  tendency  to 
undue  perspiration  during  the  night,  and  either  the  sleep  is  disturbed 
by  fits  of  coughing  during  the  night,  or  a  considerable  paroxysm  of 
coughing  takes  place  early  in  the  morning,  leaving  the  patient  with  a 
greater  feeling  of  feebleness  and  relaxation.  This  assemblage  of  symp- 
toms may  be  considered  as  constituting  the  first  stage. 

In  what  may  be  regarded  as  the  second  stage,  in  which  the  disease 
is  evidently  established  and  generally  hopeless,  the  cough  increases  in 
fi'equency,  and,  from  being  dry,  is  accompanied  with  a  purulent  mucus, 
varying  from  a  watery  whey-like  matter  occasionally  tinged  with  blood, 
to  an  expectoration  of  genuine  pus,  v/hich  may  be  variously  colored — 
livid,  deep  black,  light  brown,  light  green,  bright  or  dark  yellow,  hard 
and  lumpy,  or  soft  and  shredy,  flattened  or  round,  fetid  or  odorless. 
In  many  cases  of  the  tubercular  form  it  is  very  scanty,  while  in  a  ma- 
jority of  the  catarrhal  it  is  extremely  copious.  The  uneasiness  in  the 
chest  is  now  felt  more  constantly,  and  the  sense  of  weight  has  become 
permanent ;  hectic  fever  is  fully  developed,  and  the  breathing  is  often 
accompanied  by  a  sound  somewhat  like  the  ticking  of  a  watch.  The 
strength  fails  rapidly,  the  body  emaciates,  the  pulse  beats  more  fre- 
quently and  feebly,  generally  ranging  from  100  to  130 ;  yet  in  some 


160  P  A  T  H  0  L  G  :.  V    AND    T  H  E  R  A  P  E  U  T I C  S. 

instances  of  the  dyspeptic  variety  I  have  known  tha  pulse  to  preserve 
the  slow,  languid  motion  characteristic  of  that  form  of  digestive  de- 
rangement in  which  torpor  of  the  liver  is  a  prominent  condition,  until 
the  last.  The  teeth  usually  increase  in  transparency,  and  the  eye  man- 
ifests an  unnatural  brilliancy,  the  sclerotic  coat  becoming  of  a  pearly 
white.  The  fingei-s  are  shrunk,  except  at  the  joints,  which  become 
prominent ;  the  nails  are  bent  for  v/ant  of  support ;  the  nose  is  sharp  ; 
the  eyes  sunken ;  the  countenance  wears  a  peculiar  but  mortal  smile ; 
the  whole  body  is  shriveled ;  the  spine  projects,  instead  of  sinking, 
from  the  decay  of  the  muscles;  and  the  shoulder-blades  stand  out  like 
the  wings  of  birds. 

The  third  stage  is  attended  with  diarrhea,  apthous  or  ulcerated 
throat,  difficulty  of  swallowing,  dropsical  swellings  in  different  parts  of 
the  body,  and  various  other  symptoms  indicative  of  the  final  exhaustion 
of  the  powers  of  life. 

Although  extreme  emaciatioL  usually  occurs  before  death,  yet  in  a 
few  cases,  particularly  in  the  apostematous  variety — which  is  the  form 
most  frequently  designated  as  the  quick  or  galloping  consumption — 
the  progress  of  the  local  inflammation  is  so  rapid,  that  the  extensive 
disorganization  of  the  pulmonary  structure  produces  a  fatal  result  be- 
fore the  body  is  greatly  attenuated.  In  a  few  instances  recoveries 
have  happened  after  extensive  vomica,  or  abscesses,  have  been  formed 
in  the  substance  of  the  lungs;  and  a  veiy  few  examples  are  recorded 
in  which  the  patient  has  survived  the  entire  destruction  of  one  lung. 

Pathological  Appearances. — Dissections,  which  do  not  prove  the 
nature  but  the  effects  of  disease,  show,  in  almost  all  cases,  an  indurated 
and  ulcerated  condition  of  the  lungs.  Tubercles  are  formed  indiscrim- 
inately in  all  parts  of  the  cellular  texture  of  the  lungs,  but  more  fre- 
quently and  abundantly  at  its  upper  and  posterior  parts.  They  exhibit 
every  diversity  of  size;  are  generally  whitish  and  opake,  like  small 
absorbent  glands,  but  sometimes  semi-ti*ansparent,  like  caitilage,  with 
black  dots  in  their  substance.  They  often  augment  by  degrees  til] 
they  attain  half  an  inch  in  diameter :  but  usually,  when  about  as  large 
as  peas,  they  begin  to  soften  in  the  renter,  and  finally  open  by  one  or 
more  small  apertures  into  the  neighboring  bronchiffi,  or  remain  for  a 
longer  time  closed,  and  constitute  small  abscesses,  filled  with  a  curdy, 
half-formed  pus.  In  some  cases  large  abscesses  are  formed,  without 
any  trace  of  tubercles;  in  a  few  cases  the  lungs  appear  hardened,  he- 
patized,  or  shriveled  into  a  leathery  appearance  ;  and  occasionally  tlio 
whole  cellular  substance  is  occupied  by  tubercles,  with  little  appearance 
3f  excavations  or  open  ulcers. 

Physiological  Sign^ — Much  atter*;ion  has,  of  late  years,  been  be- 


AC  HEX  IE  S.  161 


etowed  upon  percussion  and  auscultation  as  means  for  ascertaining  the 
exact  morbid  conditions  or  structural  derangements  of  the  thoracic 
viscera  and  the  stethescope,  invented  by  Laennec,  has  come  into  very 
general  use,  as  a  convenient  acoustic  iiistrument  for  the  purpose  of 
determining,  with  greater  precision,  the  abnormal  changes  which  take 
place  in  the  lungs.  There  is  no  doubt  that,  by  much  experience,  the 
practitioner  can,  in  many  cases,  decide  with  much  greater  accuracy  as 
to  the  exact  point  of  the  lungs  most  diseased,  and,  possibly,  as  to  the 
extent  in  which  the  disease  has  involved  the  lungs  in  disorganization, 
with  the  aid  afforded  by  a  careful  stethescopic  examination ;  yet,  on 
the  whole,  I  regard  the  instrument  as  of  very  little  practical  value.  So 
far  as  the  prospect  of  cure  and  the  proper  course  of  medication  are 
concerned,  the  intelligent  physician  can  derive  no  advantage  from  the 
stethescope ;  and  even  experienced  practitioners  are  about  as  liable  to 
diagnosticate  eironeously  with  as  without  its  assistance.  I  can  name 
at  least  one  person  in  the  city  of  New  York  whose  lungs  m  ere  pro- 
nounced incurably  tuberculated  by  an  experienced  profesr^or  of  stethos- 
copy,  who  is  now  in  the  enjoyment  of  excellent  health. 

Special  Considerations. — Consumption  has  been  regarded  as  conta- 
gious by  some.  There  is  no  question  that  all  diseases  have  a  tendency 
to  propagate  their  kind — like  causes  like — yet  this  disease  is  not  more 
chargeable  with  "personal  communicability"  than  a  majority  of  others. 
It  may,  indeed — and  I  have  known  such  instances — be  acquired  by  a 
vigorous,  healthy  person,  who  has  no  hereditary  predisposition,  by  a 
ong  and  intimate  intercourse  with,  or  attendance  upon,  a  patient  who 
has  declined  under  it;  as,  for  example,  a  husband  or  wife,  devoting 
himself  or  herself  assiduously  to  the  care  of  a  bosom  companion 
through  all  the  stages  of  the  malady,  occupying  the  same  room,  sleep- 
ing in  the  same  bed,  and  personally  performing  all  the  acts  of  kindness 
and  duty  required  by  the  patient's  condition,  may  in  time  become  simi- 
larly affected.  It  has  been  remarked  by  most  authors  that  any  sud- 
denly suppressed  evacuation  or  accustomed  discharge,  is  peculiarly  lia- 
ble, especially  when  a  predisposition  exists,  to  induce  consumption.  I 
think,  however,  all  the  danger  from  this  source  could  be  obviated  by  a 
proper  attention  to  the  general  health.  A  suppression  of  the  menstrual 
secretion  in  females  is  supposed  peculiarly  to  conduce  to  the  foi'mation 
of  a  consumptive  diathesis ;  but  more  generally  the  suppression  follows 
as  a  consequence  of  prior  disease  of  the  lungs.  Pregnancy  often  arrests 
the  progress  of  the  disease,  even  when  far  advanced  ;  but  it  recurs  in 
all  its  force  soon  after  the  function  of  gestation  is  completed. 

Treatment. — It  is  the  common  consent  of  the  medical  world  that 
consumption  is  incurable,  especially  in  all  stages  afte  '  the  first ;   and 


102  PATHOLOGY     '    "     -"  -;  ^  APE  U  T  I  C  S. 


those  few  examples  of  cures  recorded  in  medical  works  have  confess- 
edly rccoveied  "spoutatieously,"  or  by  "the  efl'orts  of  nature,"  at  all 
events,  witnout  the  beuefi':s  of  drug-medication.  Under  water-treatment 
some  cures  of  apparently  hopeless  cases  have  been  made;  the  majoritj% 
however,  who  have  thus  far  sought  the  aid  of  the  new  S3Stem  have 
deferred  it  too  long,  yet,  although  they  have  necessarily  tailed  of  being 
radically  cured,  they  have,  in  nearly  all  instances,  been  greatly  bene- 
fitted, while  in  many  cases  life  has  been  extended  for  several  years. 

Practicall}',  we  are  to  regard  tJie  affection  of  the  lungs  as  a  local  ex- 
pression of  a  general  disease  ;  hence  the  constitutional  management  is 
of  incomparably  more  importance  than  the  topical.  Every  measure 
which  tends  to  invigorate  the  general  system,  and  eveiy  appliance 
which  will  conduce  to  a  more  free  expansion  of  the  lungs,  and  assist  in 
relieving  their  congested  condition  by  diffusing  the  accumulated  blood 
over  the  surface,  must  be  perseveringly  employed  ;  while,  negatively, 
all  sources  of  irritation  and  debility  must  be  sedulously  avoided.  In- 
stead of  bundling  up  in  flannels,  and  sitting  down  by  a  hot  stove,  or 
lounging  in  a  warm  room,  the  patient  must  dress  as  liglitl}^  as  possible 
without  actual  discomfort ;  he  must  take  as  much  out-door  exercise  as 
his  strength  will  permit,  and  spend  as  much  of  his  time  in  the  o^en 
air — in  walking,  riding,  sailing,  etc. — as  possible,  without  exhausting 
fatigue.  Horseback  exercise,  I  think,  is  not  advisable  after  the  disease 
is  lairly  formed,  the  other  kinds  being  altogether  preferable.  High 
mountainous  regions  are  certainly  preferable  to  low  lands  for  consump- 
tives, the  air  being  not  only  more  dense  but  more  pure.  A  residence 
inland,  and  a  voyage  at  sea,  are  both  preferable  to  a  residence  on  the 
sea- shore,  in  a  case  of  confirmed  consumption,  for  the  reason  that 
there  is  less  uniformity  of  climate  and  temperature  in  the  latter  locality 
than  in  either  of  the  other  situations.  A  removal  to  warmer  and  more 
equable  climates — Florida,  Cuba,  MadeuM,  etc. — is  not  necessary  to 
the  cure  of  the  malady.  In  some  cases,  however,  it  seems  to  stay  its 
progress,  while  in  others  the  change  hurries  it  on  rapidly  to  a  fatal  termi- 
nation. Medical  authoi-s  wholly  fail  to  account  for  these  diverse  results. 
The  explanation  is  probably  this  :  Of  those  who  go  to  the  South,  or  to 
more  genial  latitudes,  some  are  affected  with  primary  disease  of  the 
liver  and  digestive  organs,  the  lungs  being  secondarily  or  sympathiti- 
cally  diseased ;  while  in  others  the  lungs  were  the  organs  primarily 
affected  with  local  disease.  The  former  will  decline  with  greatly 
accelerated  speed  on  going  to  a  much  warmer  latitude,  but  the  latter 
will  geneialiy  experience  a  temporary  alleviation  of  symptoms. 

A  great  variety  of  muscular  or  gymnastic  exercises  can  be  employed 
to  advantage  ir.  expanding  the  chest      Striking  the  elbows  or  backs  of 


CACHEXIES.  1G3 


the  hands  together  behind  the  back ;  making  gentle  circular  motions 
with  the  hands  while  both  arras  are  extended  laterally  from  the  body; 
striking  the  hands  out  laterally  alternately,  etc.,  are  useful  methods. 
The  body  must  always  be  kept  in  the  erect  posture  whether  exercising 
or  at  rest,  sleeping  or  waking.  One  of  the  very  best  respiratory  exer- 
cises is  that  of  taking  slow,  deep,  full  inspirations,  holding  the  breath 
as  long  as  convenient  when  the  lungs  ai'e  fully  inflated,  and  then  expir- 
ing very  slowly ;  this  may  be  practiced  a  few  minutes  at  a  time,  and 
repeated  many  times  a  day.  Silver  tubes  have  been  constructed  to 
assist  the  consumptive  in  expanding  the  lungs  in  this  way,  and  in  many 
cases  very  great  benefit  has  been  derived  from  them ;  still  they  are  no 
better  than  a  common  goose-quill,  nor  have  either  any  advantage  over 
the  practice  of  respiring  through  the  nose  in  the  same  slow,  regular 
manner.  Let  it  be  remembered,  that  in  all  kinds  of  exercises  care 
must  be  taken  not  to  greatly  disturb  the  breathing  or  accelerate  the 
pulse.  Within  this  limitation  they  should  be  as  frequent  and  active  as 
possible.  Dumb-bells  afford  a  good  exercise,  but  they  must  be  handled 
gently,  and  not  be  very  heavy.     The  play  of  graces  is  also  excellent. 

With  regard  to  diet,  no  disease,  not  even  dyspepsia,  requires  a  more 
rigidly  plain  and  abstemious  course.  The  general  plan  of  dieting  is  the 
same  as  in  cases  of  dyspepsia.  But  the  irritable  state  of  the  general 
system,  coupled  with  the  inflammatory  condition  of  the  lungs,  causes 
the  most  ti'ifling  disturbance  in  the  digestive  organs  to  result  in  a  much 
more  serious  injury  to  the  lungs.  I  have  repeatedly  seen  all  the 
symptoms  severely  aggravated,  the  expectoration  entirely  changed  for 
the  worse  in  character,  the  cough  greatly  intensified,  and  all  the  ad- 
vantage gained  by  a  month's  faithfuL treatment  lost  by  a  single  injudi- 
cious meal.  Consumptives  labor  under  one  disadvantage  which  dyspep- 
tics do  not  in  the  matter  of  dieting.  The  latter  feel  whatever  hurts 
them  in  the  stomach,  and  hence  in  their  feelings  have  a  better  guide 
to  direct  them  in  the  choice  of  food,  or  rather  in  respect  to  what  may 
be  profitably  abstained  from.  The  former  have  the  sensibility  and  irri- 
tability more  concentrated  upon  the  lungs,  and  frequently  have  no  other 
evidence  of  wliat  agrees  or  disagrees  with  the  stomach  than  the  better 
or  worse  character  of  the  pulmonary  symptoms.  Experience,  there 
fore,  is,  with  the  consumptive,  a  more  blind  guide  than  with  the  dys- 
peptic. Judgment  must  reign  supreme  here,  and  appetite  and  morbid 
sensibility  obey. 

For  these  reasons  the  diet  may  be,  and,  on  the  whole,  should  be,  more 
bland,  watery,  and  innutritious  than  is  tolerated  in  the  majority  of  cases 
of  dyspepsia.  I  believe  nearly  every  case  will  do  better  by  entirely 
abandouing  all  animal  food,  save  milk,  and  even  this  should  be  used  zst 


101  PATHOLOGY    AND    THERAPEUTICS. 


a  seasoning  rather  than  as  a  substantial  part  of  the  meal.  Coarse  bread, 
wheaten  grits,  the  mildest  vegetables  and  best  fruits,  constitute  the  best 
articles  of  food,  and  a  sufficient  variety,  as  far  as  the  question  of  recov- 
ery is  concerned ;  and  even  this  simplicity  will  avail  nothing  unless 
strict  moderation  in  quantity  is  at  all  times  observed.  In  many  cases, 
and  in  all  in  which  I  have  advised  the  experiment,  the  patient  has 
been  evidently  advantaged  by  taking  a  very  light  breakfast,  a  moderate 
dinner,  and  no  supper  at  all.  The  oppressed  lungs  require  all  the 
room  and  all  the  quiet  possible  to  obtain  during  sleep ;  and  a  trifi'tng 
load  or  uritation  in  the  stomach  will  often  produce  a  restless  night,  and 
a  more  engorged  condition  of  the  lungs. 

In  all  cases  except  those  attended  with  considerable  emaciation  and 
severe  dyspeptic  symptoms,  rather  free  water-drinking  is  advisable ; 
not,  however,  to  the  extent  of  sensibly  oppressing  the  stomach.  From 
five  to  ten  tumblers  can  usually  be  taken  daily  to  advantage. 

In  regulating  the  bathing  processes,  we  must  keep  in  view  a  three- 
fold condition — general  debility,  feverish  excitement,  and  local  inflam- 
mation. Consumptives  generally  bear  cold  bathing  well,  but  the 
baths  should  seldom  be  very  long  continued.  When  the  superficial 
heat  is  not  materially  deficient,  nor  the  hands  and  feet  inclined  to  much 
coldness,  the  cold  wet-sheet  pack  for  an  hour,  followed  by  the  tepid 
shallow  bath,  for  five  mitmtes;  the  half-bath  at  72°,  five  to  ten  minutes, 
and  the  hip-bath  at  about  65°,  fifteen  minutes,  with  the  constant  em- 
ploj-ment  of  the  chest-wrapper,  constitute  a  plan  of  bathing  v.^hich, 
^^^th  such  modifications  as  will  be  suggested  by  individual  circumstances, 
is  adapted  to  the  majority  of  cases.  The  walking  foot-bath  I  have 
known  peculiarly  serviceable  in  several  cases.  The  douche,  of  mod- 
erate force,  is  a  useful  adjunct  in  the  early  stage  of  the  tubercular 
variety;  and  in  the  incipient  stage  of  all  forms,  I  have  observed  mani- 
fest relief  of  the  local  symptoms  by  the  spray  or  fountain  applied  to 
the  chest  daily,  or  every  other  day.  In  the  latter  stages,  when  the 
patient  is  troubled  with  rigors  or  chills,  the  dry  pack,  during  the  cold 
Btage,  will  usually  shorten  the  duration  of  the  chills,  and  mitigate  their 
severity.  Night  sweats  may  be  checked  or  palliated  by  the  rubbing 
wet-sheet  at  bed-time,  if  the  patient  is  able  to  bear  it,  if  not,  by  spong- 
ing the  surface  with  tepid  water. 

When  extensive  ulceration  or  tuberculation  exists  in  the  lungs,  the 
patient  will  be  extremely  sensitive  to  cold,  and  the  teinpemture  of  the 
water  should  be  milder;   care  should  be  taken,  under  these  circura 
stances,  to  avoid  any  bath  which  occasions  much  of  a  shock  to  the 
system. 

For  the  benefit  of  snich  consumptives  ns  are  compelled  to  do  the 


CACHEXIES.  166 


best  they  can  with  home-treatment,  it  may  be  stated  that  very  little 
bathing  is  absolutely  essential,  if  the  patient  will  attend  sU'ictly  to  all  the 
other  resources  of  hygiene.  One  or  two  sponge-baths  or  tow^el- washings 
daily,  and  oue  or  two  sitz-baths,  with  the  employment  of  the  chest- 
wrapper  or  abdominal  girdle,  as  the  local  symptoms  are  more  prominent 
in  the  respiratory  or  digestive  organs,  all  of  which  processes  the  patient 
can  manage  with  very  little  assistance,  will  answer  all  remedial  pur- 
poses, provided  the  patient  keeps  in  tlie  open  air  as  much  as  possible, 
takes  almost  constant  but  not  violent  exercises,  according  to  his  strength, 
and  lives  on  the  smallest  quantity  of  coarse,  bland  food,  which  will 
range  above  starvation. 

I  cannot  conclude  this  topic  without  a  paragraph  of  animadversion 
upon  the  popular  allopathic  method  of  doctoring  consumptives.  I  have 
known  so  many  scores  of  persons  killed  outright,  so  many  cases  of  incip- 
ient converted  into  confirmed  consumption,  and  so  many  confirmed  con- 
sumptives hurried  out  of  the  world,  by  diug-medication,  that  I  cannot 
speak  or  write  on  the  subject,  except  with  language  of  earnest  denun- 
ciation against  the  senseless  and  murderous  practice  of  reducing  and 
poisoning  the  systems  of  those  unfortunate  invalids,  whose  vital  powers 
are  wasting  fast  enough  without  being  aided  by  "  medical  science."  The 
ordinary  treatment  may  be  resolved,  substantially,  into  opium,  bleeding 
antimony,  blisters,  and  expectorants.  Each  article  and  each  process,  1 
affirm,  is  individually  injurious,  and  all  are  collectively  pernicious.  The 
opium  lessens  the  effort  at  coughing,  by  which  the  lungs  endeavor  to  free 
themselves  of  a  morbid  secretion,  but  aggravates  the  actual  diseased 
condition  of  the  lungs.  The  bleeding  lessens  the  patient's  sensibility 
— feeling — for  a  brief  period,  and  renders  him  less  conscious  of  his 
disease  ;  but  it  is  at  the  expense  of  his  vitality.  The  antimony  lessens 
the  febrile  excitement,  and  diminishes  the  force  of  the  circulation  by 
deadening  the  nervous  influence,  and  destroying  the  abilit}^  of  the 
muscular  fibres  to  act  at  all.  The  blisters  abate  the  pain  and  soreness 
in  the  lungs  by  paralyzing  the  natural  sensibility,  or  overwhelming  the 
lesser  with  a  gi'eater  pain ;  but  they  render  the  intercostal  muscles  sore 
and  sensitive,  make  a  free  expansion  of  the  'ungs  more  painful  and 
more  difficult,  and  thus  tend  to  fasten  the  disease  irrecoverably  upon 
the  sj^stem.  Expectorants,  which  are  given  to  facilitate  the  excretion 
from  the  bronchial  ramifications,  make  the  patient  raise  easy  by  in- 
creasing the  quantity  to  be  raised ;  and  as  the  secretion  of  mucus,  or 
pus,  is  already  morbid  and  in  excess,  there  can  be  no  possible  ultimate 
advantage  in  increasing  it.  I  know  very  well  the  theories — and  they 
are  quite  "too  numerous  to  mention" — upon  which  such  practice  is 
advocated  and  defended ;  but  theyare  as  absurd  and  irrational  as  the 


166  PATHOLOGY    AND    THERAPEUTICS. 

practice  is  unsuccessful  and  death-dealing.  Of  the  lengthy  catalogue 
of  specifics  which  have  had  and  still  have  a  reputation  in  the  medical 
world  for  curing  consumption — digitalis,  cod-liver  oil,  etc. — I  need  uot 
speak.  If  the  fact  that  all  the  patients  who  are  cured  by  them  soon 
go  to  their  graves,  is  not  a  suflficient  commentary,  and  if  the  forty  or 
fifty  deaths  in  the  city  of  New  York  returned  weekly  tx)  the  inspector's 
office  by  the  physicians  under  the  head  of  consumption,  do  not  suffi- 
ciently attest  the  follacy  and  falsity  of  the  popular  theory  and  practice, 
as  far  as  this  malady  is  concerned,  no  explanation  that  I  could  offer 
would  be  of  any  avail. 

Marasmus. — A  morbid  condition,  of  which  general  emaciation  of 
the  body,  with  debility,  without  local  inflarani<ition  or  other  disproportion- 
ate affection  of  any  particular  organ  or  viscus,  has  long  been  recognized 
by  physicians  under  the  generic  term  marasmus.  "  Leanness,"  saj'S 
Dr.  Good,  "is  not  necessarily  a  disease ;  for  many  persons  who  are 
peculiarly  lean  are  peculiarly  healthy."  It  is  only  when  increasing 
debility  accompanies  gradual  emaciation  that  the  extenuation  of  the 
system  is  to  be  regarded  as  abnormal.  The  proximate  condition  upon 
which  all  the  varieties  of  marasmus  depends,  is  bloodlessness.  The 
manuf^icture  and  supply  of  nutrient  material  is  not  equal  to  the  waste, 
aud  this  implies  a  primary  fault  in  the  digestive  or  assimilating  functions, 
or  obstruction  in  the  capillaries. 

Sytnjjtoms. — In  the  first  variety — atrophy — the  complexion  is  pale, 
often  squalid ;  skin  diy  aud  wrinkled ;  muscles  shrunk  and  inelastic ; 
the  appetite  is  feeble  or  capricious  ;  there  is  little  or  no  fever.  With 
infants  or  young  children  the  above  symptoms  are  preceded  by  flaccid- 
ity  of  the  flesh,  bloated  prominence  of  the  abdomen,  irregularity  of 
the  bowels,  and  pendulousness  of  the  lower  limbs.  To  these  symptoms 
succeed  drowsiness  and  languor,  chilliness  in  the  morning,  flushed 
cheeks,  restlessness  and  general  feverishness  toward  evening;  the 
urine  is  scanty,  the  foeces  dark,  green,  or  pitchy,  and  highly  offensive ; 
the  skin  is  hot,  drj',  and  extremely  irritable,  and  the  child  is  constantly 
picking  the  nose,  lips,  corners  of  the  eyes,  fingers,  and  anus.  This 
form  of  marasmus  has  been  variously  termed,  in  medical  books :  in- 
fantile remittent  fever,  gastric  remittent,  irij  rntile  hectic,  ivorm,  fever, 
mesenteric  fever,  stomach  fever,  low  fever  of  children,  etc. 

In  the  second  variet}--  -anheemia,  ancemia,  exsanguinily — the  whole 
surface,  and  particularly  the  face  and  lips,  are  ghastly  pale  ;.  pulse  fre- 
quent and  feeble  ;  dejections  from  the  bowels  irregular,  black,  and 
fetid  ;  appetite  greatly  impaired  ;  emaciation  and  debility  extreme. 

The  thirc'  variety — climarteri't — has  been  railed,  very  incorrectly, 


CACHEXIES  167 


decay  of  nature.  The  term  adopted  is  derived  from  the  Greek  phys- 
iologists, who  divided  the  period  of  life  into  five  epochs  or  climaxes,  at 
each  of  which  they  supposed  the  body  was  peculiarly  liable  to  some 
remarkable  and  sudden  alteration  for  better  or  worse.  It  is  character- 
ized by  general  decline  of  bulk  and  strength^  with  occasional  renova- 
tion, subsequent  to  the  middle  period  of  life,  without  any  manifest  local 
disease. 

The  fourth  variety — tahcs — has  been  known  by  the  simple  appella- 
tion, decline ;  it  is  distinguished  from  atrophy  by  the  presence  of  hec- 
tic fever.  It  appears  at  any  age  '^f  life,  and  is  also  characterized  by 
ihe  accompaniment  of  depressec  spirits.  It  is  the  consequence  of 
some  lurking  poison  in  the  system,  generally  of  a  scrofulous  or  syphi- 
litic character,  or  of  excess  or  intemperance  in  the  exercise  of  the 
animal  propensities,  or  indulgence  of  the  passions  When  occurring 
from  undue  indulgence  in  libidinous  pleasures,  it  has  been  called  tabes 
dorsalis,  from  the  great  weakness  which  is  experienced  in  the  back 
and  loins.  The  habit  of  self-pollution  often  induces  this  malady  in  bov 
and  girls,  and  sometimes  even  before  the  age  of  puberty. 

Special  Causes. — Scarcity  of  food ;  improper  aliment,  as  baker's 
sweet-cake,  and  distillery  milk ;  profuse  evacuations;  scrofulous,  scor- 
butic, or  syphilitic  taint ;  mineral  drugs,  as  mercury,  antimony,  nitre, 
and  potash;  acrid  narcotics  and  debilitating  sedatives,  as  opium,  alcohol, 
tobacco,  digitalis,  iodine,  hydriodate  of  potassa;  antiphlogistic  medicines, 
us  salts,  vinegar,  colchicum ;  irritant  drugs,  as  aloes,  pr  sparations  of 
iron,  nitrate  of  silvei",  arsenic ;  cold,  damp,  and  impure  air,  as  found  in 
low  basements,  dark  cellars,  subterranean  tenements,  rear  buildings ; 
depressing  mental  influences,  as  the  loss  of  friends,  or  reverses  of  for- 
tune ;  violent  passions  ;  venereal  excesses. 

Treatment. — In  every  case  of  genuine  marasmus,  the  grand  morbid 
condition  is  deficient  circulation  in  the  capillary  system.  Whether  the 
nutritive  functions  are  abnormally  torpid,  or  the  excretory  organs  pre- 
ternaturally  active,  or  whether  tiie  functions  of  supply  and  waste  are 
both  morbidly  affected,  the  single  indication  of  cure  is  the  same — to 
augment  ca^xllary  circulation.  Of  course,  all  the  causes  which  are 
operating  to  produce  or  continue  the  malady  are  to  be  sought  out  and 
removed  or  counteracted,  and  all  the  resources  of  hygiene  are  to  be 
applied  to  the  general  invigoration  of  all  the  organic  functions ;  but  the 
bathing  appliances  are  few  and  simple.  The  dripping  wet-sheet  or 
towel-wash,  and  the  half  or  shallow-bath  daily,  followed  by  as  much 
friction  or  rubbing  over  the  dry  sheet  as  the  patient  can  well  bear,  are 
the  best  water-processes,  and  in  most  cases  all  that  are  necessary'.  The 
temperature  is  a  matter  of  considerable  impor'iance.     It  should  be  as 


168              PATHOLOGY    AND    THERAPEUTICS.  ^ 

cold  as  is  consistent  with  prompt  reaction ;  the  proper  rule,  as  in  all  ; 

cases  ot'  feeble  circulation,  is  to  begin  with  water  of  a  comfortable  ; 

temperature,  say  about  80°,  and  very  gradually  reduce  it  as  the  pa-  ; 

tient  becomes  accustomed  to  the  impressions.    For  very  feeble  patients  ; 

one  bath  daily  may  be  sufficient  to  commence  with ;  and  such  should  ] 

lake  frequent  exercise  in  the  open  air,  by  riding  in  a  carriage  if  unable  ■ 

to  walk.     With  regard    to  water-drinking  and   diet,  the  rules  often  I 

heretofore  intimated  are  to  ')e  observed.     In  most  cases  the  strict  or  ! 

dry  diet  is  the  most  desirable,  i 

The  allopathic  treatment  consists  mainly  of  stimulating  food,  as  flesh-  j 
meat,  soups,  broths,  etc.,  and  h'ritating  drugs,  particularly  the  difterent 

preparations  of  iron ;  and  although  almost  every  author  of  that  school  j 

coincides  in  this  plan  of  treatment  as  the  only  one  to  be  relied  upon,  j 

yet  almost  every  case  on  record  so  treated  resulted  in  death !     The  \ 

form  of  this  disease  called  anhcemia  has  lately  attracted  considerable  I 

attention  in  the  medical  profession  because  of  its  frequent  occurrence  i 
in  women  soon  after  childbirth.     One  of  the  allopathic  journals,  a  few 
months  ago,  related  the  particulars  of  six  cases,  all  of  which  went 

dov>-n  to  death  rapidly  under  the  "tonic"  and  "supporting  '  system  of  l 

iron  and  wine;  and  concluded  the  sad  stor^-  of  mortality  with  an  "able  ; 

ai'gument"  in  favor  of  the  same  treatment  as  the  only  hope  of  the  | 

patient !  | 

Elephant  iasis. — This  affection,  called   in  English  elephant  skin.,  . 

consists  of  a  thick,  livid,  rugose,  tuberculated.  and  insensible  state  of  : 

the  skin.     It  is  attended  with  gi-eat  debility,  and  a  variety-  of  morbid  i 

symptoms,  the  sum  total  of  which  evince  a  general  depravation  of  all  | 

the  fluids  of  the  body.     Among  the  most  prominent  of  these  are  re-  j 

marked,  highly  oftensive  perspiration,  and  fierce,  staring  eyes.  ; 

The  first  variety — Arabian — black  leprosy — is  hereditary  in  Arabia  ' 

and  India,  and  is  in  those  countries  regarded  as  contagious.     It  is  also  \ 
known  in  the  high  northern  latitudes  of  Norway,  and  is  very  prevalent 

in  Iceland.     The  tubercles  are  chiefly  confined  to  the  face  and  joints;  < 

the  voice  is  hoarse  and  nasal;  the  hair,  except  on  the  head,  falls  oft';  ] 

the  nose  is  swelled  and  scabrous ;  the  lips  tumid ;  the  nostiils  preter-  i 

naturally  dilated ;    the  lobes  of  the  ears  are  enlarged  and  thickened,  i 

and  beset  with  tubercles;   the  external  sensibility  is  so  obtunded  that  ; 

pinching  or  puncturing  th^  skin   occasions  no  pain.     At  length  the  I 

tubercles  crack  and  ulcerate  ;  ulcerations  also  appear  in  the  throat  and  | 

nostrils;  the  breath  becomes  intolerably  fetid ;  the  nose  falls  off ;  the  \ 

|ialate  is  destro3'ed  ;  the  fingers  and  toes  become  gangrenous.,  and  drop  j 
off  one  after  another. 


CACHEXIES.  169 


The  Italian  variety  is  found  cbiefly  among  the  Milanese  and  Vene- 
tian peasantry,  who  live  in  wretched  hovels,  breathe  foul  air,  and  eal 
gross  and  unwholesome  food.  The  disetise  comes  on  with  languor, 
listlessness,  gloom,  weakness  and  stupor  in  the  lowei'  extremities,  ver- 
tigo, mental  confusion,  etc.  These  symptoms,  which  usually  occur  in 
the  spring,  are  followed,  as  the  warm  weather  increases,  with  burning 
and  itching  over  the  whole  surface,  except  that  of  the  head,  and  tliese 
are  succeeded  by  an  eruption  of  rosy  papulae,  scattered  generally  over 
the  skin,  and  terminating  in  tubercles  of  a  shining  red  color.  During 
the  summer  the  tubercles  desquamate,  and  the  skin  finally  recovers  its 
natural  color.  In  the  winter  the  patient  recovers  some  degi-ee  of 
strength,  but  the  symptoms  reappear  with  increased  violence  with  the 
return  of  spring,  and  again  subside  on  the  recurrence  of  cold  weather, 
and  so  on  for  several  years  in  succession.  In  the  end,  delirium,  furious 
mania,  or  stupid  melancholy,  diarrhea,  and  dropsy  come  on,  and  not 
unfrequently  the  miserable  victim  terminates  his  sufferings  by  the  act 
of  suicide. 

The  variety  called  Asturian,  is  the  Asturian  leprosy  of  Sauvages, 
and  some  other  nosologists,  and  the  mal  de  la  rosa  of  the  Spaniards. 
It  is  found  among  those  who  inhabit  filthy  tenements,  crowded,  unven- 
tilated  rooms,  swampy  valleys,  etc.  It  differs  from  the  preceding  variety 
in  attacking  the  head  as  w^eil  as  the  other  parts  of  the  body ;  the  tuber- 
cles are  peculiarly  painful,  highly  fetid,  more  deeply  furrowed  with 
cracks,  and  more  disgusting  to  the  sight. 

Treatment. — Cleanliness,  in  the  broadest  acceptation  of  the  word, 
comprises  the  whole  remedial  course.  Frequent  cool  or  tepid  bathing 
or  washing  of  the  whole  surface,  copious  water-drinking,  and  a  dietary 
restricted  to  plain  vegetables,  fi'uits,  and  farinacea,  are  all  the  details 
which  need  occupy  these  pages. 

Hemorrhage. — Occasional  or  accidental  hemon*nages  occur  m  a 
great  variety  of  diseases,  not  connected  with  any  general  taint  or  dep- 
ravation of  the  organism.  But  it  is  only  when  bleeding  results  from  an 
impaired  or  partially  putrescent  quality  of  the  blood  itself,  or  from  a 
debility  and  reiftxation  of  the  coats  of  its  containing  vessels,  or  from 
both  o^  these  conditions  together,  constituting  the  hemorrhagic  diathesis, 
that  the.  effeotion  propei'ly  peitains  to  the  genus  before  us.  A  flow  of 
blood  A'om  the  nose,  lungs,  stomach,  bladder,  uterus,  or  anus,  may 
result  from  local  congestion  or  incidental  plethora — constituting  the 
entonir,  hemorrhages  of  Dr.  Good — and  either  of  these  conditions  may 
depend  on  temporary  or  occasional  causes ;  the  group  of  diseases, 
therefore,  included  in  the  present  genus,  comprises  only  the  atonic 
lT-16 


i.O  I'ATIIOLJGY   AND   TU  ER  .V  f  £  L  T  IC  S. 

hemorrhages  of  authoi-s.  When  the  heinorrhRgic  diathesis  has  become 
established,  nos«-b]eeding  is  most  common  during  the  periods  of  youth 
end  of  senescence ;  bleeding  from  the  lungs  occurs  most  frequently 
between  the  ages  of  fifteen  and  thirty-five ;  and  in  .more  advanced  Ufe 
the  tendency  is  to  more  frequent  hemorrhages  from  the  abdominal 
and  pelvic  organs 

In  the  first  yav\ety—ej)istaxi:> — nose-bleeding — the  quantity  of  bloou 
lost  is.  in  some  instances,  enormous.  Examples  are  recorded  of  its 
continuance  for  several  daj'S,  and  eren  weeks,  of  the  quantity  of  blood 
discharged  amounting  to  ten,  twenty,  and  even  forty  pounds. 

In  the  second  variety — hcemoptysis — spitting  of  blood — bleeding 
from  the  lungs — it  is  often  difficult  to  determine  from  whence  the 
blood  issues ;  whether  from  the  fauces,  posterior  cavities  of  the  nos- 
trils, the  lungs,  or  the  stomach.  In  haemoptysis  the  blood  is  thrown 
up  chiefly  by  coughing ;  the  blood  is  of  a  florid,  arterial  hue ;  there  is 
a  sense  of  tickling  about  the  fauces  ;  moreover,  it  is  usually  preceded 
by  flushed  cheeks,  more  or  less  pain  in  the  chest,  with  some  degree 
of  dyspnoja.  Sometimes,  however,  there  are  no  precursive  symp- 
toms, and  the  blood  is  rather  hawked  or  spit  up  intermixed  more  or 
less  with  saliva,  and  is  of  a  darker  color ;  but  in  this  case  an  irritative 
cough  ensues,  and  the  blood  is  mingled  with  a  frothy  mucus.  When 
the  spitting  of  blood  is  from  the  cavities  of  the  nostrils,  it  will  cease  on 
lying  procumbent,  or  bending  the  head  forward,  and  will  then  probably 
flow  from  the  nose.  When  it  proceeds  from  the  fauces,  the  fact  can 
generally  be  ascertained  by  ocular  inspection. 

In  h(smalemesis — vomiting  of  blood — bleeding  from  the  stomach — 
the  blood  is  of  a  dark  color,  is  thrown  up  by  vomiting,  and  is  usually 
intermixed  with  food ;  the  discharge  is  preceded  by  tensive  pain  about 
the  stomach,  and  accompanied  with  anxiety  and  faintness.  In  some 
cases  the  blood  is  discharged  from  the  bowels  at  the  same  time. 

In  hematuria — bloody  urine — the  hemorrhage  is  from  the  bladder 
or  kidneys,  and  the  blood  is  discharged  at  the  urethra,  sometimes  in- 
termixed with  urine.  The  evacuation  is  preceded  by  pain  in  the  pel- 
vic region,  and  accompanied  with  faintness. 

Uterine  iiemon'hage  is  called  menorrhagia  in  most  medical  books, 
and  described  as  an  excess  of  the  menstrual  discharge.  This  is  a  mis- 
take. It  is  not  a  profuse  catamenial  secretion,  but  an  actual  bleeding 
from  the  uterine  vessels.  In  fact,  it  is  always  attended  with  a  real 
deficiency  of  the  menstrual  flux.  It  sometimes  occurs  in  young  girls 
from  habits  of  self-abuse  ;  and  is  very  liable  to  attack  unhealthy  females 
on  the  final  cessation  of  the  menses,  and  occasionally  attacks  fenialei 
far  advanced  in  life. 


ACHEXIES.  171 


In  anal  hemorrhage  the  blood  flows  principally  from  the  hemor- 
rlioidal  vessels;  it  is  preceded  by  a  sense  of  pain  and  weight  in  the 
rectum ;  and,  when  the  patient  is  of  rather  full  habit,  by  headache  oi 
vertigo. 

Special  Causes. — The  ordinary  exciting  causes  of  disease,  operat 
ing  upon  an  exhausted  or  depraved  organism,  in  which  relaxation  of 
Jie  muscular  coats  of  the  capillary  vessels  in  a  prominent  condition, 
may  excite  either  form  of  hemorrhage  we  have  considered,  as  the 
predisposition  exists,  more  particularly  in  the  organ  or  part  which  is 
the  seat  of  it.  All  these  varieties  of  hemorrhage  are,  however,  very 
frequently  the  result  of  external  violence,  or  symptomatic  of  other 
local  affections,  in  which  case  the  treatment  is  to  be  mainly  directed  to 
the  primary  malady.  Thus  epistaxis  may  be  the  result  of  exposure  to 
the  direct  rays  of  the  sun,  sudden  and  severe  cold  in  the  head,  violent 
coughing  or  sneezing,  and  various  emotions  of  the  mind ;  haemoptysis 
occurs  sometimes  from  an  enlarged  liver  pressing  against  the  lungs, 
suppressed  perspiration,  straining  of  the  respiratory  muscles,  excess 
in  eating  and  drinking,  suppression  of  customary  discharges,  etc. 
Haematemesis  is  often  the  consequence  of  shocks,  contusions,  vomiting, 
pregnancy  combined  with  constipation,  violent  passions,  schirrus,  or 
cancer  of  the  stomach,  etc.  Heematuria  results  frequently  from  a 
blow  or  a  fall,  gravel,  stone  in  the  bladder,  ulceration,  severe  inflamma- 
tion, and  the  use  of  some  kinds  of  irritant  drugs,  as  canthLrides.  Uter- 
ine liemorrhage  is  occasionally  caused  by  polypi  in  the  womb,  or  other 
structural  derangements ;  and  anal  hemorrhage  is  a  veiy  common 
symptom  of  hemorrhcidal  tumors,  or  piles. 

Treatment. — The  indications  are — to  excite  contraction  in  the  bleed- 
ing vessels,  balance  the  circulation,  and  invigorate  the  general  system. 
Locally  the  coldest  water,  or  pounded  ice,  may  be  employed,  untd  the 
flow  of  blood  is  checked.  For  nose-bleeding,  a  cold  stream  or  iced 
water  may  be  applied  to  the  back  of  the  neck,  and  cold  water  frequently 
sniffed  up  the  nostrils,  at  the  same  time  the  head  should  be  freely  ex- 
posed to  the  cool  or  cold  air,  and  the  bleeding  pait  be  kept  entirely 
uncovered.  In  bleedings  from  the  lungs  and  stomach,  sips  of  the  cold- 
est water,  or  even  bits  of  ice,  may  be  occasionally  swallowed,  while 
the  coldest  compresses  are  applied  over  the  stomach  and  chest.  In 
bleedings  from  the  urethra  and  rectum,  cold  injections  and  cold  hip- 
baths are  the  local  appliances.  In  all  cases  the  patient  must  keep 
quiet,  and  avoid  any  source  of  bodily  or  mental  excitement;  and  if 
there  is  feverish  heat  or  inflammatory  excitement,  the  whole  body 
must  be  promptly  cooled  with  the  dripping-sheet  or  ablution.  When 
the  extremities  are  preternaturally  cold,  rubbing  them  thoroughly,  first 


173  PATHOLOGY    AND    THERAPEUTIJS. 


with  cold  wet  cloths  and  then  with  dry  flannel,  is  advisable.  To  accom- 
plish the  third  indication,  we  must  pursue  the  appropriate  management 
for  the  restoration  of  general  health. 

Scurvy  —Dr.  Good  defines  the  general  symptoms  of  the  scurvy — 
scorbutus — "livid  spots  on  the  skin  from  extravasated  blood;  languor, 
and  loss  of  muscular  strength     pains  in  the  limbs." 

The  first  vai'iety,  simple  oi  petechial  scurvy,  is  almost  always  a  se- 
quel of  protracted  and  debilitating  fevers,  especially  of  the  putrid  type. 
Rarely,  however,  it  occurs  in  persons  of  a  gross  and  full  habit,  who 
are  not  regardful  of  liygiene  in  their  personal  habits.  It  is  character- 
ized by  numerous  small  spots  resembling  flea-bites,  chiefly  on  the 
breast,  ai-ms,  and  legs ;  the  visage  is  also  pale. 

In  the  hemorrhagic  variety — land  scurvy — the  spots  are  circular,  of 
a  purple  liue,  and  of  different  sizes ;  sometimes  in  stripes  or  patches 
irregularly  scattered  over  the  arms,  trunk,  and  thighs  ;  occasionally 
tliere  is  hemorrhage  from  the  mouth,  nostrils,  or  viscera;  and  there  is 
gi'eat  debility  and  depression  of  spirits.  In  severe  cases  the  patient 
has  the  bloodless,  exhausted  appearance  observed  in  anhaemia ;  and 
blood  flows  irregularly  and  often  profusely  from  the  lungs,  stomach,  in- 
testines, and  uterus,  as  well  as  from  the  mouth  and  nostrils. 

In  the  nautical  variety — sea  scurvy — the  spots  are  of  different  hues 
intermixed  with  livid,  principally  at  the  roots  of  the  hairs;  the  teeth 
nie  loose;  the  gums  are  spongy  and  bleeding;  the  breath  is  very  fetid, 
and  the  debility  is  extreme.  The  joints  soon  become  weak,  and  there 
is  often  a  shrinking  of  the  flexor  muscles,  rendering  the  limbs  useless, 
and  constituting  what  has  been  called  scorbutic  paralysis.  The  spots 
often  coalesce  in  large  blotches,  oi  form  ulcers,  which  discharge  a 
thin,  fetid,  sanious  fluid,  mixed  with  blood ;  and  in  the  last  stage  blood 
is  discharged  from  the  viscera  as  in  the  former  variety. 

Special  Causes. — Stale  food,  salted  provisions,  an  exclusive  flesh- 
meat  diet,  and  vitiated  air,  are  the  ordinary  producing  causes ;  they 
are  almost  always  associated  with  inattention  to  personal  cleanliness. 
Either  one  of  these  causes  alone  may  produce  a  modified  form  of 
scurvy,  but  all  operating  together  generate  the  most  aggravated  cases. 

Treatmcni, — The  proximate  condition  upon  which  this  disease  de- 
pends is  a  putrescent  state  of  the  blood.  The  indication  of  cure  is, 
therefore,  simply,  to  purify  the  blood ;  and  a  moderate  course  of  gen- 
eral bathing,  with  a  liberal  sujiply  of  fresh  vegetable  and  farinaceous 
food,  and  plenty  of  good  ripe  fruit,  will  answer  the  indication.  On  ac- 
count of  the  extreme  laxity  and  debility,  the  tepid  half-bath,  and  drip- 
ping-sheet, or  towel-wash,  are  the  preferable  water  appliances     SmaU 


CACHEXIES.  173 

quantities  of  very  cold  water  should  be  frequently  taken  into  the  stom- 
ach, and  when  the  disposition  to  hemorrhage  is  gi'eat,  cold  water  enema 
should  be  occasionally  employed.     Brown  bread,  wheaten  grits,  mealy 

potatoes,  and  good  apples,  are  the  best  antiscorbutics  known. 

< 

Plethora. — The  condition  of  the  body  to  which  nosologists  have 
applied  this  term,  is  that  of  general  engorgement  or  over-fullness ;  it 
is  the  result  a^  excessive  alimentation,  or  defective  depuration,  or  both. 
Full-feeding  and  inactivity  are  the  producing  causes. 

The  sanguine,  or  enionic  variety,  is  distinguished  by  florid  skin,  full 
strong  pulse,  turgid  veins,  with  firm  and  vigorous  muscular  fibres ;  and 
the  serous,  or  atonic,  is  denoted  by  a  full  but  frequent  and  feeble  pulse, 
smooth  and  soft  skin,  plump  but  inexpressive  figure,  and  general  lan- 
guor or  debility  of  the  vital  functions 

Treatment. — The  remedial  measure  of  first  importance  is  active  out- 
door exercise.  This  may  be  commenced  gently,  and  gi'adually  in- 
creased ;  but  it  should  always  be  to  the  utmost  extent  of  the  patient's 
capacity  to  endure,  short  of  excessive  fatigue.  It  is  of  little  consequence 
what  the  kind  of  exercise  is,  if  it  is  sufficient  in  constancy  and  degree. 
The  next  matter  requiring  attention  is  the  food;  this  must  be  plain  and 
coarse  in  quality,  and  in  quantity  no  more  than  actual  nutrition  demands. 
A  moderate  course  of  the  "starvation  regimen"  for  a  few  weeks  would 
accelerate  the  process  of  throwing  off  the  superfluity,  liardening  the 
structures,  and  invigorating  the  general  system.  Lastly,  the  whole 
surface  of  the  body  should  have  one  or  two  daily  washings  in  cold 
water,  followed  by  thorough  friction  with  a  coarse  towel  or  the  flesh 
brush. 

Scrofula — Struma — Struma  Vulgaris  —  Scorbutus  —  King's 
Evil. — The  terra  scrofula — derived  from  scrofus,  a  sow — literally  im- 
ports swine-swellings,  swine-evil,  or  morbid  tumors  to  which  swine  are 
subject.  Scrofula  has  long  been  recognized  as  a  disease  common  among 
svv'ine,  and  it  is  doubtful  if  any  of  the  domesticated  swine  are  exempt 
from  it.  It  is  well  known  that  all  hogs  fattened  in  the  ordinary  method 
are  extensively  diseased,  and  a  source  of  disease  to  those  who  eat  them. 
In  this  country  the  general  employment  of  this  filth}'^  animal  as  food,  is 
the  cause  of  many  morbid  affections,  manifested  under  a  great  variety 
of  scrofulous,  erysipelatous,  putrid,  glandular,  and  skin  diseases. 

The  Scrofulous  Diathesis. — A  scrofulous  constitution  means  simply,  a 
frail,  delicate,  infirm,  lax  organization,  a  habit  of  body  possessing  a  pre- 
disposition to  the  affection  callel  scrofula,  and  pecul  arly  liable  to  develap 
glandular  swellings  chronic  ulcerations,  tubercula'  foiiiiations,  and  vis 


174  PATHOLOGY    AND    THERAPEUTICS. 

ceral  enlargements,  whenever  the  exciting  causes  of  disease  are  applied 
with  ordinary  intensity.  The  predisposition,  however,  under  fiivorabJo 
hygienic  influences,  luay  lay  dormant  through  life,  and  only  be  called 
into  activity  in  the  succeeding  generation.  The  scrofulous  constitution 
is  said  to  be  characterized  by  relaxed  fibres,  smooth  and  soft  skin,  fair 
and  fine  hair,  a  peculiar  fullness  and  rosy  appearance  of  the  fice,  full 
upper  lip,  tumid  alae  nasi,  large  eyes,  long  silky  eyelashes,  delicate 
complexion,  large  head,  precocious  brain,  great  sprightliness  with  feeble 
endurance.  But  it  must  be  remembered  that  this  description  applies 
only  to  extreme  cases,  or  an  inherited  diathesis.  The  most  usual  path- 
ological indications  of  the  scrofulous  habit  are,  strumous  ophthalmia, 
chronic  inflammation  and  suppuration  of  the  glands  of  the  neck,  por- 
riginous  affections  of  the  scalp,  enlarged  tonsils,  rickets,  spinal  diseases, 
tabes  mesenterica,  white  swellings,  inflammation  of  the  membranes  of 
the  brain,  and  tubercular  consumption. 

SijmjHoms. — The  most  common  form  of  the  disease — that  form 
known  as  scrofula  proper — appears  in  indolent  glandular  tumors,  fre- 
quently in  the  lymphatics  of  the  neck,  but  also  often  affecting  the  ex- 
ternal or  internal  conglobate  glands,  suppurating  slowly  and  imperfectly, 
and  healing  with  difificulty.  In  size  these  tumors  usually  range  from 
that  of  a  pea  to  that  of  a  chestnut,  but  occasionally  they  are  much 
larger.  In  some  instances,  scrofulous  tumors  appear  in  clusters  about 
the  neck,  and  armpit,  and  upon  the  breast.  Usually  the  tumors  which 
appear  in  infancy  subside  at  the  period  of  maturity.  Scrofulous  inflam- 
mation frequently  attacks  the  external  structures  of  the  eye,  the  spongy, 
and  sometimes  the  cylindrical  bones,  and  the  ligaments,  cartilages,  and 
membranes  around  the  joints. 

Special  Causes. — Whatever  deteriorates  the  general  health  tends  to 
bring  the  scrofulous  predisposition  into  a  state  of  activity.  Various 
forms  of  scrofulous  disease  frequently  follow  severe  febrile  and  obsti- 
nate cutaneous  affections,  as  measles,  small-pox,  scarlatina,  yaws,  syphi- 
lis, etc.,  and  are  then  usually  ranked  among  the  sequelce  of  those  dis- 
eases. I  think  they  are  much  oftener  a  result  of  the  drug-medication. 
All  mineral  drugs,  and  particularly  mercury  and  antimony,  which  are 
Bo  freely  prescribed  in  all  the  above  diseases,  have  a  powerful  influence 
in  exciting  inflammatory  action  and  tubercular  depositions  in  scrofulous 
constitutions.  Narcotic  medicines,  as  opium,  tobacco,  alcohol,  etc.,  are 
also  efficient  exciting  causes.  The  depressing  antiphlogistics — vege- 
table, eartliy,  or  saline — as  digitalis,  senna,  polassa,  niti'e,  epsom  salts, 
etc.,  and  all  debilitating  processes,  as  bleeding,  leeching,  cauterization, 
profuse  evacuations,  etc.,  tend  to  produce  a  scrofulous  diathesis  "where 
it  did  not  previously  exist,  and  aggravate  it  when  ah-eady  existent.   The 


CACHJiiXIES.  .75 


gcrofulous  diathesis  may  therefore  be  either  inherited  or  ingenerated. 
A  combination  of  bad  food,  impm-e  water,  foul  air,  dark  tenements, 
sedentary  occupation,  and  poisonous  drugs,  is  sufiicient  to  produce  the 
scrofulous  diathesis  independent  of  any  hereditary  tamt. 

Treatment. — The  disease  before  us  being  one  of  debility  and  obstruc- 
tion, invigoration  and  purification  constitute  the  indications  of  cure. 
And  first  among  the  restorative  resources  of  hygiene  are  abi»udance 
of  pure  fresh  air,  and  plenty  of  clear  sunlight.  Sunshine  itself  is  better 
than  all  the  tonics  of  the  allopathist's  materia  medlca.  The  food  must 
be  restricted  to  the  best  fi'uits,  vegetables,  and  farinaceous  preparations, 
but  allowed  in  liberal  abundance.  For  city  children  good  country  milk 
is  essential.  The  distillery  slop-milk,  on  which  so  many  thousands  of 
our  infantile  population  are  daily  fed,  is  a  fruitful  and  frightful  source 
of  scroflilous  aflfections,  as  weU  as  other  fatal  diseases.  Scrofulous 
patients  should,  as  a  general  rule,  drink  water  rather  freely,  especially 
in  the  fore  part  of  the  day.  Generally  one  or  two  full  baths — tepid, 
cool,  or  cold,  according  to  the  debility  or  inflammatory  action  existing 
— dail}'  are  sufficient.  AVet  compresses  should  be  constantly  applied 
to  the  tumors  so  long  as  they  manifest  preternatural  heat,  redness,  or 
pain  ;  and  the  wet-sheet  pack,  followed  by  the  dripping-sheet  or  half- 
bath,  should  be  employed  daily  whenever  the  whole  body  is  feverish, 
and  once  or  twice  a  week  during  the  whole  CQurse  of  treatment ;  a 
moderate  douche  may  be  occasionally  applied  along  the  spine  to  advant- 
age ;  and  when  the  body  evinces  symptoms  of  general  obstruction, 
torpor,  over-fullness,  and  turgescence,  moderate  sweating  in  the  dry 
blanket  will  be  serviceable.  Critical  boils,  eruptions,  and  abscesses  are 
very  common  under  active  treatment. 

Ca>xer — Carcinus — Carciisoma. — The  Greek  word,  carcinus, 
means  a  crab ;  and  the  disease  is  thus  named  from  the  crab-like  rarai- 
tlcations  of  the  dark  distended  veins  of  the  cancerous  tumor.  Any 
part  of  the  body  may  become  the  seat  of  this  affection,  although  se- 
s.ernent  glands  are  most  frequently  attacked.  The  breasts  of  females, 
uterus,  testes,  glans,  penis,  tongue,  stomach,  cheeks,  l:})s,  and  angles  of 
the  mouth,  are  its  chief  localities.  The  cancerous  diathesis,  like  the 
scrofulous,  may  be  either  inherited  or  acquired,  and,  notwithstanding 
many  nosologists  have  regarded  this  disease  as  a  purely  local  one, 
the  majority  now  assent  to  the  doctrine  that  the  topical  affection 
depends  on  a  peculiar  constitutional  distemper,  taint,  or  malassimila- 
tion. 

Symptoms. — A  cancer  commences  with  a  hard,  livid,  knotty  tumor, 
with  dark,  cancriform  varices,  intersected  with  firm,  whitish,  divergeat 


176  PATHOLOGF    AND   THERAPEUTICS. 

bands ;  it  is  attended  with  acute,  burning,  lancinating  pains,  and  termi- 
nates in  a  fetid,  ichorous  ulcer,  having  thick,  livid,  distorted  lips. 

In  the  breast,  the  first  appearance  of  the  disease  is  a  small  indolent 
tumor,  which  is  attended  with  an  itching  feeling;  this  is  followed,  after 
a  longer  or  shorter  time,  by  a  pricking  sensation,  and  this  is  succeeded 
by  a  shooting  or  lancinating  pain  eventually  a  sfense  of  burning  is  ex- 
perienced, and  the  skin  becomes  livid  and  discolored.  Adhesive  bands 
are  formed  in  the  skin,  which  becomes  puckered,  and  the  nipple  is 
drawn  inward,  sometimes  entirel)' disappearing ;  the  tumor  ere  long 
becomes  more  elevated,  and  feels  knotty  to  the  finger ;  at  length  the 
ulcerative  process  appears  by  the  integument  giving  way  at  different 
points,  through  whick  an  ichorous,  erosive  fluid,  sometimes  tinged  with 
blood,  is  thrown  forth ;  as  the  ulcerative  action  advances,  a  broad,  deep 
excavation  is  made,  which  discharges  a  most  offensive  and  fetid  matter. 

Cancer  of  the  uterus  is  knowm  by  darting  pains  in  the  part,  shooting 
through  the  region  of  the  pelvis,  and  usually  indurations  in  the  part, 
which  are  sensible  to  the  touch ;  a  preceding  and  immoderate  men- 
strual or  leucorrheal  discharge,  or  both;  and  as  soon  as  ulceration 
occurs  there  is  a  sanious,  bloody,  or  mixed  discharge,  characterized  by 
the  peculiar  stench  of  the  disease. 

In  the  vagina  and  rectum  the  disease  can  be  ascertained  by  the 
touch,  in  connection  with  the  other  symptoms ;  in  the  mouth,  and  on 
various  parts  of  the  external  surfiice  it  is  obvious  to  the  sight. 

In  the  stomach  it  is  with  difficulty  diagnosticated.  An  acute  and 
burning  pain,  tenderness  of  the  epigfistrium  on  pressure,  nausea,  rejec- 
tion of  food,  offensive  fetor  in  the  breath,  are  together  su'ongly  pre- 
sumptive, though  not  absolutely  pathognomonic,  of  the  disease. 

Sjjecial  Causes. — "Of  the  remote  causes  of  cancer,"  says  Dr.  Good, 
"we  know  nothing."  Other  authors  confess  the  same  ignorance  of 
the  proximate  cause,  and  of  the  nature  of  the  cancerous  diathesis. 
The  most  common  of  the  exciting  causes  are,  external  injuries,  as 
blows,  depressing  passions,  spirituous  liquors,  narcotic  medicines,  gross, 
high-seasoned  food,  etc.  That  our  friends,  the  allopathists,  regard  the 
disease  as  in  some  way  or  other  dependent  on  or  connected  with  a 
specific  viru-^,  is  evident  from  the  remedies  which  are  put  most  promi- 
nently forward  in  their  books.  These  are,  arsenic,  lienbane,  and 
nightsliade — the  first,  a  powerfully  corrosive  poison,  and  the  last  two, 
deadly  narcotics.  The  utter  contusion  which  reigns  in  the  brains  of 
medical  book-makers  concerning  the  real  nature,  causes,  and  proper 
medication  of  cancer,  is  evident  enough  from  the  following  paragi'aph 
in  relation  to  its  treatment,  found  in  (Copland's  Medical  Dictionar>% 
Afte'' enumerating  two  or  three  hundred  j-.ternal  remedies,  all  of  \vh\cb 


CACHEXIES.  177 

have  enjoj.-;d  a  high  reputation,  but  which  cannot  noiv  be  depended  on, 
comprising,  lu  fact,  nearly  all  the  strong,  pungent,  powerful,  and  pois- 
onous drugs  and  cnemicals  of  the  apothecary  shop,  our  author  remarks : 

"Of  the  numerous  external  remedies  recommended  at  various 
periods,  the  preparations  of  arsenic  and  quicksilver,  charcoal  and  carrot 
poultices ;  the  mineral  acids,  particularly  chlorine,  hydro-chloric,  and 
chloric  acids;  the  clilorurets,  and  many  of  the  metallic  salts;  camphor, 
the  balsams,  and  the  terebinthinate  substances  ;  aminoniacum,  galba- 
num,  and  myrrh;  and  the  greater  part  of  the  asti'ingent,  antiseptic, 
detergent,  and  stimulating  vegetable  medicines,  have  obtained  a  greater 
degree  of  reputation ;  and  when  some  of  them  are  judiciously  combined 
with  one  another,  and  with  narcotics,  they  are  deserving  of  notice  us 
discutients  in  the  early  stage  of  the  disease,  and  as  palliatives  in  its 
ulcerating  state." 

Treatment. — The  constitutional  treatment  for  cancer  is  essentially 
the  same  as  for  scrofula ;  and  all  that  has  been  recommended  for 
scrofula,  in  the  matter  of  diet  and  regimen,  is  applicable  here,  with 
this  exception — cancer  requires  even  a  more  rigidly  simple  and  a  very 
abstemious  diet.  In  this  disease  the  "hunger-cure"  is  an  indispensable 
auxiliary,  or  rather,  perhaps,  the  leading  remedial  measure.  Several 
cases  are  on  record  of  foul,  fungous,  and  cancerous  tumors,  which 
had  resisted  caustics  and  the  knife,  being  cured  by  a  simple  and  strict 
dietary.  jThe  celebrated  Dr.  Twitchell,  of  New  Hampshire,  was 
cured,  a  few  years  ago,  of  a  malignant  tumor  of  the  lip,  which  had 
been  extirpated  once,  and  repeatedly  cauterized  in  vain,  by  restricting 
himself  to  a  diet  of  bread  and  cream,  the  quantity  being  barely  suffi- 
cient for  necessary  nutrition.  Brown  bread,  parched  corn,  or  other 
grain,  with  a  moderate  allowance  of  good  fruit,  and  plenty  of  soft  water 
for  drink,  constitute  a  dietary  it  would  be  difficult  to  improve  upon. 
In  all  diseases  connected  with  general  depravity  of  the  secretions,  and 
in  all  cases  where  a  strict  diet  is  advisable,  a  good  proportion  of  the 
food  should  be  hard  or  solid,  for  the  double  purpose  of  insuring  com- 
plete mastication  and  better  guarding  against  excess  in  quantity.  Med- 
ical authors  of  the  old  school  are  generally  opposed  to  "low  diet,"  in 
this  disease ;  but  with  them  low  diet  means  slop  food,  and  high,  or 
"generous"  diet  implies  stimulating  or  animal  food.  I  am  opposed  to 
both  of  these  plans,  not  only  in  this  disease,  but  in  all  others. 

Every  measure  which  can  in  the  least  conduce  to  the  general  invig- 
oration  of  the  system,  must  be  unremittingly  emploj^ed.  Abundance 
of  fresh  and  pure  out-door  air  is  indispensable,  and,  as  in  scrofulH,  one, 
two,  or  three  general  baths  may  be  employed  daily.  There  is  but 
jitt  e  to  jhooso  between  the  different  kinds  of  baths :    the  dripping- 


178  PATllOLOGy    AND    THE  LI  iPEU  TICS 

sheer,  half-bath,  or  plunge,  as  either  t»  most  agi-eeable  to  the  patient's 
feelings.  It  is  generally,  however,  imj  ortant  to  deterge  the  skin  thor- 
ougiil}',  and  keep  up  a  good  degree  of  activity  in  the  cutaneous  excre- 
tory i)rocess,  by  occasional  packings  in  the  v/et  sheet,  so  managed  as  to 
produce  moderate  but  not  debilitating  sweating ;  or,  in  very  torpid  in- 
valids, the  dry-packing,  followed  by  the  dri])ping-sheet,  with  very  active 
friction,  may  be  substituted. 

The  local  treatment  is  a  matter  of  more  difficulty.  Extirpation  will 
genei-ally  succeed,  if  resortel  to  in  the  early  stages,  provided  the  gen- 
eral health  has  been  judiciously  cared  for;  but  it  unfortunately  happens 
that  the  operation  is  not  often  resolved  upon  until  structural  disorgani- 
zation has  proceeded  too  far  to  render  it  available.  There  is  no 
doubt  that,  in  some  cases  in  which  the  local  affection  is  much  more  prom- 
inent than  the  constitutional,  caustics,  or  rather,  perhaps,  chemical  an- 
tidotes, have  been  successful.  The  matter  of  a  cancerous  growth, 
being  an  abnormal  formation,  can,  without  doubt,  be  acted  upon  and 
destroyed,  and  the  peculiar  action  or  secretion  on  which  its  existence 
depends  arrested,  by  substances  which  will  not  act  very  injuriously  on 
the  healthy  structures,  nor  materially  interfere  with  the  normal  func- 
tions ;  but  as  yet  we  are  ignorant  of  any  such  specifics  or  antidotes. 
The  "cancer  quacks,"  it  is  well  known,  use  arsenic  as  the  principal 
corrosive  to  eat  away  the  diseased  structures ;  but  death  often  results 
from  the  absorption  of  the  poison.  Iodide  of  potassium,  and  niti'ate 
of  silver  are  reported,  on  good  authority,  to  have,  in  a  few  instances, 
destroyed  the  cancerous  ulcer,  which  did  not  subsequently  reappear. 
Some  vegetable  powders,  as  bloodroot  and  blue  cohosh,  have  had  a 
similar  reputation.  It  is  certain,  however,  that  all  these  preparations 
fail  in  a  majority  of  cases,  and  an  anti-cancerous  remedy  is  yet  a  de- 
sideratum, if  indeed  it  is  a  possibility.  My  friend  and  former  patient, 
Dr.  Schell,  late  of  New  Orleans,  assures  me  that  he  is  in  possession 
of  an  antidotal  preparation  which  operates  destructively  on  the  diseased 
parts,  and  correctively  on  the  morbid  action,  without  sensibly  injuring 
the  sound  structures.  As  he  is  about  to  put  the  matter  to  a  practical 
test  on  an  extensive  scale  in  this  city,  I  need  not  dwell  longer  on  the 
subject  in  this  place,  save  to  remark  that  Dr.  S.  is  not  one  of  the 
numerous  professionable  adventurers  who  are  swarming  in  all  our  great 
cities,  but  a  scientific,  candid,  and  honorable  physician.  It  is  due,  how- 
ever, to  him  and  to  the  subject  to  say,  that  he  depends  as  much  on 
constitutional  as  on  local  ti-eatment,  deeming  the  latter  useless  without 
attention  to  the  general  health,  tliis  attention  to  be  in  all  respects 
eti'ictly  hydro})athic. 

I  have  not  yet  had  ai    opportu?:ity  of  testing  refrigeration,  or  the 


CACHEXIES  m 


application  of  extreme  cold  to  a  cancerous  tumor ;  but,  judging  theo- 
retically, I  should  expect  much  benefit  from  it.  Tt  is  always  advanta- 
geous to  keep  the  diseased  part  covered  with  wet  compresses  of  as  cold 
temperature  as  can  be  borne  without  increased  pain ;  and  I  cannot  help 
believing  that  actually  freezing  the  part  occasionally,  by  the  application 
of  refrigerating  mixtures,  is  among  our  most  promising  topical  appli- 
ances. 

Melanosis. — The  disease  called  melanose,  or  hlack  cancer,  consists 
in  the  formation  of  a  morbid  product  of  secretion,  of  a  dark  color,  more 
or  less  inspissated,  and  staining  or  studding  the  organ  or  structure  af- 
fected. Every  part  of  the  body  is  liable  to  these  discolorations  or  tu- 
bercles, and  sometimes  all  the  structures  are  loaded  with  them.  In 
the  areolar  texture  the  melanotic  matter  often  accumulates  in  the  cells, 
and  forms  tumors  of  various  sizes. 

Symptoms. — The  color  of  melanosis  varies  from  a  dark  yellow  to 
brown,  deep  blue,  approaching  to  black,  and  to  complete  black,  which 
is  the  most  common.  The  secretion  is  easily  detected  by  its  peculiar 
shades  of  color  in  any  part  or  organ  containing  it,  as  the  surrounding 
tissues  are  lighter  colored,  and  form  a  remarkable  contrast  with  it;  it 
is  usually  of  a  pultaceous  consistence,  the  tubercles  pea-sized  to  walnut- 
sized,  and  scattered  in  groups ;  they  are  sometimes  situated  upon  the 
surface,  but  more  generally  below  it ;  an  irritative  fever,  mostly  of  the 
hectic  form,  attends,  and  the  patient  experiences  great  debility.  The 
seci-etion  is  nearly  destitute  of  smell  and  taste ;  and  as  no  vessels  or 
nerves  have  ever  been  in  it,  the  matter  appears  to  be  an  unorganized 
deposit. 

Prognosis. — Dr.  Good  remarks :  "  The  cause,  progress,  and  diag- 
nosis, are  at  present  obscure  and  unsatisfactory,  and  the  ti'eatment  is 
yet  to  be  learned."  The  majority  of  cases  have  thus  far,  under  allo- 
pathic treatment,  terminated  fotally. 

Treatment. — This  need  not  detain  us.  The  cure  depends  on  restor- 
ing the  normal  condition  of  the  secernent  system,  and  this  presupposes 
the  employment  of  all  the  means  for  invigorating  the  general  system 
and  purifying  the  circulating  fluids,  which  have  been  detailed  under 
preceding  heads,  more  especially  when  treating  of  scurvy,  scrofula, 
and  cancer. 

Catac  \usis. — This  is  a  condition  of  general  combustibility  of  the 
body,  produ  -ed  by  the  use  of  alcoholic  drinks.  Examples  of  sponta- 
neous combustion  as  having  occurred  in  persons  long  accustomed  to 
the  immoderate  employment  of  spirituous  liquors,  are  too  well  authep" 


180 


PATIIULOGY    AND    THERAPEUTICS. 


ticated  to  be  longer  doubted.  The  condition  of  body  liable  to  this  strange 
phenomenon  may  properly  be  called  the  alcoholic  diathesis.  In  a  major- 
ity of  cases  recorded,  females  advanced  in  life  were  the  subjects  of 
the  malady.  In  some  cases  the  self-consuming  flame  has  arisen  with- 
out any  obvious  exciting  cause ;  but  in  others,  a  fire,  a  lighted  candle, 
the  heat  of  a  stove,  or  an  electi'ic  spark,  has  ignited  the  inebriate 
body.  It  is  a  remarkable  fact  tliat  the  flame  which  decomposes  and  re- 
duces every  fi-agment  of  the  bodily  sti'uctuve  to  ashes,  does  not  essentially 
injure  the  common  fui'niture  or  bedding  with  which  it  comes  in  con- 
tact; and  more  marvelous  still  is  the  statement  that  water,  instead  of 
quenching  the  fire,  seems  rather  to  quicken  it.  As  this  is  the  only  mor- 
bid condition  known  which  renders  the  human  body  combustible,  and 
the  only  morbid  fire  which  hydropathy  cannot  extinguish,  the  subject 
need  not  be  further  prosecuted,  save  to  point  the  obvious  moral  for  the 
benefit  of  whom  it  may  concern — that  all  spirit-drinkers  burn,  and  mar, 
and  disorganize  their  structures  in  an  exact  ratio  to  the  amount  of  alco- 
hol they  consume,  even  if  the  alcohol  does  not  consume  them  by  a 
spontaneous,  ingenerated  fire  in  return. 


CHAPTER   VII. 


DISEASES    OF    THE    EYE. 


The  morbid  conditions  of  the  visual  organ  requiring  attention  in  this 
place  may  be  arranged  as  in  the  following  table  : 


Ophthalmia  ' 


Structural  Derange- 
ments afifccting  the    < 
Sight 


■  Acute, 

Chronic, 

Purulent, 

Infantile, 
.  Granulated. 

'  Nebulae, 
Ulcers, 
Pterygium, 
Stiiphyloraa, 
Closed  Pupil, 
Cataract, 
Amaurosis, 
^  Strabismus. 


'  Psorophthalmia, 
Trichiasis, 
Entropium, 
Structural  Affections     Ectropium, 
of  the  Eyelids        "^  Hordeolum, 

Excrescences, 
Ptosis, 

Fistula  Lachrymalif 
'  Asthenopia, 
Hemeralopia, 
V  Nyctalopia, 
Myopia, 
,  Presbyopia. 


Perverted  States 
of  Vision 


/•Ecchymosis, 
Injuries  and  Acciilcnts<  Extraneous  Substances, 
l  Burst  Eye. 

The  most  common  morbd  aflfection  of  the  eye  is  inflammatioQ.     Il 


DISEASES    OF    THE    EYE.  181 

may  attack  any  of  its  structures,  but  is  most  frequently  seen  in  the 
membrane  covering  tlie  external  coat  constituting  the  ophthabnia 
proper,  or  ophthalmitis  of  authors.  Sclerotitis,  iritis,  retinitis,  etc  , 
designate,  in  technical  Latin,  inflammatory  states  of  the  sclerotic,  iris, 
retina,  etc.  As  they  should  ail  be  treated  precisely  in  the  same  man- 
ner as  acute  or  chronic  ophthalmia,  as  the  violence  or  mildness  of  their 
symptoms  approximates  the  character  of  either,  they  need  not  be  sep- 
arately considered. 

Acute  Ophthalmia. — This  is  the  common  form  of  active  inflam- 
mation. It  commences  with  a  pricking  sensation,  as  though  dust  was 
in  the  eye,  soon  followed  by  heat,  redness,  swelling,  and  extreme  in- 
tolerance to  light.  Often  there  is  severe  headache,  with  more  or  less 
general  fever. 

Treatment. — Keep  the  eye  shaded  from  strong  light,  but  not  con- 
fined from  the  air  by  close  bandaging.  Apply  linen  cloths  wet  in  cold 
water,  changing  them  very  frequently,  until  the  temperature  becomes 
natural,  and  the  redness  disappears.  Wet  the  head  often  in  cold  wa- 
ter. If -there  are  irregular  chills  and  heat,  employ  the  wet  pack  sheet 
once  or  twice  daily  for  an  hour,  followed  by  the  cold  ablution.  Move 
the  bowels  fteely  with  tepid  water  injections.  If  the  feet  are  cold, 
use  warm  foot-baths.  The  patient  should  eat  nothing  stronger  than 
water-gruel,  and  but  little  of  that,  until  the  violence  of  the  disease  has 
very  materially  abated. 

Chronic  Ophthalmia. — This  condition  of  sore  eyes  often  results 
from  riotous  living,  bad  air,  bad  food,  liquor,  tobacco,  etc.,  and  is  very 
often  a  sequel  of  maltreated  acute  ophthalmia.  Millions  of  eyes  are 
rendered  miserable  to  look  upon,  or  from,  by  the  drugifications  of  doc- 
toring, washes,  lotions,  leeching,  blistering,  bleeding,  calomelizing,  etc., 
to  cure  the  acute  form. 

Treatment. — Particular  attention  must  be  paid  to  the  general  health. 
A  daily  rubbing-sheet,  and  a  daily  hip-bath,  should  be  part  of  the  treat- 
ment. Walking  foot-baths  are  excellent  auxiliaries.  The  eyes  should 
be  bathed  several  times  a  day  in  moderately  tepid  water  at  first,  and 
finally  as  cold  as  may  be  found  consistent  with  comfortable  sensations 
after  the  application. 

Purulent  Ophthalmia — Egyptian  Ophthalmia. — This  form  of 
inflammation  is  rapidl)-^  destructive,  and  requires  prompt  and  energetic 
treatment.  In  addition  to  the  pain,  heat,  and  redness  of  acute  oph- 
thalmia, it  is  charactei'ized  by  the  enormous  swelling  of  the  eyelids, 


IS2  PATHOLOGY    AND    THERAPEUTICS. 


Boon  followed  by  the  discliaige  of  a  large  quantity  of  thick,  yellowish, 
or  greenish  matter. 

Treatment. — If  thero  be  much  general  heat  of  body,  the  wet-sheet 
packing  should  be  employed  two  or  three  times  a  day,  followed  by 
washing  the  surfice  in  tepid  water.  If  the  body  incline  to  chilliness, 
the  sheet  should  be  wrung  out  of  warm  w^ater.  The  eyes  are  to  be 
very  frequently  washed  with  pure  soft  water,  wai"m  at  first,  then  tepid, 
and  then  cold — never  veiy  cold.     Attend  to  the  bowels  as  above. 

Infantile  Ophthalmia — Purulent  Infantil^ Ophthalmia. — 
Children  of  a  few  days  or  weeks  old  are  often  attacked  with  this  for- 
midable malady.  The  symptoms,  however,  usually  come  on  with  less 
violence,  and  progi'ess  less  rapidly.  But  the  common  lotions  and  po- 
tions, washes  and  swashes,  are  very  apt  to  aggravate  the  disorder,  de- 
form the  eyelids,  or  destroy  the  sight.  The  treatment  is  the  same  as  in 
the  case  of  the  adult,  substituting  the  warm  or  tepid  bath  for  the  pack. 

Granulated  Ophthalmia — Granular  Eyelids. — In  this  affec- 
tion the  conjunctival  membrane,  or  white  of  the  eye,  is  raised  into 
little  projections,  presenting  a  rough,  irregular  appearance.  It  is  a 
consequence  of  long-continued  or  maltreated  inflammation.  If  not 
cured,  it  mny  in  time  occasion  opacities  of  the  cornea,  by  the  irritation 
it  causes,  followed  by  blindness.  The  only  chance  of  cm*e  hydropath- 
ically  is  by  a  persevering  course  of  general  and  local  treatment.  Mod- 
erate bathing,  say  a  daily  rub-sheet  and  douche,  the  local  application 
several  times  a  day  of  veiy  cold  or  iced  water,  or  even  pounded  ice, 
with  a  strictly  abstemious  regimen,  carefully  avoiding  all  exciting  con- 
diments, and  all  sorts  of  stimulants,  constitute  the  outlines  of  the  rem- 
edial plan. 

Nebula  and  Specks,  or  Opacities  of  the  Cornea. — Nebulas 
are  superficial  deposits  in  the  transpai-ent  part  of  the  eye,  giving  it  a 
cloudy  appearance ;  opacit  es  are  deeper  seated,  producing  a  dense 
and  pearly  appearance.  They  are  caused  by  inflammation.  Their 
treatment  should  be  managed  precisely  as  for  granular  eyelids,  with  the 
addition  of  means  to  excite  powerful  absorption.  A  strong  douche  and 
walking  foot-baths  are  the  best  measures  for  this  particular  indication. 

Ulcers  of  the  Cornea. — These  occasionally  result  from  long- 
standing indammation,  and  are  also  soni.itimes  produced  by  mechani- 
cal and  chemical  irritants.  The  treatment  is,  in  all  respects,  as  the 
preceding. 


DISEASES    OF    THE    EYE.  188 

Pterygium. —  A  small  reddish  triangular  tumor,  gi'owing  from  the 
inner  cornea  of  the  eye,  or  from  some  portion  of  the  eyelid.  It  can 
be  readily  removed  by  cutting,  the  operation  being  entirely  painless. 

Staphyloma. — A  pearly,  conical,  whitish  tumor,  formed  by  tne 
enlarged  cornea  projectmg  between  the  lids.  It  is  the  consequence 
of  severe  ophthalmia,  and  of  badly-managed  eruptive  fevers,  as  the 
small-pox.  It  can  only  be  removed  by  a  surgical  extirpation ;  though 
a  rigidly  abstemious  and  hygienic  regimen  might,  in  many  instances, 
prevent  the  disease  from  proceeding  to  a  dangerous  extent.  The  sight 
is  always  desti"oyed. 

Closed  Pupil. — Inflammation  of  the  iris  is  sometimes  followed  by 
an  obliteration  of  the  pu*  '  Vision  is  often  partially  restored  by  form- 
ing an  artificial  pupil. 

Cataract. — ^This  is  an  opacity  of  the  crystalline  lens  or  its  capsule. 
Its  progi'ess  is  very  slow,  and  it  generally  commences  without  any  ap- 
parent cause.  The  first  symptom  of  the  approaching  disease  is  indis- 
tinct vision.  Objects  seem  enveloped  in  a  mist  before  the  eyes.  A 
speck  can  then  be  observed  in  the  center  and  behind  the  pupil.  As 
the  opacity  increases,  the  sight  grows  dim,  and  vision  is  better  in  a 
moderate  than  a  strong  light. 

Treatment. — Surgeons  have  three  operations  for  its  cure.  1st. 
Breaking  up  the  crystalline  lens  with  needles,  which  is  probably  tho 
best.  2d.  Depressing  or  pushing  the  lens  aside  from  the  angle  of 
vision.     3d.  Extracting  the  lens. 

When  this  affection  is  first  discovered,  its  further  progress  may  be 
arrested,  and  possibly  a  cure  effected,  by  the  management  applicable  tp 
nebulae,  specks,  etc. 

Amaurosis — Drop  Serene. — A  total  or  oartial  loss  of  vision  from 
paralysis  of  the  optic  nerve,  or  an  affection  of  the  nervous  structure 
of  the  retina.  It  is  produced  by  inflammation,  severe  exposure  to  in- 
tense light,  intemperance,  gluttony,  tobacco,  alcoholic  liquors,  excessive 
niglit  labor,  etc.  Milton  was  a  notable  example  of  this  affection.  Th>e 
defect  of  vision  comes  on  gradually ;  letters  and  other  objects  at  first 
look  misty  or  confounded,  or  run  into  each  other;  sometimes  objects 
seem  double,  and  at  other  times  portions  of  objects  are  undistinguish- 
able.  Between  the  objects  and  the  eye,  numerous  insects,  cobwebs, 
or  other  substances  seem  to  be  interposed.  The  eye  itself  manifests 
little  or  no  change  to  the  obser'ar.     Sometimes  flashes  of  light  appeui* 


184  PATHOLOGY    AND    THERAPEUTICS. 


before  the  eyes,  and  the  head  is  often  aftected  with  vertigo,  pain,  and 
heaviness. 

Treatment. — Confirmed  amaurosis  is  incm-able.  If  taken  in  its  in- 
cipient stage,  it  may  be  arrested  and  generally  cured.  Being  essen- 
tially a  disease  of  exhaustion,  the  full  hydropathic  system  should  be 
thoroughly  and  perseveringly  applied.  The  general  or  constitutional 
treatment  is  mainly  to  be  relied  on,  the  local  applications  being  of  sec- 
ondary importance.  The  simple  and  single  indication  is,  to  invigorate 
the  whole  system.  The  rubbing  wet  sheet,  the  pack  followed  by  the 
shallow-bath  or  plunge,  sifz,  and  foot  baths,  with  occasional  douches, 
should  be  adapted  discriminatingly  to  the  particular  condition  of  each 
case.  Every  part  of  a  hygienic  regimen  is  important.  In  no  disease 
is  strict  temperance  in  eating  and  drinking  more  indispensable.  A  lit- 
tle of  the  ''  hunger  cure"  would  be  serviceable  in  all  of  these  chronic 
maladies  of  the  eyes. 

Strabismus. — Squinting,  or  cross-eyes,  is  sometimes  congenital,  and 
sometimes  produced  by  diseases  and  accidents.  Measles,  dropsy  in  the 
head,  worms,  looking  too  much  at  objects  obliquely,  are  exciting  causes. 
More  generally  it  results  from  a  permanent  conti'action  of  a  particular 
muscle  which  holds  the  eye  in  a  wrong  direction.  It  is  curable,  by  di- 
viding the  obnoxious  muscle,  an  operation  scarcely  painful  or  dangerous. 

PsoROPHTHALMiA. — A  form  of  chronic  inflammation  of  the  eyelids, 
attended  with  itching,  redness,  watery  discharge  during  the  day,  and  a 
sticky,  glutinous  secretion  durii>^-  sleep.  Its  causes  and  treatment  are 
the  same  as  of  chronic  ophthalmia. 

Trichiasis. — Irritative  soreness  of  the  eye,  from  the  eyelashes 
growing  in  toward  the  ball.  Extract  the  inverted  haii-s,  and  bathe 
often  in  cool  water. 

Entropium. — The  eyelid  is  sometimes  inverted,  or  turned  inward. 
It  requires  surgical  ti-eatment,  viz.,  the  careful  excision  of  the  inverted 
edge  of  the  lid. 

EcTROPiuM. — An  eversion  or  turning  outward  of  the  eyelid.  It  cre- 
ates a  hideous  deformity,  and  the  lid  must  be  excised  as  for  entropium. 

Hordeolum. — Commonly  known  as  st</e.  It  consists  of  a  small  in- 
flammatory tumor  near  the  edge  of  the  eyelid.  It  is  very  painful,  but 
generally  suppurates  and  heals  in  a  few  days.     Frequent  bathing  of  th* 


D I S  E  A  S  E  S    C  F    T  H  E    E  Y  E.  185 

affected  part  wi'li  water  of  a  temperature  most  agi'eeable  to  the  feel" 
ings,  lessens  the  pain  and  accelerates  the  cure. 

ExcRESCENSES. — "Wart-like  and  other  trifling  tumors  sometimes 
form  about  the  eyelids ;  they  are  easily  and  safely  clipped  oif  with  the 
knife  or  a  pair  of  scissors. 

Ptosis. — A  hanging  down  of  the  eyelid  over  the  eyeball,  from  re- 
laxation or  paralysis  of  the  muscle,  whose  action  elevates  the  lid. 
Frequent  cold  bathing,  occasiona  head-baths,  gentle  manipulations  over 
the  eye  with  the  bare  hand,  and  attention  to  the  general  health,  are  all 
proper,  and  generally  all  are  necessary. 

Fistula  Lachrymalis. — This  is  a  stoppage  of  the  tear  passage, 
caused  by  obstruction  from  a  thickening  of  its  lining  membrane.  The 
tears,  instead  of  passing  off  by  the  nose,  run  over  the  cheek,  giving 
the  eye  a  watery  appearance,  especially  when  exposed  to  wind  or  cold. 
In  protracted  cases  a  swelling  occurs  at  the  inner  angle  of  the  eye, 
sometimes  forming  matter.  It  requires  to  be  treated  on  the  same  gen- 
eral plan  as  ptosis.  Usually  the  general  health  is  so  disordered  as  to 
render  a  rigidly  abstemious  diet  advantageous.  In  bad  cases  it  may  be 
necessarj'^  to  probe  the  obstructed  canal,  or  wear  an  artificial  tube. 

Asthenopia. — Weak  vision.  This  depends  on  constitutional  or  local 
debility,  and  requires  the  full  invigorating  plan  before  mentioned. 

Hemeralopia. — Day-blindness.  A  peculiar  sensibility  of  the  re- 
tina, by  which  the  patient  sees  better  in  the  evening  than  in  clear 
daylight.  The  Albino  manifests  more  or  less  of  this  condition.  It  is 
irremediable. 

Nyctalopia. — This  is  the  reverse  of  the  former  condition,  the 
Bubject  having  natural  vision  in  the  daj^ime,  but  very  imperfect  in  the 
evening,  or  twilight.  Glasses  sometimes  assist  this  night-blindi>ess  to 
Borae  extent. 

Myopia. — Short-sightedness.  The  subject  cannot  read  ordinary 
print  well  beyond  the  distance  of  fifteen  or  sixteen  inches.  In  looking 
at  distant  objects,  he  half  closes  the  eyelids.  It  is  most  common  in 
young  persons.  The  oculists  remedy  this  defect  by  concave  glasses. 
Manipulations  have  been  found  successful  as  the  difficulty  depends  on 
too  gi-eat  convexity  of  the  globe  of  tbe  eye      Flattening  the  eyeball  by 


186 


PATHOLOGY    AND    TIIER4PEU  TICS. 


pressing  gently  with  the  fingers  across  it,  from  within  outwardly,  tends 
to  restore  the  proper  focal  point  of  vision. 

Presbyopia. — Far-sightedness.  The  subjects  of  this  complaint 
read  with  the  book  or  paper  at  the  distance  of  t^vo  feet  or  more.  The 
corner  is  too  fiat,  the  pupil  is  contracted,  and  the  eyes  have  a  more 
sunken  appearance.  It  is  most  common  to  aged  persons.  Convex- 
glasses  are  prescribed  by  the  oculists.  The  defect  may  be  final!}"  over- 
come in  many  j^ersons  by  manipulating  from  without  toward  the  nose, 
so  as  to  increase  the  roundness  of  the  eyeball.  Press  the  fingers  gen- 
tly from  the  outer  angle  of  the  ey '»  inward,  and  rather  around  than 
across  the  globe. 

EccHYMOsis. — "Rowdy's  coat  of  arms."  This  is  the  common  black 
eye  of  rowdy  characters.  Generally  it  comes  from  an  unlucky  blow, 
but  a  fall,  sting  of  an  insect,  or  leech  bite,  may  produce  it.  Bathe 
freely  in  the  coldest  water. 

Substances  in  the  Eye. — Foreign  bodies  often  insinuate  them- 
selves between  the  eyelids,  causing  great  pain.  Draw  down  the  lower 
lid  (fig.  183),  and  remove  by  a  piece  of  moistened  paper.  If  the  sub- 
stance be  under  the  upper  hd,  place  a  bodkin  across  the  lid,  and  draw 

Fis.  184. 


DEPRESSING  THE  LOWER  LIU 


INVERTING    THE    UPPER   LID. 


back  the  lid  so  that  it  is  completely  inverted  (fig.  184).  Very  minute 
pieces  of  iron  are  often  driven  with  such  violence  that  a  surgeon  is 
compelled  to  cut  them  out;  but  the  operation  should  not  be  attempted 
by  other  parties,  as  they  may  destroy  4;he  eye.  fnfiammation  is  very 
apt  to  occur  after  these  accidents,  for  which  the  eye  should  be  well 
bathed  with  tepid  or  warm  water  frequently,  until  the  pain  abates;  then 
follow  with  cool,  auJ.  finally  cold  apprm\':ions. 


1  ISEASES    OF    THE    EYE,  187 


Lime  and  Roman  cement  are  very  destructive  to  the  eyes.  Wash 
repeatedly  with  a  mixture  of  a  table-spoonful  of  some  vegetable  acid  in 
a  tumbler  of  water,  as  vinegar  or  lemon  juice. 

Burst  Eve. — From  severe  blows  the  eye  is  sometimes  burst.  Do 
not  attempt  to  touch  it,  as  vision  may  be  irremediably  damaged  by 
touching  it  with  the  finger.  The  careful  surgeon  will  frequently  be  ena- 
bled to  preserve  sight.  Place  the  patient  at  once  in  bed,  darken  the 
room,  and  treat  the  subsequent  inflammation  with  cool  compresses. 


CHAPTER  VIII. 

DISEASES    OF   THE    EAR. 


The  various  fi^^normal  affections  of  the  organ  of  hearing  may  be  con- 
veniently grouped  under  tlie  general  heads  of  inflammation  and  deaf- 
ness ;  the  kinds  of  the  inflammatory  afiiection  constituting  the  varieties 
of  the  former,  and  the  causes  of  the  malady  forming  the  varieties  of 
the  latter.  This  arrangement,  I  confess,  has  nothing  classic  or  sj-stem- 
atic  to  recommend  it;  nor  will  it  embrace  two  of  the  diseases  belonging 
to  the  chapter,  which  must,  therefore,  be  placed  under  a  third  liead, 

thus : 

r  External  Acute  Inflammation, 
Otitis-^  Internal  Acute  Inflammation, 
I  Chronic  Inflammation. 

f  From  Cold, 

"  Hardened  Ear-wax, 

"  Excrescences, 

"  Abscess, 

"  Caries, 

Deafness  ■{        "  Altered  Membrana  Tympani, 

"  Diseases  of  the  Eustachian  Tube 

"  Extravasation, 

"  Nervous  Affections, 

"  Dumbness, 

"  Senility. 

,,        .  ,  Earache, 

Promiscuous  <  ,  ^ 

F^'"eign  Bodies  and  insects. 


188  PATHOLOGY    AND   THERAPEUTICS. 


Inflammatory  affections  of  the  ear  have  usually  been  distinguished 
by  nosologists  into  acute  and  chronic ;  the  former  being  termed  olitis, 
the  latter  oiorrhcta.  Otitis  has  been  divided  into  external  and  internal^ 
as  it  affects  chiefly  the  external  or  internal  ear;  and  otorrhcea  has  been 
regarded  as  mucous  or  purulent,  according  to  the  character  of  the  dis- 
charge. Other  distinctions  have  been  oredicated  on  the  causes  of  the 
disease,  as  scrofulous,  syphilitic,  etc 

External  Acute  Otitis. — Acute  inflammation  of  the  external 
ear  commences  with  slight  pain,  or  sense  of  heat,  or  intense  irritation, 
or  itching,  followed  by  more  acute  and  distressing  pain.  The  pain  is 
augmented  on  pressure,  by  the  motions  of  the  lower  jaw,  and  generally 
by  the  contact  of  very  cold  air,  or  very  warm  fluids.  Hearing  is  con- 
fused, and  unusual  noises  trouble  the  ear,  and  sometimes,  within  three 
or  four  days,  a  thin  fluid  is  discharged  from  the  m.eatus,  which  gener- 
ally soon  becomes  thicker  and  puriform.  Sometimes  it  is  greenish,, 
fetid,  and  extremely  acrid.  When  the  inflammation  subsides,  the  mat- 
ter hardens  into  a  caseous  or  cheesy  consistence,  which,  unless  removed, 
obstructs  the  passage,  and  occasions  partial  deafness. 

Treatment. — This  is  plain  and  simple.  Fasting  until  the  inflamma- 
tory stage  materially  subsides ;  the  constant  application  of  several  folds 
of  cold  wet  cloths  to  the  part;  occasionally  syringing  the  ear  with  cool 
but  not  very  cold  water ;  and  general  bathing,  once,  twice,  or  thrice  a 
day,  by  means  of  the  dripping-sheet  or  wet-sheet  pack,  comprise  all 
the  needful  plan  of  medication. 

Internal  Acute  Otitis. — Acute  inflammation  of  the  internal  ear 
is  attended  with  a  distressing  sense  of  distention,  painful  throbbing,  and 
nervous  distui-bance,  consequent  on  the  obstruction  of  the  Eustachian 
tube,  and  the  diflliculty  of  discharging  the  secreted  matter  externally. 
The  pain  is  deep-seated ;  there  is  often  a  feeling  as  though  the  ear 
would  burst,  and  loud,  clanging,  or  beating  noises  are  heard,  and  the 
ear  is  painfully  susceptible  to  scind.  In  some  cases  the  face  is  flush- 
ed, the  eyes  are  red  and  watei-} ,  the  head  delirious,  and  the  attending 
fever  of  the  typhoid  character.  If  the  disease  is  not  speedily  relieved, 
suppuration  takes  place,  and  the  accumulated  matters  are  discharged 
through  an  ulcerous  perforation  of  the  membrane  of  the  drum,  or  into 
the  throat  by  the  Eustachian  tube,  or  by  a  fistulous  opening  in  the 
mastoid  process  of  the  temporal  bone.  The  former  is  tlie  usual  termi- 
nation ;  the  second  seldom  occurs ;  and  the  latter  result  .s  extremely 
rare.  St)"uctural  changes  sometimes  result  from  internal  otitis,  whicb 
partially  or  totally  destroy  the  sense  of  liearing. 


DISEASES    OF    THE    EAR.  189 


Treatment. —  This  disease  should  be  met  with  prompt  and  vigorous 
treatment.  In  addition  to  the  processes  recommended  for  the  preced- 
ing variety,  cold  water  should  be  poured  over  the  sides  and  back  of  the 
head,  several  times  a  day,  and  several  minutes  at  a  time,  or  until  the 
preternatural  heat  of  the  head  is  thoroughly  subdued.  The  wet  sheet 
must  be  resorted  to  sufficiently  to  keep  down  the  general  fever;  and 
the  bowels  should  be  kept  well  cleansed  by  tepid  injections.  In  some 
cases  the  purulent  matter  becomes  so  inspissated  that  it  makes  its  way 
through  the  opening  in  the  membrana  tympani  with  great  difficulty,  in 
which  case  its  discharge  may  be  facilitated  by  very  frequent  injections 
ot  warm  water  into  the  external  meatus.  Sometimes  the  Eustachian 
tube  is  entirely  obstructed ;  this  fact  can  be  ascertained  by  causing  the 
patient  to  make  a  forcible  attempt  at  expiration  with  the  mouth  and 
nose  closed  ;  if  the  tube  be  permeable,  bubbles  of  air,  mixed  with  the 
fluid  secretions,  will  escape  at  the  external  meatus.  If  the  early  treat- 
ment is  thorough,  and  thoroughly  hydropathic,  this  affection  will  almost 
always  terminate  by  resolution,  leaving  none  of  those  deplorable  results 
which  are  so  common,  as  sequels,  after  a  course  of  allopathic  manage- 
ment. Indeed,  under  the  ordinary  drug-treatment  the  disease  often 
continues  with  violence  from  three  to  six  weeks,  and  not  unfrequently 
results  in  a  complete  disorganization  of  the  internal  ear. 

Chru.xic  Inflammation — Otorrhea. — A  prolonged  discharge,  or 
running  from  the  ear,  is  frequently  the  consequence  of  acute  otitis, 
and  often  one  of  the  sequelae  of  malti-eated  eruptive  fevers,  particu- 
larly small-pox,  scarlet  fever,  and  erysipelas.  The  mucous  form  is  the 
most  common  among  delicate  and  scrofulous  children,  and  frequently, 
under  the  popular  system  of  treatment,  continues  for  years.  The 
purulent  variety  is  often  connected  with  caries,  or  ulceration  of  the 
surrounding  bony  sti'ucture.  The  patieat,  in  this  case,  complains  of  a 
dull  pain  in  the  ear,  extending  over  the  side  of  the  head ;  of  impaired 
hearing;  and  exhibits  a  dullness  and  heaviness  of  expression.  The 
mastoid  process  is  oftentimes  the  seat  of  ulceration,  the  external  parts 
being  then  swollen  and  cedematous. 

Treatment. — All  forms  of  chronic  abscesses,  ulcerations,  mucous  or 
purulent  discharges  from  the  ear,  should  be  treated  on  one  and  the 
same  general  plan.  They  always  indicate  depravity  of  fluids,  or  de- 
bility of  functions,  or  both;  hence  the  uniform  indication  is  to  cleanse, 
or  strengthen,  or  both.  First  of  all,  the  general  health  must  be  at- 
tended to.  The  coarse,  plain,  farinaceous,  and  frugivorous  diet,  a  care- 
ful abstinence  from  all  saline,  alkaline,  or  greasy  foods  or  condiments, 
with  a  persevering  application  of  such  forms  of  general  bathing  as  the 


190  PATHOLOGY    AND    THE^i,  APEU  TI  C  S. 


general  constitution::!  condition  demands,  \re  ilie  essentials  of  the  plan 
The  rubbing  wet  sheet,  with  frequent  h>;  and  foot  baths,  as  deiivalives, 
niake  a  good  bathing  arrangement.  If  t'xO  iskin  is  obstructed  or  bilious, 
the  pack  sheet  should  be  occasionally  ve&oited  to ;  and  it  is  more  or 
less  frequently  useful  in  nearly  all  casej.  After  the  general  health  liaa 
become  substantially  improved,  warm,  and  ihen  tepid,  and  then  cool 
injections,  should  be  thrown  into  the  ear,  '\t,  as  is  usually  the  case,  there 
is  more  or  less  deafness,  and  this  should  be  persevered  in  for  weeks 
and  months,  if  necessary. 

Deafness. — The  pathological  conditions,  stnictural  and  functional, 
of  the  various  parts  entering  into  the  formation  of  the  ear,  which  may 
produce  a  greater  or  less  depravation  of  the  sense  of  hearing,  are  very 
numerous ;  and  many  of  them  are  exceedingly  difficult  of  diagnosis. 
Fortunately,  the  worst  cases  are  of  rare  occurrence  ;  and  those  which 
are  common  are  easily  discriminated,  and  successfully  treated. 

Deafness  from  Colds. — A  state  of  atony,  or  sub-paralysis  of  th© 
auditory  nerves,  from  "taking  cold,"  frequently  occasions  deafness  in 
one  or  both  ears,  for  days,  weeks,  or  months.  It  is  cumble  by  perse- 
veiing  tepid  injections,  with  due  attention  to  the  general  health. 

Deafness  from  Hardened  Ear- Wax — An  accumulation  of  hard 
ened  wax,  obstructing  the  function  of  hearing,  is  generally  the  resuU 
of  an  erythematic  inflammation  of  the  auditory  passage.  Persons  of 
bad  habit  of  body,  torpid  skin,  deranged  digestion,  etc.,  are  peculiarly 
liable  to  this  affection.  It  is  known  by  an  increased  sensibility  or  sore- 
ness in  the  meatus,  a  sense  of  itching,  and  often  a  burning  or  pricking 
sensation,  confusion  in  the  head,  noises  in  the  ear,  with  a  tearing  or 
dragging  sort  of  pain  about  the  ear  and  kead. 

It  is  curable  in  the  same  manner  as  the  preceding;  but  due  attention 
to  the  general  health  is  the  leading  indication  ;  and  among  the  most  im- 
portant of  the  hygienic  appliances  is  a  rigidly  plain  and  unconcentrated 
diet.  Head-baths  are  useful  when  the  inflammatory  symptoms  are 
prominent. 

Deafness  from  Excrescences. — Morbid  excrescences,  usually  soft 
wart-like  tumors,  or  spongy  vesicular  polypi,  are  sometimes  found  in  the 
ear-passage.  They  are  the  result  of  chronic  inflammation  of  the  folli- 
cles of  the  meatus,  or  the  membrana  tympani.  These  excrescences 
are  red,  sensitive,  and  readily  bleed  when  irritated,  except  in  a  few 
cases," when  they  are  hard  and  indurated.     To  detect  their  character, 


DISEASES    OF    THE    EAR.  1^1 

the  meatus  must  be  examined  with  the  ear  speculum,  oi  a  common  tri- 
angular reflecting  prism  of  flint  glass,  by  which  light  can  be  sent  to  the 
bottom  of  the  external  ear-passage. 

Treatment. — In  treating  these  conditions,  the  inflammatory  action 
ghould  be  subdued,  and  the  general  health  restored,  as  already  mention- 
ed, and  then  the  fungus  growths  extirpated,  after  which,  both  tepid  and 
sold  injections  should  be  emploj'ed  for  a  considerable  length  of  time. 
The  polypi  and  other  tumor?  can  generally  be  eradicated  by  a  pair  of 
fine  curved  scissors,  or  a  cur\ed  double-edged  knife,  having  a  blunt  and 
rounded  extremity,  or  a  pair  of  delicate  forceps,  with  sharp  points,  or 
with  a  ligature  passed  around  them,  and  occasionally  tightened  until 
they  are  cut  off".  Such  excrescences  as  are  incapable  of  removal  by 
mechanical  means,  can  generally  be  destroyed  by  caustics,  for  which 
purpose  they  may  be  repeatedly  touched  with  nitrate  of  silver.  Its 
employment  demands  great  care,  to  prevent  the  sound  parts  from 
being  cauterized  also. 

Deafness  from  Abscess. — The  abscess  is  a  phlegmonous  inflam- 
mation of  the  cellular  tissue  of  the  passage,  usually  caused  by  severe 
cold  or  exposure  to  strong  currents  of  air.  It  should  be  treated  pre- 
cisely like  acute  inflammation. 

Deafness  from  Caries. — Some  persons  are  afl*ected  with,  and 
children  of  a  scrofulous  diathesis  are  very  liable  to,  an  inflammation  of 
the  periosteum,  which  generally  results  in  inflammation  of  the  bonj 
structure,  and  fi-equently  terminates  in  exfoliation  of  the  diseased  bone, 
by  which  the  passage  is  narrowed  or  obliterated.  The  inflammatory 
stage  should  be  treated  by  the  means  previously  recommended,  and 
as  the  healing  process  goes  on,  the  passage  should  be  prevented  from 
closing  by  caustic  or  metallic  tubes.  The  hearing  always  remains  dull 
in  these  cases. 

Deafness  from  an  Altered  Membrana  Ttmpani. — Neglected 
or  maltreated  inflammatory  aff'ections  are  occasionally  followed  by  a 
thickening,  opacity,  fungous  excrescence,  or  destruction  of  the  mem- 
brane of  the  drun.  Sometimes  the  membrane,  examined  by  the 
speculum,  appears  as  if  covered  by  small  projecting  glands  or  follicles; 
at  other  times  it  is  very  red  and  vascular,  the  blood-vessels  being  dis- 
tinctly visible.  The  pain  is  accompanied  by  buzzings,  as  if  something 
were  fluttering  in  the  ear,  and  by  diminished  hearing.  The  pain  ia 
increased  by  loud  sounds,  by  variations  of  temperature,  and  by  press- 
ure upon  the  ear. 


102      PATHOLOGY  AND  THERAPEUTICS. 

Treatment. — There  is  nothing  peculiar  in  the  treatment  of  this  af- 
fection, as  distinct  from  that  of  the  other  forms  of  inflammation  and  its 
consequences,  sdreaJy  described.  It  is  woith  remembering,  that  in 
many  chronic  diseases  of  the  head,  and  particularly  of  the  ears,  deriva- 
tive, hip,  and  half-baths  are  among  the  best  applications.  They  should 
be  aa  lengthy  as  the  patient  can  bear  them,  without  disagreeable  feel- 
ings in  the  brain  or  lungs,  generally  thirty  or  forty  minutes.  Artificial 
perforation  of  the  membrana  tympani  has  been  frequently  performed 
in  cases  where  it  was  so  thickened  as  to  nearly  or  quite  destroy  the 
hearing ;  but  it  has  seldom  succeeded  in  restoring  it. 

Deafness  from  Diseases  of  the  Eustachian  Tube. — The 
Eustachian  tube  is  sometimes  obstructed  by  the  presence  of  tumors  in 
its  vicinity,  by  inflammation  resulting  in  swelling  of  the  mucous  mem 
brane,  effusion,  constriction  or  obliteration  of  a  portion  of  the  canal 
These  conditions  cannot  well  be  ascertained  without  explorations  by 
ear  forceps  or  catheters.  Injections  of  warm  water,  and  of  air,  have 
been  employed  to  ascertain  the  nature  and  extent  of  any  existing  ob 
structiou ;  but  all  these  operations  are  attended  with  no  small  degree 
of  danger.  Several  fatal  accidents  are  recorded  in  medical  journals, 
as  having  recently  occurred  in  London,  from  the  pumping  of  air  from 
a  press  into  the  Eustachian  tube.  The  wisest  policy  in  these  import- 
ant cases  is  to  be  content  with  the  thojough  employment  of  all  meas- 
ures conducive  to  the  general  and  local  health. 

Catarrhal  aflections,  inflammation  of  the  throat,  and  eruptive  fevers, 
not  unfrequently  leave  an  accumulation  of  mucus  in  the  Eustachian 
tube,  obstructing  it,  and  occasioning  more  or  less  deafness.  In  such 
cases  cold  water  gargles  are  an  excellent  addition  to  the  general  plan 
of  treatment. 

An  inflananation  principally  confined  to  the  mucous  membrane  of 
the  Eustachian  tube,  which  is  often  but  the  extension  of  a  disease  of 
me  throat,  frequently  causes  deafness.  When  this  inflammation  is 
confined  If.  the  guttural  part  of  the  tube,  the  patient  hears  well  at 
times,  but  only  momentarily.  His  own  voice  sounds  worse  to  him 
than  the  voices  of  others,  and  has  sometimes  a  gurgling,  crackling,  or 
detonat-n-^  sensation.  Th«  pain  is  greatly  increased  on  gaping,  or  by 
the  act  of  mastication.  Ice-cold  gargles,  with  the  whole  general  anti- 
inflammation  treatment,  should  be  perseveringly  employed. 

Enlarged  tonsils  sometimes  press  upon  the  guttural  extremity  of  the 
Eustachian  tube,  so  as  to  produce  deafness,  as  also  do  fungous  excres- 
cences, polypi,  and  enlarged  parotid  glands.  Those  obstructions,  of 
course,  must  be  removed  by  ligature  or  excision  ;  though  enlarged  ton- 


DISEASES    OF    THE    EAR.  193 


siis  can  generally  be  reduced  by  cold  gargles,  and  thorougli  general 
treatment,  with  a  rigidly  abstemious  diet. 

Deafness  from  Extravasation. — External  injury,  violbot  sneez- 
ing, or  severe  constriction  of  the  neck,  may  produce  a  lesion,  causing 
an  extravasation  of  blood  in  the  cavity  of  the  drum.  Cold  compresses, 
gargles,  injections,  and  any  other  baths  demanded  by  the  state  of  the 
general  system,  will  generally  produce  an  absorption  of  the  extrava- 
sated  fluid,  if  it  does  not  pass  off  b}'  the  Eustachian  tube,  and  remove 
the  deafness. 

Nervous  Deafness. — The  term  nervous,  in  this  sense,  is  very  in- 
definite. It  is  applied  by  medical  authors  indiscriminately  to  all  forms 
of  impaired  hearing,  unconnected  with  apparent  inflammatory  pheno- 
mena or  sti'uctural  changes.  The  proximate  causes  of  this  form  of 
deafness  are  numerous :  it  may  arise  fi-om  simple  atony,  paralysis,  or 
exhaustion  of  the  nerves  pertaining  to  the  sense  of  hearing,  or  those 
nerves  may  be  compressed  by  tumors,  purulent  formations,  or  ex- 
travasations, not  manifested  by  any  external  symptoms  ;  or  from  organic 
afi^ections  of  the  brain  pressing  on  the  origin  of  the  nerves. 

The  most  prominent  symptoms  which  indicate  compression  of  the 
nerves  are  vertigo  or  dizziness,  severe  and  constant  headache,  noise  in 
the  ears,  weak  sight,  and  defective  memory.  It  is  generally  incurable, 
although  the  means  applicable  to  the  preservation  of  the  general  health 
may  prevent  the  further  progress  of  the  condition  producing  the  deaf- 
ness ;  and  in  some  cases  the  hearing  may  be  greatly  improved  by  the 
same  sanatory  measures. 

Palsy  of  the  acoustic  nerve  arises  from  severe  shocks,  contusions  of 
the  brain,  convulsions,  apoplexy,  fever,  plethora,  and  still  more  fre- 
quently from  sympathy  with  some  chronic  derangement  of  other  parts 
or  organs,  generally  the  digestive.  The  reader  need  not,  perhaps,  be 
told  that  in  all  the  afl'ections  of  this  class,  which,  in  fact,  are  many,  the 
prospect  of  cure  depends  entirely  upon  the  degi'ee  of  general  health 
which  can  be  reproduced. 

Dumb  Deafness. — Deafness  in  infancy  may  arise  from  original 
constitutional  malformation,  or  from  structural  diseases  occurring  in  the 
early  periods  of  life.  When  congenital,  it  is  incurable ;  but  in  many 
oases  resulting  from  diseases  in  the  first  few  years  of  existence,  a 
cure  may  be  effected  by  careful  attention  to  the  local  condition  and 
general  health ;  it  is  especially  important  to  avoid  all  concentrated  and 
stimulating  articles  of  food  in  these  cases. 
11—17 


IVl  PATHOLOGY    AND   1  If  E  R  A  P  c)  U  TIC  S. 

Senile  Deafness. — Old  age  should  not,  in  a  natural  development 
ttod  decline  of  the  bodily  functions,  be  subject  to  deafness,  blindness, 
noi  other  loss  of  external  sensibility,  only  in  the  ratio  that  all  the  phy- 
siological functions  cease  to  perform  their  otYices.  But  the  usual  habit* 
of  living  tend  to  thicken  the  fluids  an  ^  hasten  these  results  premature- 
ly— the  fine  capilliiry  vessels  of  the  dehcate  structure  of  the  organs 
of  sense  become  obstructed,  and  their  functions  impaired  disproportion- 
ately to  those  of  other  and  more  vital  organs.  Hence  the  great  fre- 
quency of  deafness  in  old  persons.  We  have  no  panacea  to  ofler  ib 
this  relation,  of  preventive  or  curative  efficacy,  save  a  life  in  conformity 
with  tile  laws  of  life. 

Earache — Otalgia. — This  is  usually  symptomatic  of  inflammation. 
or  of  foreign  bodies  or  insects  in  the  meatus.  But  the  affection,  con- 
sidered as  idiopathic,  is  of  a  nervous,  neuralgic,  or  rheumatic  charac- 
ter, coming  on  abruptly,  and  disappearing  suddenly,  and  is  unattecdej^ 
with  febrile  irritation.  Noises  in  the  eai*,  and  slight  4eafness,  are  fre 
quent  accompaniments  of  otalgia. 

Treatment. — Fasting  a  day  or  two,  syringing  th-^  ear  with  warii> 
water,  and  a  few  tepid  foct-batlis,  will  generally  soon  vemove  the  worst 
attacks.  A  warm  or  vapor  bath,  or  a  wet-sheet  packJ^F,  will  often  re- 
move the  trouble  at  once.  If  the  stomach  is  foul,  a  warm  water  eme- 
tic should  be  employed,  and  if  the  bowels  are  not  enthely  free,  copious 
W!U-m  water  injections  are  advisable. 

Foreign  Bodies  and  Insecil>  — Children  at  play  occasionally  put 
beans,  peas,  small  pebbles,  and  other  substances  into  the  enr-passage. 
These  may  remain  an  indefiuite  time  without  trouble ;  but  frequently 
inflammation  and  ulceration  ensue,  w^ith  a  constant  discharge  of  irr;- 
tating  or  fetid  matter.  They  often  produce  the  most  intense  agony, 
and  are  sometimes  so  surrounded  by  fungous  growths  as  only  to  be  de- 
tected by  the  most  critical  exa-nination  with  the  speculum,  forceps,  oi 
probe.  If  the  body  be  hard,  as  a  stone  or  metallic  substance,  the 
grating  of  the  probe  will  discover  it. 

Their  removal  by  mechanical  means  requires  the  most  careful  and 
dextrous  mnnagement,  to  avoid  injuring  the  adjacent  structures. 

Insects  and  worms  somptimes  effect  a  lodgment  in  the  meatus,  pro- 
ducing nwfu\  suffering.  Tiiere  is  little  doubt  that  inattention  to  clean- 
liness, particularly  in  diseased  or  ulcerated  states  of  tlie  passage,  attractP 
the  animals  to  deposit  their  ova  there,  which  in  time  are  converted  into 
worms ;  and  it  is  possible  they  may  oe  generated  there  as  they  are  in 
a  morbid  condition  of  the  secretions  of  the  raucous  membrane  of  the 


ERYTHEMATOUS    INFLAMMATICXS. 


196 


Btoraach  and  bowels.     In  either  case  they  are  unprofitublti  and  danger- 
ous residents. 

When  they  can  be  seen,  they  should  &e  removed  with  the  forceps. 
A  pledget  of  lint,  covered  with  some  viscid  substance,  as  oil  and  honey, 
to  which  worms  when  small  and  numerous  will  adhere,  will  often  ena- 
ble us  to  remove  them.  They  may  be  destroyed  also  by  narcotic 
poisons   Hs  oil  of  almonds,  or  a  strong  infusion  of  gi'een  tea,  or  tobacco. 


CHAPTER   IX. 


ERYTHEMATOUS   INFLAMMATIONS. 


In  the  loose,  slip-shod  medical  literature  of  the  day,  the  terms,  ery- 
thematic,  or  erythematous,  and  erysipelatous,  are  indiscriminately  ap- 
plied to  a  great  variety  of  topical,  eruptive,  and  symptomatic  inflam- 
matory affections,  some  of  which  are  actually  exanthems,  or  eruptive 
fevers,  and  others  mere  rashes,  attended  with  little  or  no  constitutional 
febrile  disturbance.  In  its  strictest  sense,  erythema  means  inflamma- 
tory blush,  and  is  applied  to  those  external  ma-nifestations  of  inflamma- 
tion which  are  not  necessarily  connected  with  fever;  whereas  ery- 
sipelas is  usually  limited  to  an  eruptive  fever.  Again,  therefore,  I  find 
it  necessary  to  sacrifice  uniformity  of  method  to  convenience — my 
limits  precluding  tlie  idea  of  a  perfect  nosological  arrangement — and 
comprise,  in  the  present  chapter, 


Edematous, 
Erysipelas, 
Gangrenous, 
Erythemas  -{   Vesicular, 
Anatomical, 
Chilblain, 
Fret. 


m  Rasii  Exanthem — Nettlerash. 

S3 
O 

S     Icherous  Exanthem  )     ^    ' ' 
^  (  remphigus. 

c 

a 

H  Carbuncular  Exanthem — Yaws. 


Erythemas. — All  the  varieties  of  erythema  are  characterized  by 
red,  tumid,  fullness  of  the  skin,  disappearing  on  pressure,  attended 
with  a  burning  pain,  and  termii^ating  generally  in  cuticular  scales,  or 
vesicles,  sometimes  in  ulceration    and  more  rarely  in  gangrene. 

In  the  cedematous  variety  the  Bkin  exhibits  a  bright  scarlet  color; 
the  affection  spreads  widely  ant    deeply  through  the  areolar  tissue 


196  PATHOLOGi'    AND    THERAPEUTICS. 


whicli  ofteu  suppurates  imperfectly,  and  occasionally  sloughs  and  be- 
comes gangrenous.  The  swelling  is  principally  caused  by  extravasated 
serum;  it  is  generally  found  iu  dropsical  constitutions,  and  usually  de- 
nominated, "■  adematous  injiammalion.^^ 

In  erysipelatous  erythema  the  color  is  of  a  deeper  red,  and  super- 
ficial, with  a  determinate  edge,  usually  in  a  serpentine  or  winding  di- 
rection, the  part  fir^t  attacked  healing  as  the  disease  extends  over  the 
surfiice.  This  form  is  called  '■'■erysipelatous  inflammation''''  in  many 
medical  books.  Sometimes,  though  rarely,  it  is  attended  with  some 
degree  of  extravasation,  producing  a  soft  swelling,  and  attended  with 
a  shiniog  surface.  It  often  follows  wounds,  injuries,  and  surgical  ope- 
rations. In  some  cases  it  extends  beneath  the  skin,  and  runs  into  sup- 
puration and  mortification,  constituting  the  erysipelas  phlegmonodes  of 
Galen. 

Gangrenous  erythema  is  characterized  by  a  superficial  dusky  red 
color ;  a  bloody  serum  separates  the  cuticle  from  the  true  skin ;  the 
cutis,  when  denuded,  exhibits  dark  brown  spots,  which  are  disposed 
to  blister  and  slough.  It  attacks  chiefly  the  exti'emities.  It  ia  always 
found  in  extremely  relaxed  and  debilitated  constitutions,  and  is  most 
common  in  advanced  age,  especially  when  the  vitality  has  been  pre- 
maturely exhausted  by  narcotics  and  stimulants,  as  tobacco  and  alcohol. 
It  is  sometimes,  however,  seen  in  weakl}'  intancj'.  Either  of  the  pre- 
ceding varieties  may  pass  into  the  gangrenous  form. 

In  the  vesicular  variety-  the  color  is  pale  red  ;  the  surface  is  rough- 
ish,  and  covered  with  minute  crowding  vesicles,  filled  with  acrid,  often 
reddish  fluid.  Authors  distinguish  two  sub-varieties:  the  first,  benign, 
in  which  the  vesicles  advance  without  a  breach  of  the  cuticle;  and  the 
second,  corrosive,  in  which  the  vesicles  break  in  the  part  first  afflected 
and  the  corrosive  fluid  produces  tracts  of  sanious  ulceration  as  the  red 
ness  advances.  This  and  the  preceding  variety  were  called  ignis 
saccr — holy  fire — by  the  ancients,  from  the  superstitious  notion  thai 
they  were  special  inflictions  of  the  Deity,  or  of  His  ministers.  There 
are  also  sub-varieties  of  this  form  of  erythema,  produced  by  the  me- 
dicinal administration  of  mercury  and  arsenic;  the  former  has  been 
called  erythema  mercuriale  and  hydrargyria  in  medical  books. 

The  anatomical  variety  is  the  erythematous  inflammation,  ^^hich 
arises  from  dissection.  Unlike  all  the  other  forms  of  erythema,  and, 
indeed,  unlike  most  other  inflammations  originating  from  a  local  caflfee,  it 
commences^  at  least  in  the  gi-eat  majority  of  cases,  with  a  constitution^] 
febrile  disturbance  ;  the  locnl  aflection  first  ai)pearing  about  the  shoul- 
der or  axilla,  while  the  injured  part  shows  little  or  no  inflammatory 
action      Tlie  characteristic  symptoms,  as  well  stated  by  Dr.  Good,  are 


ERYTHEMATOUS    INFLAMMATIONS.  197 

"Inf]airmiation,  wiih  lancinating  pains  about  the  axilla,  shooting  down 
the  chest,  ushered  by  severe  rigors  and  anxiety,  succeeding  rapidly  to 
the  dissection  of  a  fresh  corpse,  with  a  puncture  or  abrasion  of  the 
hand  of  the  anatomist;  blush,  a  deep  crimson,  with  a  spongy  fullness, 
chiefly  over  the  pectoral  muscle  ;  fever,  a  typhus."  Those  few  cases 
in  which  the  local  symptoms  take  the  lead  of  the  constitutional,  are 
always  the  least  dangerous ;  and  this  remark  probabl}^  holds  true  with 
every  form  of  disease  resulting  from  local  injury  or  infection. 

The  immediate  cause  of  this  affection  has  never  been  satisfactorily 
explained.  It  has  been  ascribed  to  a  specific  virus,  to  the  irritation 
of  a  putrescent  fluid,  or  to  simple  irritation  or  inflammation  operating 
upon  a  peculiar  idiosyncrasy,  or  constitutional  habit.  There  is  little 
doubt  that  a  dead  body,  in  the  incip'-ent  stage  of  putref.iction,  may  de- 
velop some  chemical  element,  which,  analogous  to  a  ferment,  is  capable 
of  inducing  a  process  of  transformation  or  decomposition  in  some  of 
the  elements  of  the  blood,  or  other  fluids  of  the  body,  not  very  dis- 
similiar  to  what  happens  in  small-pox,  measles,  and  other  diseases 
dependent  on  a  specific  virus,  or  ti'ausformation  of  matter.  To  this 
view  it  has  been  objected  that  the  disease  is  never  taken  from  a  corpse 
in  the  advanced  stage  of  putrefaction;  but  I  think'  the  objection  itself 
furnishes  a  strong  presumption  of  the  coirectness  of  the  opinion ;  for, 
it  v/ill  readily  be  admitted,  that  all  forms  of  matter  which,  in  a  particular 
stage  of  the  process  of  decomposition  develop  an  infectious  or  poisonous 
principle,  must  necessarily  be  changed  into  something  different  if  the 
process  of  decomposition  goes  on.  Thus  yeast,  the  vaccine  virus,  and 
alcohol,  all  pi'oducts  of  decomposition  or  putrefaction,  may  be  resolved 
into  very  different  and  comparatively  inert  compounds  of  elementary 
matters,  by  further  decomposition.     , 

The  local  inflammation  and  the  accompanying  fever  resulting  from 
the  bite  of  venomous  serpents — as  the  cobra  do  capello,  and  rattlesnake, 
from  whose  virus  death  often  results  within  twenty-four  hours — in  all 
essential  circumstances,  resemble  the  erythema  before  us ;  the  chief 
difference  being  that  the  local  and  constitutional  symptoms  Loth  com- 
mence and  continue  simultaneously,  while  the  progress  of  the  disease 
is  much  m.ore  rapid,  the  vitality  being,  as  it  were,  destroyed  as  by  an 
electric  shock,  by  the  first  impression  of  the  poison. 

There  are  also  two  classes  of  insects  which  occasion  more  or  less 
local  inflammation  of  an  ery thematic  character,  in  some  cases  followed 
by  a  constitutional  disturbance  similar  to  that  of  anatomical  erythema, 
Ind  in  a  very  few  cases  terminating  in  death.  The  first  class — as 
bees,  wasps,  hornets,  ichneumons,  etc. — sting,  and  the  second  class — 
as  the  gnat,  horsefly,  flea,  big,  eto   —pierce  the  skin  and  suck  the 


196  PATHOLOGY    AXD    l  IT  E  li  APEUTIC  S. 

blood.  Whether  the  injury  results  mainly  from  poison,  or  the  rritation 
of  a  rough,  ragged  wound,  is  not,  in  nil  cases,  clear.  The  following 
cut  exhibits  tje  instrumentality  by  which  these  insects  pierce,  cut,  and 
tear  the  fine  capillary  network  of  blood-vessels  and  nerves : 

Fig.  185. 


STIXGIXG    AND    BITING    INSECTS. 


In  Fig.  185,  a  is  a  representation  of  the  hornet;  b,  the  gnat;  c,  lancets  of  horsefly  ;  d, 
eting  of  wasp  ;  .    lancet  of  flea  ;  /,  lancets  of  bug. 

The  variety  called  cJiilhlain,  or  pernio,  affects  principally  the  hands 
and  leet,  and  is  occasioned  by  exposing  the  parts  alternately  to  extreme 
cold  and  heat.  In  very  cold  climates  the  nose,  ears,  and  lips  are  some- 
times destroyed  by  it.  The  skin  is  of  a  crimson  color,  suffused  with 
blue,  and  is  troubled  with  an  excessive  and  obstinate  itching. 

The  remaining  variety— -//e/,  intertrigo,  erosion  of  the  skin — is  gen- 
erally seen  behind  the  ears  of  children,  and  about  the  groins  and  anus 
of  children  and  adults.  The  inflamed  part  is  of  a  brijiht  red  color,  the 
cuticle  is  eroded,  nnd  the  exposed  skin  oozes  a  limpid  and  acrimonious 
fluid;  the  di.scharge  is  often  peculiarly  offensive.  The  whole  t.heoiy 
of  its  nature,  advanced  by  Dr.  Good,  in  his  elaborate  "Study  of  Med- 
icine," is  In  the  following  words:  "It  is  an  eiythema  with  weak  vas- 
cular action,  and  often  considerable  irritability,  in  consequence  of  such 
weakness."  The  plain  English  of  the  matter  is  this.  It  is  an  erythema 
with  filthy  personal  hal)its,  and  always  considerable  uncleanliness  of  the 
skin  u3  a  consequence  of  such  habits.     I  have  never  known  a  man. 


ERYTHEMATOUS    INFLAMMATIONS.  199 

woman,  or  child  who  took  a  daily  bath  or  wash  over  the  whole  surface, 
to  be  troubled  with  it. 

Treatment. — In  the  first  four  forms  of  erytheinatic  inflammation,  we 
have  to  deal  with  local  irritation,  in  connection  with  great  general  debil- 
ity; in  the  fifth-named  variety  these  conditions  are  coupled  with  the 
peculiar  morbid  action  of  a  specific  virus  ;  while  in  the  last  two  varieties 
the  only  morbid  condition  is  irritation.  TJic  indications  of  cure  are, 
therefore,  sufficiently  obvious. 

QEdematous  erythema  is  rarely  found  except  as  symptomatic  of 
some  primary  malady;  but  when  occurring  idiopiithicaliy,  the  local  wet 
compress,  frequently  alternated  with  gentle  friction  by  means  of  soft 
flannel  or  the  bare  hand,  and  the  general  tepid  or  cool  ablution,  or  half- 
bath,  constitute  the  leading  remedial  measuies.  Bandages  of  wet  linen, 
when  the  absorbents  are  nearly  powerless,  and  the  accumulated  fluid 
produces  very  painful  distension,  are  frequently  useful  auxiliaries,  pro- 
vided they  are  evenly  and  smoothly  adjusted. 

From  the  fiicts  that  erysipelatous  erythema,  frequently  attacks  chil- 
dren soon  after  birth,  and  that  children  are  sometimes  bory  with  it,  we 
mny  reasonably  infer  that  the  malady  is  closely  fillied  to  the  voluntary 
h.ibits,  especially  the  dietetic  habits,  of  the  j)atient,  or,  in  case  of  infancy, 
the  mother.  Hence  a  strict  and  rigidly  simple  dietary  is  of  first  im- 
portance in  the  remedial  course.  The  greater  tendency  to  general 
fever  requires  more  thorough  general  bathing,  and  frequently  a  resort 
to  the  wet-sheet  pack. 

The  gangrenous  and  vesicular  forms  require  more  particular  atten- 
tiun  to  the  local  treatment.  While  the  general  treatment  is  regulated 
by  the  superficial  heat  and  the  feelings  of  the  patient,  the  temperature 
of  the  water  being  as  cool  or  cold,  but  no  colder,  than  is  compatible 
with  a  prompt  and  comfortable  glow  on  the  surface ;  the  local  appli- 
cations should  be  veiy  cold,  so  as  to  produce  a  tonic  and  constringing 
eflfect.  If  very  cold  applications  are  painful,  they  need  not  be  contin- 
ued long  at  a  time,  but  may  be  frequently  repeated. 

Allopathic  authorities  have  not  yet  settled  the  question  whether  the 
antiphlogistic  plan — bleeding  and  reducing,  or  the  stimulating  plan — 
bark  and  wine — is  the  most  proper;  for  neither  claims  to  be  successful. 
Messrs.  Hutchinson  and  Lawrence,  eminent  European  surgeons,  rec- 
ommended making  numerous  and  extensive  incisions  in  the  afilected 
parts,  v/ith  a  view  of  arresting  the  disorganization  of  the  structures ;  a 
practice  which  has  been  copied  by  several  American  practitioners, 
though  not,  I  believe,  with  such  success  as  will  commend  its  general 
repetition. 

I  am  lot  aware  that  any  hydropathist  has  had  an  opportunity  of  test-' 


200  PATHOLOGY    AND    THERAPEUTICS. 

ing  the  new  system  in  a  case  of  erythema  arising  from  dissection ;  nor 
do  I  believe  that  all  cases  could  be  cured  by  hydropathic,  or  any  other 
means.  Some  anatomists  who  become  tt  ns  affected  are  among  those 
wliose  physiological  habits,  especially  in  the  matter  of  eating  and  drinking, 
are  gross  and  unhealthful;  hence  they  may  have  that  degi'ee  of  putres- 
cency  of  blood  which  can  offer  but  slight  resistance  to  the  destructive 
action  of  the  infectious  principle ;  aL  attack,  therefore,  may  be  certain 
death.  And  the  same  remarks  apply  to  the  bites  of  venomous  serpents. 
But  the  most  hopeful  plan  of  treatment  is  clear.  The  intensity  and 
malignancy  of  the  disorganizing  inflammation  should  be  opposed  b)''  a 
succession  of  wet-sheet  packs,  sufficient  to  keep  the  morbid  heat  in 
check,  and  promote  free  perspiration,  if  possible.  In  a  later  stage  of 
the  disease,  when  the  strength  is  much  exhausted,  and  the  extremities 
inclined  to  coldness,  I  v/ould  employ  the  warm  wet-sheet,  and  apply  hoi 
bottles  to  the  feet.  Water-drinking  should  be  insiated  on  to  the  full  extent 
of  the  stomach's  capacity  to  receive  it  without  painful  repletion.  I  am 
not  aware  that  any  advantage  is  pretended  to  have  been  derived  from 
any  of  the  numerous  local  applications  which  have  been  tried.  In  the 
erythema  fi-om  the  virus  of  serpents,  a  ligature  above  the  injury,  if 
applied  immediately  after  the  bite,  or  the  removal  of  the  wounded  part 
by  excision,  or  the  actual  cautery,  when  resorted  to  inskintly,  have  no 
doubt  many  times  materially  abated  the  violence  of  the  disease,  or 
possibly  have  prevented  it  altogether.  And  in  some  instances  it  is  said 
that  sucking  the  poison  from  the  wound  ver}^  soon  after  the  serpent's 
fang  has  been  withdrawn,  has  prevented  all  injurious  consequences — 
the  mouth  being  defended  by  a  wash  of  olive  oil.  It  is  exceedingly 
difficult  to  determine  the  value  of  these  resources,  for  the  reason  that 
the  majority  who  are  bit  are  not  poisoned  at  all ;  hence  a  remedy  per- 
fectly inert  may  acquire  the  reputation  of  a  specific.  It  is  worthy  of 
remark,  however,  that  the  virus  of  the  rattlesnake — and  the  same  is  true 
of  the  fetid  secretion  of  the*  skunk,  and,  indeed,  of  the  venomous 
matter  of  most,  if  nut  all,  poisonous  serpents,  reptiles,  and  insects — is 
not  dangerously  noxious  when  taken  into  the  mouth  or  even  into  the 
stomach  in  considerable  quantities;  indeed,  it  has  been  employed  in 
one,  two,  and  three  deep  doses  as  an  antispasmodic,  in  difficult  breath- 
ing, asthmatic  affections,  etc.,  its  sensible  operation  being  rather  agree- 
able, nervine,  and  somewhat  exhilarating,  like  the  effect  of  castor, 
musk,  and  similar  animal  secretions.  Compressing  the  vessels  around 
the  bitten  part  veiy  soon  after  the  accident  by  a  cupping-glass  or  any 
similar  instrument,  by  interrupting  the  process  of  absorption,  may  con- 
ti-ibute  something  to  the  safety  of  the  patient.  The  general  treatment 
•8,  of  course,  precisely  the  same,  whether  the  system  is  poisoned  from 


ERYTHEMATOUS    INFLAMMATIONS.  201 

the  ingenerated  virus  of  a  dead  corpse,  or  the  venomous  secretion  of 
the  living  reptile.  The  irritation  or  poison  resulting  from  the  stings  or 
bites  of  insects  is  mos:  promptly  relieved  by  the  coldest  water,  and  the 
preferable  mode  of  application  is  the  constant  stream  or  douche.  The 
constitutional  affection,  should  it  supervene,  requires  the  same  manage- 
ment as  the  anatomical  variety. 

Chilblain  requires  a  daily  general  bath  or  ablution,  and  frequent 
local  bathing  in  the  coldest  water.  As  a  prophylactic,  the  patient 
should  never  suddenly  approach  a  hot  fire  when  the  feet  and  hands 
are  very  cold. 

The  last  named  variety,  as  already  intimated,  only  requires  that  the 
skin  be  well  washed  all  over  once  a  day,  or  oftenei",  with  pure  cold 
water.  If  there  be  any  sufferers  who  cannot  possibly  be  satisfied  with- 
out some  "medicated"  wash,  a  small  quantity  of  either  bar  or  soft  soap 
may  be  added  to  the  water.  Like  all  the  empirical  infallibles  of  the 
day,  "it  will  do  no  harm,  if  it  does  no  good." 

Nettle-Rash — Urticaria. — Some  authors  have  treated  of  this 
disease  as  a  variety  of  scarlet  fever.  The  precursive  fever  is  slight, 
although  the  &tomach  usually  manifests  considerable  disorder.  The 
rash  appears  about  the  second  day,  attended  with  a  peculiar  itching, 
like  the  sensation  produced  by  nettle-stinging ;  the  eruption  wanders 
from  part  to  part,  and  fades  and  revives  irregularly.  It  terminates  in 
a  few  days  with  cuticular  desquamation. 

Special  Causes. — Irritating,  constipating,  or  indigestible  food ;  salt, 
vinegar,  spices,  narcotics,  shell-fish,  stale  sausages,  old  cheese,  frowzy 
butter,  tainted  animal  flesh,  etc. 

Treatment. — A  warm  water  emetic,  tepid  injections  daily  to  keep 
the  bowels  free,  a  daily  dripping-sheet  or  half-bath,  with  plain  and 
abstemious  diet,  are  all  that  need  be  said  on  this  subject. 

Aptha — Thrush. — This  disease  consists  of  minute  vesicles,  con- 
taining, when  matured,  a  whitish  or  milky  fluid.  Authors  distinguish 
three  varieties:  infantile,  or  ivJiile  thrush,  appearing  in  infants  soon 
after  birth,  often  extending  from  the  mouth  to  the  stomach,  and  even 
intestinal  canal ;  the  vesicles  granular,  roundish,  and  pearl-colored,  and 
terminating  in  curd-like  sloughs ;  malignant,  or  hlack  thrush,  is  seen 
most  frequently  as  a  symptomatic  affection  in  typhus  and  innlignant 
fevers ;  but  it  is  said  to  be  sometimes  found  idiopathically  in  old  age, 
and  other  exhausted  states  of  the  vital  powers;  the  fever  is  a  strongly- 
marked  typhus,  and  the  sloughs  are  dark-colored  or  1  ack ;  chronic 
ihrush  is  attended  with  gi'eat  emaciation  and  hectic  fever    the  eruption 


202  PATHOLOGY    AND    THERAPEUTICS. 

extends  through  the  whole  length  of  tiie  alimentary  canal,  the  edges 
of  the  tongue  are  affected  with  piraplog,  huperficial  blisters  appear 
within  the  mouth  aivd  fauces,  and  the  stomach  is  at  all  times  troubled 
with  a  sense  of  heat  and  soreness.  Dian-hea  often  attends,  and  ulcer- 
ations of  the  bowels  are  frequent  consequences. 

Special  Causes. — Hot  drinks;  the  excessive  use  of  tea  and  coffee, 
especially  the  drug-colored  green  tea  of  commerce ;  highly-seasoned 
food;  confined  air;  repelled  eruptions ;  too  concentrated  food;  rancid 
greasi^  of  any  kiti'l ;  poi'k  gi-avies ;  retained  animal  putrefaction,  from 
inattention  to  bathing  the  skin,  etc. 

Treatment. — The  abdominal  bandage,  the  wet-sheet  pack  once  or 
twice  a  week,  cool  injections  daily  when  diarrhea  attends,  moderate 
drinking  of  cool,  but  not  very  cold  water,  a  daily  half-bath,  ablution,  or 
dripping-sheet;  and  the  adoption  of  a  bland,  simple,  sti'ictly  vegetable 
diet,  save  the  article  of  milk ;  with  a  strict  avoidance  of  all  the  producing 
causes,  comprise  the  remedial  plan. 

Pemphigus — Vesicular,  or  Bladdery  Feafr. — This  affection  is 
generally  symptomatic  of  visceral  inflammation  ;  though  several  nosol- 
ogists  of  celebrity  describe  it  as  an  idiopathic  disease,  and  even  distin- 
guish it  into  several  varieties.  Its  diagnosis  is,  ti'ansparent  vesicles 
scattered  over  the  body;  filbert-sized,  with  a  red,  inflamed  edge,  but 
without  surrounding  blush  or  tumefaction ;  the  vesicles  contain  a  fluid 
which  is  pellucid  or  but  slightly  colored ;  on  breaking,  the  vesicles  are 
disposed  to  ulcerate  ;  and  the  affection  is  accompanied  with  a  fever  of 
the  typhoid  type. 

In  the  variety  called  vulgaris — common  vesicular  fever — the  vesicles 
appear  from  the  second  to  the  fifth  day,  in  successive  crops,  often  ex- 
tending over  the  n>outh  and  intestinal  canal ;  another  variety,  called 
glandular,  is  preceded  by  swelling  of  the  neck  and  throat,  and  in  Switz- 
erland, where  it  has  been  chiefly  noticed,  it  is  considered  as  highly 
contagious ;  and  a  third  form,  termed  infantile  vesicular  fever,  attacks 
infants  soon  after  birth. 

Treatment. — As  this  disease,  in  its  essential  nature  and  causes,  is 
nearly  allied  to  the  preceding,  the  treatment  need  not  be  materially 
different.  In  many  cases,  frequent  sponging  with  tepid  water  is  suf- 
ficient. M.  Langhaus,  who  has  given  us  a  description  of  the  gland- 
ular pemphigus  of  Switzerland,  and  who  ti-eated  the  disease  by  bleed- 
ing and  sweating,  tells  us,  with  a  self-stultification  peculiar  to  the  school 
to  which  he  belonged,  in  one  part  of  his  narrative,  that  "  it  was  so 
contagious  as  to  spread  with  great  rapidity  through  numerous  families, 
and  80  malignant  that  al'  persons  affected  b}-  it  diec    "  and  yet,  in  allu- 


ERYTHEMATOUS   INFLAMMATIONS.  203 


sion  to  his  bleeding  and  sweating,  recommends  it,  "  with  the  most  san- 
guine hope  that  it  will  effect  a  speedy  cure." 

Yaws. — Ruhula  and  frambo&sia  are  other  terms  by  which  this  dis- 
ease is  known.  Some  nosologists  have  classed  it  among  the  eruptive 
fevers,  although  the  attending  fever  is  merely  adventitious ;  while  oth- 
ers have  regarded  it  as  properly  belonging  to  the  order  of  tumors.  It 
resembles  syphilis  and  other  infectious  diseases,  in  being  communicable 
by  contact;  and  the  exanthems  and  contagious  diseases  in  rendering 
the  body  nvulnerable  to  a  second  attack. 

Symptoms. — The  disease  consists  of  numerous  and  successive  tu- 
mors, commencing  with  mere  specks,  and  gradually  increasing  to  the 
size  of  a  raspberry,  which  they  somewhat  resemble ;  some  of  the 
smaller  papulae  become  real  pustules,  and  discharge  an  opake,  whitish 
fluid  when  broken,  and  concrete  into  dense  scabs  or  crusts ;  the  larger 
ran  into  fungous  excrescences,  and  in  their  granular  surface,  ns  well  as 
size  and  color,  resemble  the  raspberry,  from  which  their  name  is  de- 
rived. These  tumoi-s,  one  of  which  becomes,  at  length,  much  larger 
than  any  of  the  rest,  have  but  little  sensibility,  suppurate  very  imper- 
fectly, and  discharge  a  sordid,  icherous  matter.  They  originate  in 
scattered  groups  over  the  bod}-,  and  their  connection  with  personal  un- 
cleanliness  and  infection  is  sufficiently  evinced  by  the  fact,  that  they 
are  chiefly  found  in  the  groins,  axillae,  about  the  anus  and  pudenda, 
though  they  often  disfigure  the  neck  and  face. 

This  is  one  of  the  most  unsightly  diseases  known  ;  and  nothing  car\ 
exceed  the  revolting  spectacle  of  a  West  India  yaw-house,  where  the 
slaves,  suffering  under  this  disease,  are  collected  together.  Dr.  Good 
has  distinguished  the  disease  into  two  vaiieties — African  and  Ameri- 
can. The  diversity  of  the  symptoms,  however,  is  slight,  and  attribut- 
able wholly  to  local  circumstances.  In  duration  the  disease  varies  from 
one  to  three  months.  Sometimes  callous  tumors  are  formed  on  the 
soles  of  the  feet,  in  consequence  of  the  yaw-tubercles  not  being  able 
to  press  through  the  thick  skin ;  these  are  called  tuhha,  or  ci-ab-yaivs, 
and  greatly  impede  the  exercise  of  walking. 

Treatment. — One  or  two  tepid  or  moderately  cold  general  baths, 
either  by  the  dripping-sheet,  pack,  or  ablution,  witii  a  strictly  vegetable 
and  rigidly  simple  and  absteoiious  diet,  ai'e  the  pro;"er  iherapeutw 
app'iauces 


204 


PATHOLOGY     A  .N  D    THERAPEUTICS. 


CHAPTER  X. 


SPASMODIC     DISEASES. 


Thkre  nre  n  variety  of  disease?,  whose  most  prominent  phenomena 
are  :  irregular  muscular  conti'actions,  in  some  cases  amounting  to  a 
more  or  less  permanent  rigidity  of  particular  muscles,  and  in  others 
attended  with  convulsive  agitation  of  some  part  or  of  the  whole  mus- 
cular system.  These  may  be  conveniently  grouped  in  thi  present 
chapter  in  the  following  manner : 


^        ^         ( Convulsion, 
Comatose   I 

Spasm     ^^P'leP^y' 


Synclonic 
Spasm 


Suffocative 
Spasm 


I  Hysterics, 
f  Tremor, 

Delirium  Tremens, 

Shaking  Palsy, 
']  St.  Vitus'  Dance, 

Raphania, 
I  Barbiers. 
(  Cough, 

Dyspnoea, 

Asthma, 

Laryngismus, 

Incubus, 

Bronchitis, 

Sternalgia, 

Pleuralgia, 


Clonic 
Spasm 


Consti'ictive 
Spasm 


''  Hiccough, 

Sneezing, 

Palpitation, 

Nictitation, 

Subsultus, 
^  Stretching. 

^  Hydrophobia. 

Acrotismus, 

Tetanus, 

Locked-Jaw 

Cramp, 

Muscular  Spinal 
Distortion, 

Muscular     Stiff- 
Joint. 
^  Wry  Neck. 


The  generic  distinctions  in  the  above  arrangement  may  be  thus 
defined :  The  comatose  spasm  is  attended  with  muscular  agitation, 
diminished  sensibility,  inability  of  utterance,  followed  by  a  tendency  to 
drowsiness;  the  synclonic  spasm  is  characterized  by  a  simultaneous 
trembling,  or  chronic  agitation  of  various  sets  of  muscles,  especially 
when  excited  by  the  will;  the  suffocal'ive  spasm  disturbs,  momentarily 
or  permanently,  the  muscles  of  respiration  alone ;  the  clonic  spasm  is 
the  forcible  excitation  of  one  or  more  muscles  in  sudden  and  irregular 
enalche'? :  and  the  constrictive  spasm  is  an  irregular  form  of  muscular 
contraction  producing  rigidity. 


CovuLSiON. — Deaths    from    convulsion-fits,  especially  among  th© 


SPASMODIC    DISEASES.  206 

infantile  population  of  our  country,  are  becoming  alarmingly  frequent 
In  the  city  of  New  York  its  fatality  ranks  next  to  that  from  consump- 
tion, and  is  all  the  while  increasing,  and  as  far  as  I  have  been  able  to 
gather  information  on  the  subject,  the  same  is  true  of  nearly  all  parts 
of  the  United  States.  Why  twenty  or  thirty  children,  all  of  them  not 
far  from  two  or  three  years  of  age,  should  die  weekly  the  year  round, 
in  this  city,  from  this  disease,  may  well  engage  the  earnest  thoughts 
of  philanthropists  and  physicians,  and,  above  all,  of  mothers. 

Although  convulsion  occasionally  attacks  persons  in  all  periods  of  life, 
the  disease,  as  already  intimatea  is  conspicuously  frequent  and  tatal  in 
infancy;  pregnant  women  are  also,  after  the  sixth  month,  during  labor, 
and  immediately  afterward,  liabl*;  to  the  disease  then  denominated 
puerperal  convulsions. 

Symptoms. — The  muscula*  agitations  are  violent,  and  wilh  very 
young  children  the  spasmodic  movements  are  extremely  rapid ;  the 
fingei-s  work,  and  the  eyelids  quiver;  the  teeth  gnash;  sometimes  the 
convulsive  motions  skip  from  one  part  to  another;  at  other  times  the 
body  is  universally  convulsed;  occasionally  the  paroxysms  intermit  and 
recur  at  irregular  intervals ;  often  they  are  accompanied  with  shrieks 
or  yells.  In  infancy,  the  disease  is  usually  preceded  by  twitchings  and 
startings,  and  a  companied  with  a  blueness  about  the  eyes  and  uppei 
lip.  When  it  occurs  in  adults,  the  muscles  are  powerfully  exercised, 
the  mouth  foams,  the  eyelids  open  and  shut  perpetually,  or  are 
stretched  upon  a  full  stare,  while  the  protuberant  eyeball  rolls  rapidly 
in  every  direction,  and  the  whole  face  is  hideously  distorted. 

Special  Causes. — In  the  course  of  this  work  I  have  more  than  once 
had  occasion  to  allude  to  the  unhealthful  habits  and  fashions  which 
prevail  in  fashionable,  and,  indeed,  in  nearly  all  civilized  society,  in  the 
matter  of  rearing  children.  The  disease  before  us  is  one  of  the  many 
special  evidences  of  the  general  bad  feeding,  bad  dressing,  bad  doctor- 
ing, and  bad  management  that  rule  in  the  nursery;  and  as  especially 
prominent  among  the  special  causes  may  be  named  concentrated  food 
and  confections — baker's  bread,  sweet-cakes,  candies,  etc. — and  the 
paregoric  and  purgatives  which  are  given  to  silence  the  pain  and 
remove  the  co»stipation  which  they  produce. 

Treatment. — The  first  thing  to  be  done  in  a  convulsion-fit  is  to 
expose  tlie  patient  to  abundance  of  cool  air  and  plenty  of  cold  water. 
There  is  no  danger  from  any  amount  of  ventilation  in  the  coldest  of 
weather  while  the  fit  continues.  The  cold  ablution,  or  dripping-sheet, 
will  answer  for  bathing  purposes,  but  the  half-bath,  during  which  the 
surface  is  actively  rubbed  with  the  bare  hand,  is  the  preferable  mode. 
As  the  bowels  are  usually  clogged  with  il  -digested  matters,  or  irritated 
18 


20C  PATHOLOGY    AND    THERAPEUTICS. 

by  acrimoJiious  secretions,  tepid  injections  should  not  be  omitted.  After 
the  spasms  are  overcome,  the  prophylactics  to  employ  in  the  intervals 
nre  brown  lioine-madc  bread,  and  milk,  potatoes,  squashes,  pumpkins, 
apples,  etc.,  and  a  daily  bath  or  universal  vvash-down. 

Kpilepsy — Falling-S  jkness.  —Epileptic  fits  present  all  degrees 
of  violence,  from  a  slight  general  spasmodic  agitation  and  distortion 
of  the  muscles  of  the  face,  with  a  momentary  suspension  of  conscious- 
ness, succeeded  by  a  sense  of  drowsiness  or  stupor  scarcely  apprecia- 
ble, to  the  most  violent  convulsive  movemeiits  of  the  face  and  chest, 
while  the  limbs  are  fixed  and  rigid,  and  followed  by  several  hours  of 
total  unconsciousness. 

Symptoms. — In  some  instances  the  disease  is  ushered  in  by  precursive 
Byraptoms,  which  warn  the  patient  of  the  approaching  attack.  The 
most  usual  of  these  is  a  sensation  of  a  cold  creeping  vapor  from  some 
particular  part  of  the  body,  which  has  been  called  an  aura  ejnlejytica. 
But  more  generally  the  paroxysm  comes  on  suddenly,  and  often  com- 
mences with  a  startling  scream ;  the  patient  is  instantly  deprived  of  al. 
sense  of  perception  and  power  of  motion,  and  if  standing,  he  falls, 
while  the  body  is  more  or  less  convulsed ;  the  muscles  of  the  tace 
and  eyes  are  always  much  affected,  and  the  countenance  violently 
distorted ;  the  tongue  generally  protrudes  from  the  mouth,  which  dis- 
charges a  frothy  saliva;  the  lower  jaw  is  strongly  convulsed,  and  the 
teeth,  gnashing  upon  the  tongue,  often  wound  it  severely;  sometimes 
the  urine  and  foeces  are  discharged  involuntarily.  A  profound  lethai'gic 
sleep  succeeds  the  severer  attacks,  from  which  the  patient  at  length 
awakes,  unconscious  of  having  suffered  pain. 

When  the  disease  is  owing  to  an  organic  cause,  the  attack  is  more 
abrupt ;  the  patient  suddenly  falls  prostrate :  there  is  more  rigidity  and 
less  spasmodic  agitation  of  the  muscles,  and  optical  illusions  are  very 
common.  This  form  of  epilepsy  has  been  called  falling-sickness,  or 
cerebral  epilepsy. 

Special  Causes. — Among  the  organic  causes  are  various  structural 
derangements,  as  misformation  of  the  head,  external  injuries,  interna) 
tumors  or  collections  of  matter.  When  the  disease  is  functional,  the 
causes  which  specially  excite  the  paroxysm  in  the  individual  predisposed 
to  it,  are — strong  mental  emotions,  especially  of  the  depressing  kind,  as 
anger,  grief,  fright ;  indigestible  food,  an  overloaded  stomach,  or  any 
source  of  gastric  irritation,  may  prove  an  exciting  cause ;  repelled 
eruptions,  and  the  sudden  suppression  of  customary  evacuations,  have 
induced  it;  exhausting  indulgences,  either  in  the  exercise  of  the  lower 
anmial  propens>tie9,  or  in  the  use  of  stimulants  and  narcotics,  frequently 


SPASMODIC     DISEASES  20/ 

occasion  an  attack  ;  confirmed  drunkards  are  pecul  arly  liable  to  it ;  in 
a  few  instances  the  disease  }ia«  arisen  from  worms. 

Prognosis. — The  chance  of  cure  will   be  favorable  or  unfavorable 
as  the  symptoms  do  or  do  not  indicate  functional  derangement  or  local 
irritation  as  the  cause.     When  connected  with  deficiency  or  malform- 
ation of  brain,  organic  changes,  or  exhausted  nervous  power,  it  is  gen 
erally,  and  probably  always,  incurable. 

Treatment. — During  the  fit  very  little  can  be  done,  on  account  of 
the  muscular  distortions.  Cold  water,  however,  should  be  freely 
applied  to  the  head,  cold  compresses  to  the  stomach,  and  warm  appli- 
cations to  the  feet.  In  the  intervals,  the  cure  must  be  prosecuted  by 
a  careful  attention  to  the  general  health ;  and  here  we  have  another 
condition  where  the  dietetic  part  of  hydropathy  is  more  important  than 
the  watery,  although  both  are  useful.  So  utterly  powerless  for  good, 
if  not  mischievous,  has  the  drug- treatment  proved  in  this  disease,  that 
one  of  the  most  experienced  of  the  old  school  authors,  Dr.  Armstrong, 
testifies  that  he  has  seen  more  benefit  derived  fi'om  removing  the  excit- 
ing cause,  than  from  any  thing  else.  "  As  to  diet,"  his  language  is, 
'■'■  simplicity  in  the  kind  of  food,  and  moderation  in  its  quantity,  is  the 
golden  rule."  In  making  the  practical  application  of  this  golden  rule, 
we  should  prescribe  the  dry  diet  as  crusts  of  good  brown  bread,  roasted 
potatoes,  and  good  baked  or  boiled  apples,  as  the  leading  articles. 
Caution  must  be  exercised  not  to  distend  the  stomach  unduly  with  a 
variety  at  a  meal,  of  even  the  blandest  articles  ;  very  little  drink  should 
be  taken  at  meals,  and  the  supper  should  be  extremely  light,  or  what 
is  better,  altogether  omitted.  Among  the  bathing  processes,  derivative 
appliances — shallow- baths,  sitz-baths,  and  foot-baths — should  take  the 
lead.  As  a  general  rule,  they  should  be  of  short  duration,  and  fre- 
quently repeated,  so  as  to  guard  against  determination  to  the  brain. 
If  the  skin  evinces  considerable  torpor  or  obstruction,  the  patient 
should  be  thoroughly  rubbed  in  the  dripping-sheet,  or  packed  occa- 
sionally. 

Hysterics — Hysteria. — This  disease  is  commonly  supposed  to  be 
peculiar  to  the  female ;  but  some  authors,  having  noticed  all  its  charac- 
teristic symptoms 'occasionally  in  the  male  subject,  have  described  two 
varieties — hysteria  feminini,  and  hysteria  masculini.  It  is  certainly 
:nore  frequent  in  the  female,  and  most  disposed  to  sho  w  itself  during 
the  menstrual  period. 

Symptoms. — The  precursive  signs,  which,  however,  do  not  always 
exist,  are — a  sense  of  nausea  or  sickness,  flatulency,  palpitation,  de- 
Dression  of  spirits,  weeping,  crying,  etc.,  without  any  assignable  caus«- 


208  PATHOLOGY    AND    THERAPEUTICS. 


The  fit  soon  follows,  indicated  by  a  coldness  or  shivering  over  the  whole 
body;  quick,  fluttering  pulse;  a  feeling  of  acute  pain  in  the  head,  as 
though  a  nail  were  driven  into  it:  there  is  often  an  acute  sense  of  pain 
in  the  left  side,  about  the  flexure  of  the  colon,  with  a  sense  of  disten- 
bion,  giving  the  idea  of  n  ball  or  globe  rolling  itself  about  in  the  abdo- 
men, and  gradually  advancing  upward  till  it  gets  into  the  stomach, 
whence,  rising  to  the  throat,  it  occasions  a  sense  of  suffocation,  as  if 
a!i  extraneous  body  were  pressing  thei'e ;  this  feeling  has  been  called 
globus  hystericus.  The  convulsive  struggle  now  commences,  which  is 
sometimes  extremely  violent;  the  trunk  of  the  body  is  twisted  back- 
ward and  forward,  the  limbs  are  variousl}^  agitated,  the  fists  are  firmly 
clenched,  the  breast  is  spasmodically  beaten,  the  muscles  of  the  chest 
ai-e  agitated  in  every  way,  and  the  patient  bursts  into  violent  paroxysms 
of  laughter,  sobbing,  or  screaming,  utters  incoherent  expressions,  and 
is  in  a  state  of  temporary  deUrium.  On  the  cessation  of  the  si^asms, 
there  are  flatulent  eructations,  and  a  copious  discharge  of  limpid  urine, 
the  patient  usually  lies  stupid,  and  apparently  almost  lifeless,  for  a  short 
time,  but  in  an  hour  or  so  recovers  the  exercise  of  sense  and  motion, 
without  retaining  any  distinct  recollection  of  what  has  taken  place,  but 
feeling  a  severe  pain  in  the  head,  and  a  general  soreness  over  the 
whole  body. 

Diagnosis. — Hysteria  may  be  distinguished  from  epilepsy  by  the 
insensibility  b;-ing  only  partial ;  by  the  sighing  and  sobbing  respiration  ; 
by  the  globus  hystericus;  by  a  peculiar  trembling  of  the  eyelid;  and 
by  the  absence  of  distortion  of  the  features.  In  a  milder  and  modified 
form,  the  paroxysm  consists  of  sudden  insensibility,  laborious  breathing, 
swollen  neck,  flushed  cheeks,  and  a  closed  and  trembling  eyelid,  and 
the  patient  comes  out  of  the  fit  talking  incoherently,  or  crying  and 
sobbing. 

Special  Causes. — Intense  mental  emotions,  especially  grief  and  anx- 
iety; constipated  bowels;  excessive  evacuations;  obstructed  menses; 
plethora;  hot,  enervating  drinks,  as  lea  and  coflfee. 

Treatment. — A  hysterical  paroxysm  is  almost  the  only  disease  in  the 
treatment  of  which  allopathic  and  hydropathic  prfctitioners  harmonize. 
It  is  true  the  books  recommend  smelling-salts,  asafoetida,  fetid  spirits 
of  ammonia,  ether,  castor,  musk,  valerian,  skunk-cabbage,  opium,  etc., 
yet  the  same  book-makei-s  are  kind  enough  to  tell  us  they  do  no  good ! 
Says  Dr.  Guy,  author  of  a  Medical  Jurisprudence:  ''Cold  affusion  is 
the  only  remed\-  which  can  be  relied  on,  and  is  worth  a  whole  phar- 
macopoeia of  antispasmodics."  Drs.  Hooper,  Good,  Cooper,  Neill, 
Smith,  and  Copland — all  accredited  authors  of  the  drug  school — rec- 
ommend   the  cold-water  practice.      A^.d   Dr-    Alfred   iSmee,   F.R  S.« 


SPASMODIC    DISEASES. 


20S 


Burgeon  to  the  Bank  of  England,  etc.,  gives  the  following  directions, 
illustrated  by  a  plate,  both  of  which  are  worth  copying : 


flHOfiLVtB 
TREATMENT    OF    KYSTEH'^ 


"  Place  the  head  over  a  basin,  and  pour  water  tVoni  a  jug  over  the 
head  and  chest  till  the  patient  becomes  chilly  and  revives.  Never  use 
any  thing  but  cold  water  for  the  hysterical  fir,  unless  the  party  turn 
very  cold,  when  you  should  discontinue  it,  and  apply  warmth  to  the 
feet.  I  once  saw  the  cold  applied  for  three  hours,  but  the  patient  was 
quite  well  the  next  day." 

To  correct  the  condition  on  which  the  hysterical  paroxysms  depend, 
we  must,  during  their  intervals,  employ  the  abdominal  bandage,  fre- 
quent hip-baths,  and  occasional  dripping-sheets  or  packs.  In  almost 
all  cases  the  bow^els  are  more  or  less  constipated,  and  the  diet  must  be 
regulated  accordingly. 

Tremqr — Trembling. — A  tremulous  agitation  of  the  head,  limbs, 
or  both,  especially  on  some  voluntary  exertion,  often  occurs  in  the  pro- 
gress of  acute  and  chronic  diseases.  But  in  some  instances  the 
affection  appears  disconnected,  as  fiu'  as  we  can  observe,  with  any  dis- 
tinct primary  disease,  although  it  is  manifestly  in  all  cases  symptomatic 
of  nervous  exhaustion.  It  is  produced  by  violent  exertion,  vehement 
indulgence  of  the  mental  or  sexual  passions,  by  various  poisons,  as  mer- 
cury, lead,  opium,  tea,  tobacco,  and  is  only  to  be  cured  by  religiously 
and  perseveringly  abstaining  from  all  the  debilitating  causes  which  con- 
duce to  it ;  in  brief,  all  the  voluntary  habits  must  be  thoroughly  ortho- 
therapeutic. 

Delirium  Tremens — Drf:?karl's  Delirium.— " This   disease/' 


m  PATHOLOGY  AND  THERAPEUTICS. 

Bays  Dr.  Doane,  "is  unfortunately  veiy  frequent  in  the  United  States;" 
to  which  may  be  added,  that  hardly  a  day  passes  without  some  suicide 
or  iiiu)der  being  chronicled  in  the  newspapers  as  committed  under  its 
intluence ;  nor  can  any  different  result  be  expected,  so  long  as  our  law- 
making representatives  authorize  and  commission  by  special  license, 
one  class  of  onr  fellow  citizens  tc  poison  all  the  other  classes  by  selling 
them  intoxicating  drinks. 

Symptoms. — Delirium,  during  which  the  jiatient  recognizes  those 
about  him,  answers  questions  rationally,  and  does  hurriedly  what  he  is 
told  to  do  ;  the  hands,  lips,  and  muscles  generallj^  tremble  more  or  less, 
especially  when  speaking,  or  making  any  voluntary  effort;  the  patient  is 
restless,  sleepless,  talks  incessantly,  and  evinces  a  great  anxiety  to  be 
doing  something;  he  fancies  that  he  is  surrounded  with  enemies,  or 
that  he  is  in  a  strange  place,  from  which  he  is  constantly  endeavoring 
to  escape;  or  he  thinks  some  great  evil  has  befallen  him,  or  is  impend- 
ing; he  is  suspicious  of  those  about  him,  and  is  tormented  with  fright- 
ful images  or  sounds  ;  and  often  appears  to  be  searching  earnestly  in 
unlikel}'  places  after  something  on  which  his  mind  is  intent.  There  is 
frequently  profase  perspiration,  a  frequent  pulse,  and  a  moist  and 
slightly  furred  tongue.  In  the  most  dangerous  attacks  the  patient  is 
himself  not  violent ;  but  in  more  moderate  cases,  when  the  muscular 
energies  are  less  prostrated,  he  is  sometimes  exti-emely  furious. 

Special  Causes. — The  habitual  employment  of  alcoholic  beverages 
in  most  cases ;  in  a  few  instances  the  disease  has  arisen  from  the  use 
of  opium,  tobacco,  andt^ea.  The  immediate  exciting  cause  is  generally 
sudden  abstinence  from  the  accustomed  stimulant,  particularly  if  such 
abstinence  has  been  preceded  by  an  unusual  debauch. 

Treatment. — When  the  patient  is  not  ungovernable  the  wet-sheet 
pack  is  the  most  soothing  process  we  can  employ;  in  otlier  cases  we 
must  rely  mainly  on  the  tepid  shallow-bath,  accompanied  with  active 
and  persevering  friction;  the  dripping-sheet  is  also  one  of  the  best  ap- 
pliances when  considerable  feverish  heat  exists-  When  the  stomach 
is  ft)ul,  evinced  by  bilious  taste  and  fetid  breath,  a  warm  water  emetic 
is  useful,  or  even  the  copious  drinking  of  warm  water  without  emesis; 
and  a  daily  tepid  injection  is  almost  always  seiTiceable.  Cold  cloths 
should  be  applied  to  the  head,  and  when  there  is  the  least  indication 
to  coldness  of  the  feet,  the  warm  foot-bath  should  be  prescribed.  Ei- 
ther of  the  general  baths  may  be  repeated  two  or  three  times  daily,  or 
nil  of  them  may  be  alternated.  When  the  patient  is  too  irritable  or 
restless  to  perm'.t  any  general  l)ath  to  be  em|)loyed  in  the  ordinary 
Way,  wet  towels  may  be  applied  to  the  chest,  abdomen,  jind  thighs,  and 
frequently  renewed;  and  copious  cold  water  injections  may  be  thrown 


SPASMODIC    DISEASES.  211 


up  the  bovvd  5.     In  all  cases  cold  water  may  be  di-ank  to   any  extent 
the  thirst  deinands. 

In  lelalion  to  drug-treatment  in  this  disease,  the  allopathic  school  is 
about  equally  divided  between  large  doses  of  opium  and  liberal  draughts 
of  brandy.  Dr.  Johnson,  in  his  "Domestic  Hydropathy,"  tells  us  that 
the  only  way  to  cure  the  disease  is  to  procure  sleep ;  and  that  there  is 
no  way  of  procuring  sleep  but  by  means  of  large  doses  of  opium ;  but 
the  doctor  climaxes  his  own  climax  of  absurdity  when  he  adds  that, 
although  the  opium  induces  a  sleep,  which  cures  the  delirium  tremens, 
the  patients  often  die  in  the  sleep  which  the  opium  induces  ! 

Shaking  Palsy. — Paralysis  Agitans. — Tiie  term  palsy,  is  not 
strictly  applicable  to  this  disease,  for  the  reason  that,  although  there  is 
a  diminution  of  muscular  strength  and  of  voluntary  power  in  the  part 
atfected,  there  is  no  absolute  loss  of  muscular  motion,  nor  of  sensation, 
one  of  which,  or  both  Conditions,  being  alwajT  present  in  genuine  pa- 
.'alysis. 

Symptoms. — "  Permanent  agitjition  of  the  head  or  lim.bs  without  vol- 
untary excitement ;  body  bent  forward,  with  a  propensity  to  run  and 
fall  headlong;  usually  appearing  after  maturity."  The  first  symptoms 
usually  noticed  are  a  slight  sense  of  weakness  with  a  proneness  to  trem- 
bling, ommonly  in  the  hands  and  arms,  but  sometimes  in  the  head. 
These  increase  gradually  and  almost  imperceptibly,  until,  in  a  few 
months,  the  legs  begin  to  be  similarly  affected,  and  the  body  bends  for- 
ward. As  the  disease  progresses,  the  tremor  becomes  constant  and 
universal;  the  muscles  refuse  to  act  in  obedience  to  the  v/ill ;  and, 
should  the  tremulous  agitation  be  stopped  in  one  limb  by  a  sudden 
change  of  posture,  it  soon  makes  its  appearance  in  another.  When 
he  attempts  to  walk  he  is  thrown  on  his  toes  and  forepart  of  his  feet, 
and  thus  compelled  to  adopt  a  running  pace.  In  the  advanced  stages 
the  tremulous  motions  also  occur  during  sleep  ;  the  bowels  become  tor- 
pid, mastication  and  deglutition  are  difficult,  and  the  saliva  continually 
dribbles  from  the  mouth.  Toward  ine  closing  scene,  the  power  of 
articulation  is  lost,  the  ordinary  evacuations  are  involuntary,  and  coma 
wi^h  siight  delirium  occurs. 

Special  Causes. — Long  exposure  to  damp,  unwholesome  vapors, 
nervine  excitants,  as  ardent  s})irits,  strong  tea  or  coffee,  narcotic  poi- 
sons, as  tobacco,  nightshade,  etc.;  metallic  vapors,  especially  mercurial; 
drastic  purgatives.  Those  who  are  emploj-ed  in  mines,  and  hence 
constantly  exposed  to  the  exhalations  of  mineral  vapors,  are  the  most 
frequent  and  severe  sufferers  from  this  disease. 

Treatment. — As  the  proximate  cause  is  simple  debility  of  the  whole 


n-l  PATHOLOGY  AND  THERAPEUTICS 

nervous  system,  the  simple  indication  of  c::re  is  to  sti-engthen  the  sys- 
tem ;  the  only  point  of  skill  is  in  adapting  the  processes  to  the  particu- 
lar condition  of  the  patient.  The  best  general  plan  is,  a  daily  ablution, 
or  thorough  rubbing  in  the  dripping  sheet,  early  in  the  morning,  one 
or  two  shallow  or  hip-baths  in  coui-se  of  the  day,  followed  by  active 
friction  with  the  dry  sheet  or  dry  hand ;  and  where  the  system  has 
been  evidently  poisoned  with  metallic  emanations,  moderate  sweating, 
either  in  the  wet  or  dry  sheet,  as  often  as  t%Aic€^  a  week.  Cold  water 
should  be  drank  rather  freely,  and  cold  injections  employed  daily,  just 
preceding  the  time  when  the  bowels  are  or  should  be  evacuated.  The 
wet  girdle  to  the  abdomen  is  worth  something.  The  food  should  be 
of  the  most  bland  and  unconcentrated  kind,  as  cracked  wheat  dry 
brown  bread,  hominy,  potatoes,  baked,  boiled,  or  uncooked  apples,  etc. 
Nothing  can  be  more  obvious  than  the  nature  of  this  affection ;  and 
nothing  can  be  more  ridiculous  than  the  reasoning  on  the  subject  in 
medical  books,  nor  more  absurd  than  the  practice  recommended.  Thus 
Bonet  ascribes  the  affection  to  a  diseased  state  of  some  portion  of  the 
cerebrum;  and  Mr.  Parkinson  fixes  the  seat  of  the  disease  in  the  cer- 
vical portion  of  the  spinal  marrow,  from  which  he  supposes  it  to  shoot 
up  hy  degrees  to  the  medulla  oblongata  I  "The  remedial  process," 
says  Dr.  Good,  "is  not  very  plainly  indicated;"  yet  he  recommends 
vesicatories  and  other  stimulants  to  the  neck  ;  setons,  cav.sties,  and 
even  the  red  hot  iron  applied  to  different  parts  of  the  spine  ;  and  for 
internal  remedies,  prussic  acid  n.nd  arsenic  !  !  Dr.  Elliotson  ti'eated 
several  cases  with  copious  bleeding,  blisters,  mercury,  setons,  zinc,  and 
sub-carbonate  of  iron  ;  but  save  in  a  single  instance,  no  benefit  whatever 
was  experienced.  Such  is  a  fair  specimen  of  the  "  medical  science" 
of  the  day. 

CiioRKA — St.  ViTus's  Daxce — Chorea  Saxcti  Viti. — This  dis- 
ease is  characterized  by  "alternately  tremulous  and  jerking  motion  of 
the  face,  legs,  and  arms,  especially  when  voluntarily  callrJ  into  action, 
resembling  the  grimaces  and  gestures  of  l)uffoons."  The  name  of  St. 
Vitus's  Dance — in  colloquial  French,  Dance  de  St.  Guy — according 
to  Horstius,  was  given  to  this  affection,  or  some  other  resembling  it,  in 
consequence  of  the  reputed  cures  produced  on  certain  women  of  dis- 
ordered mind,  upon  their  visiting  the  chapel  of  St.  Vitus,  near  Ulm, 
and  dancing  from  morning  till  night,  or  until  completely  exhausted. 
Many  marvelous  stories  are  related  of  these  dancers  by  the  old  writers, 
some  of  whom,  in  their  easy  credulity,  give  the  patients  credit  for  hav 
ing  danced  a  whole  week  or  whole  month  together. 

Sympioms. — The  disease  appears  most  frequenth  from  the  eighth  to 


^P^SMODIC    DISEASES.  213 

tlie  fourteenth  year;  and  attacks  boys  and  girls  indiscriminately,  but 
chiefly  those  of  weak  or  impaired  constitutions.  Its  approaches  are 
glow,  and  are  marked  by  variable  and  often  ravenous  appetite,  loss  of 
usual  vivacity,  swelling  and  hardness  of  the  lower  belly,  and,  in  gene- 
ral, constipated  bowels,  which  symptom  becomes  aggravated  as  the 
disease  advances;  slight,  irregular,  involuntary  motions  of  different" 
muscles,  particularly  those  of  the  face,  precede  the  more  violent  con- 
vulsive agitation.  The  convulsive  motions  present  a  great  variety  of 
appearances.  The  muscles  of  the  extremities,  of  the  face,  those  mov- 
ing the  lower  jaw,  thfe  head,  and  the  trunk  of  the  body,  are  each  at 
different  times,  and  in  different  degi'ees  affected  ;  the  patient  walks  un- 
steadily, his  gait  resembling  startiugs  or  jumpings  :  and  sometimes  walk- 
ing is  impossible.  The  agitation  of  the  muscles  is  constant  during  the 
day,  but  ceases  during  sleep.  The  eye  eventually  loses  its  lustre,  the 
complexion  becomes  pale,  and  the  countenance  is  expressive  of  languor 
nnd  vacancy,  giving  the  patient  afiituitous  appearance. 

Special  Causes. — Repelled  eruptions  ;  lead;  mercur}';  constipation; 
ncTrcotics  ;  worms.  Dr.  Good  remarks,  "The  predisponent  cause  of 
this  disease  is  an  irritability  of  the  nervous  system,  chiefly  dependent 
upon  debility,  and  particularly  a  debility  of  the  stomach  and  its  collati- 
tious  organs."  The  passage  is  certainly  very  fine,  but  if  it  has  any  par- 
ticular meaning  I  am  unable  to  discover  it.  Dr.  Armstrong  gives  us  a 
less  eloquent  but  more  practical  view  of  the  subject.  "Chorea,"  saya 
he,  "  is  always  preceded  by  some  disorder  of  the  stomach,  liver,  or 
bowels  ;  and  the  affection  which  takes  place  in  the  brain  and  spinal  cord- 
seems  to  be  secondajy.  You  may  always  trace  its  rise  to  some  im- 
proper diet." 

Treatment. — The  whole  plan  of  medication  named  in  the  preceding 
disease  is  applicable  here.  The  gi^eat  majority  of  cases,  however,  will 
be  found  in  connection  with  torpid  liver,  costive  bowels,  and  obstructed 
skin ;  for  which  a  thorough  daily  ablution,  an  injection  every  day,  or 
every  other  day,  and  a  diet  of  brown  bread,  wheaten  grits,  potatoes, 
and  a  moderate  quantity  of  the  best  fruit,  wiU  •  e  sufficient. 

Raphania. — This  disease  was  first  descrrued  by  Linnaeus,  and  se 
named  because  he  supposed  it  to  arise  from  eating  the  seeds  of  a  spe- 
cies of  wild  radish,  the  rapliania  raphanistrum.  Other  writers  have 
imputed  it  to  spurred  rye  or  ergot,  and  others  to  still  other  vegetable 
poisons.  The  symptoms  indicate  the  operation  of  a  narcotic ;  and 
probably  several  plants,  and  perhaps  also  duTerent  vegetables  in  a  state 
of  disease  or  decay,  or  in  a  pai'ticular  stage  of  putrefaction,  may  gen- 
erate the  poisonous  element. 


214  PATHOLOGY   AND    THERAPEUTICS. 

Symptoms. — The  disease  commences  with  cold  cliills  and  lassituao, 
headache,  and  anxiety  about  the  picECordia ;  these  are  followed  Ijy 
Bpasmodic  twitching,  and  afterward  rigid  conti'action  of  the  limbs  or 
joints,  with  excruciating  pains,  often  accompanied  with  fever,  coma,  or 
delirium,  a  sense  of  suffocation,  and  a  difficulty  of  articulation.  It  con- 
tinues from  one  to  four  weeks,  and  when  fatal,  terminates  with  a 
diarrhea,  or  convulsive  paroxysm. 

Treatment. — Moderate  cold  water-drinking,  the  free  employment 
of  cold  water  injections,  the  wet-sheet  pack  daily,  or  twice  a  day. 
when  there  is  considerable  feverishness,  and  at  other  times  frequent 
tepid  ablutions,  constitute  the  leading  measures  of  the  curative  plan. 

Note. — An  anomalous  disease  has,  during  the  last  ten  years,  prevailed 
in  different  parts  of  this  country,  more  frequently  in  our  Western 
states,  to  Vv'hich  the  physicians  have  been  unable  to  assign  a  name,  and 
which  strikingly  resembles  the  disease  before  us.  If  it  is  not  identical 
60  far  as  its  causes  are  concerned,  it  is  sufficiently  similar  in  character 
to  be  apprepriately  ti'eated  on  the  same  plan. 

Barbiers — Beribery. — This  affection  is  probably  unknown  in  this 
country.  It  is  common  to  various  parts  of  India,  and  of  very  frequent 
occurrence  in  Ceylon,  and  on  the  Malabar  coast. 

Symptofns. — General  lassitude,  painful  numbness  of  the  whole  body, 
stiffness  of  the  legs  and  thighs,  and  a  spasmodic  retraction  of  the 
knees,  and  inability  to  walk,  are  among  the  early  symptoms.  In  some 
cases  the  limbs  are  paralytic,  and  spasmodic  actions  affect  irregularly 
the  muscles  of  the  body,  chest,  and  larynx.  In  a  later  period  of  the 
disease,  the  legs  swell,  and  subsequently  the  whole  body  becomes 
bloated  and  cedematous,  the  internal  cavities  are  filled  with  fluid,  and, 
in  fatal  cases,  extreme  difficulty  of  breathing,  great  restlessness,  intol- 
erable anxiety,  constant  vomiting,  and  general  convulsions,  close  the 
scene. 

Special  Causes. — Sudden  ti-ansitions  from  a  dry  to  a  damp  atmos- 
phere, and  from  sultry  calms  to  chilling  breezes,  are  assigned,  by 
medical  writers,  as  the  principal  causes.  But  as  the  subjects  of  its 
attack  are  almost  invariably  persons  of  weakly  constitutions,  irregular 
lives,  debauched  habits,  or  liquor  and  tobacco  topers,  and  above  twenty 
years  of  age,  it  is  evident  that  the  causes  named  are  only  exciting  cir- 
cumstances, when  the  constitution  is  predisposed  by  debilitj',  or  the 
bad  habits  which  cause  the  debility. 

Treatment. — A  daily  al  lution  and  half-bath,  plain  food,  regiilated 
exercise,  according  to  the  strength,  and  cold  injections,  would  seem 
adapted  to  the  therapeutic  indication,  which  is  essentially  tonic 


SPASMODIC    DISEASES.  215 


Cough. — There  are  three  kinds  of  cough  which  are  ranked  as  id:o 
j)athic  diseases  by  authors — comynon  cough,  dry  cough,  and  hooping' 
cough.  Tbey  are  all  attended  with  a  sonorous  and  violent  expulsion  of 
air  from  the  lungs,  from  a  spasmodic  or  convulsive  action  of  the  res^)!- 
ratory  muscles ;  the  first  and  second  varieties  are  often  symptomatic 
of  a  multiplicity  of  other  diseases. 

Symptoms. —  Common  cough,  or  humid  cough,  is  accompanied  with 
an  expectoration  of  a  mucous  or  serous  fluid.  The  dry  cough  is  so 
called  because  it  is  unattended  with  expectoration.  In  the  hooping- 
cough — kin-cough,  pertussis — it  is  accompanied  with  a  shrill,  reiterated 
hoop;  vomiting  is  also  a  frequent  incident.  The  last  variety  is  conta- 
gious under  certain  circumstances,  which  are  not  very  well  ascertained. 
The  disease  comes  on  with  rne  usual  symptoms  of  catarrh;  the  excre- 
tion is  always  viscid,  though  small  in  quantity  at  first.  The  hoop,  or 
sonorous  spasm,  is  frequently  violent,  the  iiice  becoming  turgid  and 
purple  from  suffusion,  and  th«  eyeballs  swollen  and  prominent.  The 
paroxysms  at  first  recur  several  times  during  the  day,  are  most  violent 
toward  evening,  and  least  so  during  the  night.  After  the  disease  has 
continued  some  time,  they  return  only  in  the  morning  and  evening, 
and  toward  the  end  of  the  disease  in  the  evening  only.  The  violence 
of  the  disease  varies  from  the  slightest  indisposition  without  feverish- 
jess,  to  the  severest  spasmodic  agitruion,  attended  with  high  and  dan- 
gerous fever.  Its  duration  varies  from  one  week  to  one  year,  the  usual 
period  ranging  from  three  weeks  to  three  months.  The  pathognomonic 
sign  cf  the  hooping-cough  is  the  noisy  inspiration  accompanied  by  a 
lengthened  hibsing.  It  is  generally  a  disease  of  children,  and  the 
danger  is  in  the  invei-se  initio  to  the  age. 

Special  Causes. — The  first  and  second  varieties  are  produced  by 
"colds,"  or  the  inhalation  of  irritating  dust,  vapors,  or  other  extraneous 
particles.     The  third  is  the  result  of  specific  contagion. 

SequelcE. — Bronchial  inflammation,  consumption,  and  dropsy  in  the 
head,  are  commonly  specified  in  medical  books  as  among  the  sequelae 
of  all  forms  of  cough,  but  more  especially  of  the  hooping  kind.  They 
are  more  commonly  the  sequelae  of  the  poisonous  cough  mixtures  with 
which  children  are  generally  so  liberally  fed. 

Trealment. — All  forms  of  idiopathic  cough  may  be  very  easily  man- 
aged. Cold  water  should  be  treely  drank  ;  the  diet  must  be  plain  and 
rather  abstemious ;  and  one  or  two  ablutions  daily,  followed  by  thorough 
friction  or  active  exercise,  are,  in  Jhe  majority  of  cases,  amply  reme- 
dial. When  the  system  is  incline;!  to  feverishness,  the  pack,  prolonged 
eufficiently  to  produce  moderate  SAveating,  may  bo  necessary ;  and 
when  there  is  an  inflammatory  state  or  fixed  soreness  of  any  part  off 


218  PATHOLOGY    AND    THERAPEUTICS. 

the  chest  or  lungs,  the  chest-wrapper  should  be  applied.     When  the 
paroxysms  of  hooping-cough  are  veiy  severe  and  sufifocative,  a  warm 
water  emetic  is  advisable;  and  in  bad  cases  a  tepid  half-bath  and  foot- 
bath should  be  added  to  the  daii^^  processes. 

The  allopathic  treatment  of  cough  affords  a  melancholy  reflection  for 
the  intelligent  philanthropist.  How  many  little  children  are  poisoned  out 
of  their  constitutions  by  the  multitudinous  cough-medicines  of  the  day! 
It  is  true  the  regular  doctors  declaim  against  the  irregular  nostrums, 
by  which  children  are  poisoned  through  the  media  of  lozenges,  medi- 
cated candies,  and  narcotic  syrups ;  but  unfortunately  their  own  pre- 
scriptions are  not  a  whit  less  poisonous.  The  most  deadly  drugs  of  the 
materia  medica  are  the  active  principles  of  nearly  all  the  popular  cough 
remedies,  and  chief  among  theiu  all  are  tartar  emetic  and  opium:  while 
henbane,  deadly  nightshade,  poison  hemlock,  and  prussic  acid,  are  in 
the  next  highest  class  of  remedies! 

Dyspnea. — The  generic  symptoms  of  this  disease — the  anhelation 
of  Dr.  Good — are :  permanent  difficulty  of  breathing,  with  a  sense  of 
weight  in  the  chest.  Like  cough,  dyspnoea  is  symptomatic  of  an  ex- 
tensive range  of  diseases. 

Symptoms. — Idiopathic  difficulty  of  breathing  is  distinguished  into 
•;wo  varieties,  c/iro^zc,  and  eracei-batins; — the  orthoptKea  of  authors.  In 
the  former  the  breathing  is  uniformly  short  and  heavy,  and  usually 
accompanied  with  a  cough;  in  the  latter  it  is  deep,  stertorous,  and  suf- 
focative, subject  to  sudden  and  irregular  exacerbations,  and  relieved  by 
an  erect  position. 

Diagnosis. — Dyspnoea  is  distinguished  from  usthma  by  the  breathing 
being  permanently  yet  irregularly  affected ;  >shereas  in  asthma  the 
difficulty  is  recurrent  with  considei*able  intervals  of  perfect  ease. 

Special  Causes. — Irritating  dust,  or  pulverulent  particles  to  which 
etone-hewers  i^lass-cutters,  china-manufacturers,  workers  upon  metals, 
millers,  starch-makers,  horn  and  pearl-workers,  weavers,  wool-carders, 
and  feather-dressers,  etc..  are  subject;  the  vapor  of  mineral  acids, 
metallic  exhalations,  narcotic  vapors,  various  structural  derangements, 
ns  corpulency  or  obesity,  hydatids,  tumors,  indurations,  adhesions,  etc. 
In  some  instances,  a  condition  of  emphysema,  or  preternatural  dilatation 
of  the  air-cells  of  the  lungs,  resulting  from  catarrh,  has  produced  both 
dyspnoea  and  asthma. 

Treatment. — When  the  cause  is  organic,  little  more  can  he  done 
than  to  mitigate  the  sufferings  of  the  patient  by  a  careful  attention  to 
the  general  health.  When  the  disease  depends  on  functional  derange- 
ment, the  general  management  is  the  same  as  for  common  cough.     A 


SPASMODIC    DISEASES  217 


moderate  douche  to  the  spinal  column  would  be  of  additional  service  in 
-nost  cases  by  promoting  absorption ;  and  where  patients  have  been 
3xposed  to  poisonous  vapors  or  effluvia,  moderate  sweating  is  desirable 
Sauvages  relates  the  case  of  a  female  who  was  bled  three  times  a  day, 
antil  the  venesections  amounted  to  two  thousand,  without  benefit !  By 
warm  bathing  and  active  friction,  so  a«3  to  produce  free  perspiration 
?he  was  cured  in  ten  days. 

Asthma. — This  affection  is,  too,  much  more  frequently  a  symptom- 
atic than  an  idiopathic  affection.  Its  pathognomonic  characteristics  are : 
recuiTent  and  temporary  difficulty  of  breathing,  accompanied  with  a 
wheezing  sound,  and  sense  of  constriction  in  the  throat,  with  cough 
and  expectoration.  Authors  distinguish  two  varieties,  dry,  convulsive, 
or  nervous — asthma  siccum ;  and  humid,  or  common — asthma  humidum. 

Symptoms. — In  the  first  variety  the  attacks  are  sudden,  violent,  and 
of  short  duration;  the  sense  of  constriction  is  hard,  dry,  and  spasmodic; 
cough  slight,  expectoration  scanty,  and  only  appearing  toward  the  end 
of  the  paroxysm.  In  the  second  variety  the  paroxysm  is  gradual  and 
protracted ;  the  consti-iction  heavy,  laborious,  and  humid ;  cough  vio- 
lent; the  expectoration  commences  early,  is  at  first  scanty  and  viscid, 
but  afterward  copious,  and  affording  great  relief.  In  many  cases  the 
attack  is  in  the  night,  and  most  frequently  an  hour  or  two  after  mid- 
night. 

Special  Causes. — Neaiiy  all  the  causes  named  in  the  preceding  dis- 
ease may  produce  this.  It  is  frequently  caused  by  turgescence,  or 
swelling  of  the  liver  or  spleen,  which  impedes  the  motions  of  the  dia- 
phragm, or  interrupts  the  supply  of  nervous  influence.  Strong  mental 
emotions,  repelled  eruptions,  suppressed  discharges,  rank  odors,  foggy, 
misty,  or  damp  weather,  indigestible  food,  and  other  dietetic  errors,  are 
fi-equent  exciting  causes.  The  predisposition  is  sometimes  occasioned 
by  malformation  of  the  chest,  small  size  of  the  glottis,  dyspepsia,  all 
of  which  may  be  conditions  of  hereditary  transmission.  Dr.  S.  Cooper 
names  among  the  occasional  causes,  "the  influence  of  light  and  dark- 
ness"— an  idea  altogether  too  diffuse. 

Treatment. — Medical  authors  admit  that  asthma  is  seldom  cui'ed 
drugopathically,  yet  console  themselves  with  the  reflection  that  patients 
seldom  die  of  the  disease,  as  such,  or  until  it  takes  some  other  form ; 
hence  an  opportunity  is  afforded  to  try  any  kind  of  medication  that 
fact  or  fancy  can  suggest.  It  is  ti'ue  that  expectorants  and  nauseants, 
as  squills  and  antimony,  and  relaxants  and  debilitants,  as  tobacco,  coffee, 
gin,  saltpetre,  and  bleeding,  generally  relieve  the  paroxysm  for  the 
time,  at  the  expense,  if  frequently  repeated,  of  the  total  ruin  of  the 
ri-19 


218  PATHOLOGY   AND   THERAPEUTICS. 


digestive  powers  and  nervous  system ;  and  that  emetics,  especially  of 
lobelia,  have  entirely  suspended  the  symptoms  of  the  disease  in  the 
humid  variety,  for  a  longer  or  shorter  period,  without  any  great  injury 
to  the  constitution ;  and  this,  I  believe,  is  all  that  can  be  said  in  favor 
of  the  popular  practice. 

The  rubbing  wet-sheet,  pack,  and  douche,  with  the  chest-wrapper, 
are  the  leading  ])rocesses.  Any  of  the  other  bathing  appliances  may 
be  useful  or  necessary  in  particular  cases,  but  these  are  applicable  and 
important  in  the  great  majority.  When  the  digestive  organs  are 
strongly  implicated,  the  tepid  shallow-bath  is  excellent,  and  then  the 
abdominal  bandage  may  be  substituted  for  the  chest-WTapper.  Asth 
raatic  patients  can  usually  take  three  or  four  baths  daily  with  advantage. 
The  following  combination  I  have  employed  successfully  in  several 
cases :  Dripping-sheet  five  minutes,  followed  by  the  douche  three  min- 
utes, on  rising;  at  ten  to  eleven  a.m.,  wet-sheet  pack  forty-five  to  sixty 
minutes,  followed  by  shallow-bath  at  72°,  ten  minutes;  at  four  p.m., 
sitz-bath  at  65°,  fifteen  to  twenty  minutes,  or  shallow  foot-bath  at  65'^, 
five  to  ten  minutes.  Where  there  is  a  good  degree  of  animal  heat,  a 
dripping-sheet  at  bed-time  is  very  serviceable.  The  bowels  must  be 
kept  free,  by  tepid  or  cool  injections,  if  necessary,  and  the  patient 
may  generally  drink  six  or  eight  tumblere  of  water  in  the  forepart  of 
the  day.  Equally  important,  and  perhaps  more  so,  is  the  diet.  Here 
we  have  another  opportunity  to  magnify  "the  hunger-cure."  In  all 
cases  the  diet  should  be  simple  and  unconcentrated,  and  in  those  cases 
connected  with  or  caused  by  diseased  livers  or  spleens,  or  primary 
dysjjepsia,  it  must  be  rigidly  abstemious;  and  even  this  should  be  com- 
posed principally  of  the  articles  named  in  a  former  part  of  this  work 
under  the  head  of  dry  diet,  or  something  similar. 

During  the  pai'oxysm  we  should  palliate  and  abbreviate  the  sufferings 
of  the  patient  as  much  as  possible,  by  exposing  him  freely  to  the  cold 
air — which  is,  indeed,  what  his  feelings  most  intensely  desire,  and 
which  is  always  safe  while  the  fit  is  violent — giving  him  warm  water  to 
drink,  even  to  the  extent  of  vomition,  and  applying  the  warm  half  or 
hip-bath ;  or  when  the  breathmg  is  so  laborious  that  he  is  obliged  to 
sit  erect,  the  hot  fomentation  to  the  chest  and  abdomen. 

Laryngismus  —  Laryngismus  Stridulus.  —  This  complaint  is 
known  by  the  various  synonyms  of  spasmodic  croup,  spasmodic  asthma 
of  children,  child-crowing^  crowing  inspiration,  angina  stridula. 

Symptoms. — The  disease  consists  essentially  of  a  sense  of  spasmodic 
suffocation  in  the  larynx,  which  usually  comes  on  suddenly  in  the  night, 
attended  with  a  struggle  for  breatli,  ani  a  shrill,  croaking  sound  of  the 


SPASMODIC    DISEASES  219 


voice,  or  crowing  inspiration,  somewhat  analogous  to  .'rjup ;  the  coun- 
tenance is  flushed  and  swollen,  and  in  the  severest  cases  convulsions 
occur.  Dr.  Good  names  "  troublesome  cough,"  as  among  the  pathog- 
nomonic symptoms,  while  Hooper  says  it  is  "unattended  by  cough." 
The  symptom  in  controversy  is  merely  incidental.  This  disease  some- 
times, though  rarely,  attacks  adults. 

Diagnosis. — It  is  distinguished  from  croup  by  the  attack  being  more 
sudden,  and  the  symptoms  relaxing  or  intermitting ;  the  freedom  of 
the  breathing  during  the  intervals  ;  the  absence  of  febrile  or  catarrhal 
symptoms  ;  and  usually  the  presence  of  hot  swollen  gums. 

Special  Causes. — Repelled  eruptions,  especially  of  the  head,  face,  or 
neck;  intestinal  irritation  from  worms ;  indigestible  aliment ;  enlarge- 
ment of  the  glands  of  the  neck  and  chest ;  cold,  and  teething  are  some- 
times exciting  causes.  An  (Edematous  swelling  of  the  mucous  folds  in 
the  ventricles  of  the  larynx,  has  been  supposed  by  some  authors  to  be 
the  proximate  condition  on  which  this  affection  depends. 

Treatment. — The  ordinary  drug-treatment  is,  an  antimonial  emetic, 
a  calomel  cathartic,  an  opium  anti-spasmodic,  and  a  Spanish-fly  vesica- 
tory— a  plan  of  medication  far  more  dangerous  than  the  disease  itself. 
Several  folds  of  v/et-cloths  well  covered  with  dry  to  the  throat,  a  tepid 
bath  followed  by  the  dry  pack,  or  by  putting  the  patient,  in  bed,  well 
covered  so  as  to  promote  perspiration,  free  warm  water-drinking,  and  a 
tepid  injection  if  the  bowels  are  not  entirely  free,  is  the  [ilan  of  a  safe 
and  successful  treatment. 

Incubus. — Authors  distinguisfi  two  varieties  of  incubus,  one  of  which 
is  called  nightmare,  and  the  other  day  ma"  e.  The  ancient  Anglo-Saxon 
name  for  this  affection  was  elf-squatiing — eij  sidenne — so  denominated 
because  of  the  imaginary  resemblance  of  the  sudden  sense  of  an  op- 
pressive and  suffocative  weight  on  the  chest,  to  the  feeling  produced  by 
some  hideous  monster  lying  on  the  chest. 

Symptoins. — Both  varieties  are  attended  with  sighing,  suffocative 
difficulty  of  breathing,  intercepted  utterance,  or  entire  temporary  ina- 
bility to  speak  or  move,  with  a  sensation  of  some  external  weight  press- 
ing heavily  o*-  the  chest,  from  which  the  patient  awakens  aftVighted.  In 
the  daymare,  which  occurs  during  wakefulness,  the  sense  of  pressure 
is  severe,  and  is  extended  over  the  abdomen  ;  the  respiration  is  fre- 
quent, laborious,  and  constricted ;  the  eyes  are  fixed  ;  the  sighing  is 
deep  and  violent;  and  the  intellect  is  undisturbed.  The  nightmare  i» 
the  more  common  form  ;  it  occurs  during  sleep,  which  is  interrupted 
with  a  violent  struggle  and  tremor ;  the  pressure  on  the  chest  seemi 
to  be  that  of  some  hideous  monster  or  phantom  ;  it  is  usually  preceded 


220  PATHOLOGY    AND    THERAPEUTICS. 


by  a  painful  or  troubled  dream,  during  which  the  patient  imagines  some 
position  of  danger,  as  a  high  building,  steeple,  or  precipice,  from  which 
he  is  about  to  fall ;  or  fancies  some  horrid  accident  or  calamity,  as  mur- 
der or  suicide,  or  conceives  an  attack  from  some  enemy,  hag,  spectre, 
ghost,  or  goblin,  whose  grasp  he  is  incapable  of  eluding. 

Special  Causes. — It  is  generally  occasioned  by  excessive  fatigue,  ex- 
haustion from  want  of  sleep,  an  overloaded  stomach,  or  some  indigesti- 
ble irritant  in  the  alimentary  canal.  Dyspeptics,  and  nervous  females 
are  very  liable  to  it.  All  persons  who  eat  heavy  or  late  suppers  are  in 
a  state  of  predisposition. 

Treatment. — Shaking,  agitating,  or  awakening  the  patient  will  imjne- 
diately  arrest  the  paroxysm,  which,  by  the  way,  seldom  lasts  a  fiill 
minute.  The  preventive  management  is  found  in  alight  evening  meal, 
a  hard  bed,  and  sleeping  on  rather  high  pillows,  with  the  body  a  little 
inclined  on  the  side.  The  curative  plan  may  be  found  in  a  daily  bath, 
plain  qualit}^  and  moderate  quantity  of  food,  and  a  free  daily  action  of 
the  bowels,  which  should  be  promoted  by  injections  if  necessary. 

Bronchitis. — Although  this  disease  is  attended  with  more  or  less 
Butfocation  and  spasmodic  respiration,  it  is  really  caused  by,  or  rather 
is  in  fact,  an  inflammatory  affection  of  the  mucous  membrane  of  the 
bronchial  ramifications.  It  is  frequently  the  precursive  condition  of 
consumption  ;  and  not  unfrequently  the  treatment  pursued  by  the  med- 
ical man,  rapidly  hastens  on  the  fatal  termination,  by  developing  tuber- 
cles in  the  lungs  It  is  comparatively  a  modern  disease,  and  is  alarm- 
ingly on  the  increase,  owing  to  the  luxurious  and  enervating  habits  of 
fashionable  society. 

Authors  distinguish  the  disease  into  the  acute  and  the  chronic  forms  ; 
but  as  the  former  is  not  essentially  different  from  a  severe  catarrh,  or 
mild  pneumonia,  either  in  its  symptoms,  progi'ess,  or  termination,  it  is 
only  what  is  usually  known  as  chronic  bronchitis  that  concerns  us  here. 
Irritative  and  inflammatory  affections  of  the  mucous  membrane  of  the 
throat,  fauces,  larynx,  pharynx,  and  adjacent  parts,  are  often  confounded 
with  bronchitis  proper  :  and  are  described  as  and  confounded  with  this 
disease  under  the  various  terms  of  pulmonic  erysipelas,  pituitous  ca- 
tarrh., bronchial  angina,  suffocative  catarrh,  catarrhal  bronchitis,  bron- 
chial peripneumony,  pulmoriary  catarrh,  catarrhal  fever,  acute  mucous 
catarrh,  acute  suffocative  catarrh,  etc. 

Symptoms. — The  disease  commences  with  more  or  less  cough,  irri- 
tation about  the  throat,  sense  of  tightness  in  the  c^iest,  and  shortness 
of  breath,  which  do  not,  fur  a  considemble  time,  attract  much  atten- 
tion.    The  first  difllcul^y  which  is  generally  noticed  as  of  importance. 


SPASMODIC    DISEASES. 


18  a  sense  of  roughness,  with  frequent  attempts  to  clear  the  throat,  ac- 
companied with  or  followed  by  titillation  of  the  larynx,  exciting  a  dry, 
hard  cough  ;  these  are,  after  a  longer  or  shorter  period,  succeeded  by 
gome  degree  of  hoarseness  of  voice,  w^th  a  sense  of  tightness  across 
the  chest,  and  sometimes  a  slight  pain  or  diffused  soreness  upon  cough- 
ing, or  inflating  the  lungs  fully  by  a  prolonged  and  deep  inspiration.  As 
the  disease  progresses  dyspnoea  comes  on,  which  is  increased  by  exer- 
tion, coughing,  or  exposure  to  cold,  and  some  degree  of  expectoration 
occurs,  at  first  scanty,  then  more  copious  and  of  a  glairy  appearance, 
like  the  white  of  an  egg ;  and  in  still  more  advanced  stages  it  becomes 
muco-purulent  or  purulent  and  sometimes  tinged  with  blood.  In  some 
cases  all  of  the  symptoms  are  abated  every  summer  and  exacerbated 
every  winter  for  several  years  in  succession.  The  constitutional  dis- 
turbance is  marked  by  lassitude,  pains  in  the  limbs  and  back,  slight  shiv- 
erings  or  chills,  frequent  and  feeble  pulse,  feverishness  after  dinner  or 
toward  evening,  and  eventually  night  sweats.  In  some  cases  the  prin- 
cipal local  symptoms  are,  hoarseness  or  loss  of  voice,  a  hard,  dry  cough, 
with  a  sense  of  soreness,  rawness,  dryness,  and  heat  under  the  ster- 
num ;  in  most  cases  the  cough  is  always  excited  by  a  full  inspiration ; 
m  a  few  instances  the  breathing  is  sittiing  or  wheezing,  owing  to  the 
air  struggling  through  the  viscid  mucus  accumulations  in  the  bronchi ; 
and  sometimes,  though  rarely,  the  voice  is  scarcely  altered,  while  the 
breathing,  on  the  slightest  disturbing  causes,  becomes  painfully  spas- 
modic, in  consequence  of  the  tenacious,  glaring  secretion  becoming  con- 
creted upon  the  lining  membrane  of  the  bronchial  tubes. 

Special  Causes. — All  the  causes  of  consumption,  may,  under  a  mod- 
ified set  of  circumstances,  produce  this  form  of  pulmonary  disease. 
But  there  is  no  doubt  that  the  increasing  quantity  of  tea,  coffee,  and 
tobacco  consumed  by  our  people  is  a  special  uii*se  of  the  increasing 
prevalence  of  this  disease  among  us. 

Treatment. — Nearly  all  that  has  been  said  in  relation  to  the  man- 
agement for  consumptives  wnll  apply  here  ;  and  to  that  the  reader  is 
referred.  A  majority  of  the  patients  come  to  us  bundled  up  in  flan- 
nels, extra  silk,  double  stockings,  India  rubbers,  and  other  contrivances 
for  keeping  off  the  cold,  to  which  these  very  contrivances — usually  per 
advice  of  the  doctor — have  rendered  them  extremely  susceptible.  All 
these  worse  than  superfluities  of  dress  must  be  removed  by  degrees,  as 
the  pa  ient's  skin  becomes  accustomed  to  the  contact  of  cold  air  and 
vrater.  The  best  processes  to  commence  with  are  generally  the  sponge 
or  towel-bath,  or  rubbing-sheet,  accompanied  with  active  though  not 
severe  friction.  After  a  few  days  the  chest-wrapper  should  be  applied, 
and  all  the  derivative  appliances — half,  hip  and  fcot-baths — employed. 


£22  PATHOLOGY   AND   THERAPEUTICS. 

as  frequently  atiJ  as  cold  as  the  patient  can  bear  without  disagreea- 
ble or  prolonged  chilliness.  Precaution  is  necessary  also,  to  avoid 
greatly  disturbing  the  circulation  cr  respiration,  by  too  great  a  shock 
or  too  cold  an  in  pression.  When  the  general  heat  of  the  surface  is 
equal  to,  or  above  the  natui-al  standard,  the  pack  should  be  resorted  to 
daily,  or  tri-weekly.  Those  patients  who  are  particularly  troubled 
with  short  brenth,  and  are  easily  fatigued  by  exercise,  should  walk 
regular!}'  and  perseveringly  in  the  open  air,  within  the  bounds  of  much 
fatigue  at  first,  and  gradually  increase  the  distance. 

At  best  bronchitis  is  a  dangerous  and  most  obstinate  disease,  and  pa- 
tients ought  to  understand  before  commencing  a  course  of  water-treat- 
ment, that  time  and  patience  are  important  considerations.  I  have 
known  a  few  cases  recover  in  ten  or  twelve  weeks,  but  a  majority  re- 
quire cai'eful  ti'eatment  from  six  to  twelve  months,  vrhile  many  cases 
cannot  be  thoroughly  cured  in  less  time  than  from  one  to  two  years. 
This  may  seem  like  a  long  and  discouraging  process;  but  if  the  sufferer 
can  draw  any  consolation  from  the  fact  that  no  other  method  ever  cures 
at  all,  he  will  find  abundant  evidence  of  the  fact  if  he  will  look  over  the 
long  catalogue  of  remedies  which  are  put  forward  in  medical  books ;  a 
list  whose  formidable  length  is  alone  conclusive  that  no  real  confidence 
is  felt  in  anyone  of  its  ingi*edients,  nor  in  all  together. 

Perhaps  a  page  or  two  of  this  work  could  not  be  more  instructively 
occupied  than  in  presenting  a  fair  sample  of  the  interminably  experi- 
mental nature  of  drug-ti'eatmeut — as  few  unprofessional  pei'sons  have 
ever  dreamed  of  the  confusion  which  pervades  medical  books  on  the 
subject  of  prescribing  remedies.  As  an  illustration,  therefore,  I  will 
copy  in  full,  from  one  standard  work — Copland's  Medical  Dictionary — 
all  and  singular  the  remedies  and  curative  processes,  commended  for 
the  ti'eatment  of  the  different  states,  forms,  stages,  and  complications  of 
the  disease  under  consideration.  These  may  be  conveniently  collated 
under  the  heads  of  classes,  processes,  fumes  and  fumigations,  inhala- 
tions, drugs  and  preparations,  and  regimenal  directions. 

1.  Classes  of  Medicines. — Acids,  alkalies,  emetics,  purgatives,  expoctoruDts.  laxatives, 
tonics,  nfrigeri.nte,  stimulants,  antiphlogistics,  dpmulcents,  cathartics,  emollients,  rube- 
facients, mucilages,  vesicatories,  revulaants,  counter-irritants,  diaphoretics,  diuretics,  se- 
datives, bitters,  alteratives,  attenuants,  antispasmodics,  narcotics,  diluents,  enemata,  ano- 
dynes, and  narcotics. 

•2.  Processes  of  Medication. — Gener&l  bleeding  by  the  lancet ;  local  bleeding  by  leeches  ; 
topical  depletion  by  cupping;  Inncing  the  gums  (in  children)  ;  blisters  applied  to  various 
parts;  burning  the  skin  by  hot  turpentine;  cauterizing  the#kin  by  moxa  burnings;  pus- 
tulating the  Bkin  by  ointment  ot'tartarized  antimony  ;  leeches  applied  over  the  sternum, 
leeches  applied  behind  the  ears  ;  leeches  applied  below  the  occiput ;  cupping  on  the  nape 
of  the  nock ;  issues  ;  sctons  the  warm-bath  ;  sponging  thebDdy  with  warm  water  and  vin- 
egar ;   sponging  with  a  wa"*! lotion  of  nitro  n  uriatic  acid  ;  astringent  gargles  ;   cooling 


I 


SPAS. IODIC    DISEASES.  1523 

gargles ;  antiseptic  gargles  ;  demulcent  linctuses  ;  lotions  of  common  salt  and  water ;  semi- 
cupium  ,  pedili.Tnviura  ;  poultices  ;  liniments  ;  and  fomentations. 

3.  Fumes  and  Fumigations. — Of  tar,  camphor,  benzoin,  amber,  frankincense,  myrrh, 
etoras,  cloves,  sulphur,  assafoetida,  and  various  tarpentines  and  balsams  ;  also  the  smok- 
ing of  balsam  of  tola. 

4.  Inhalations. — Of  chlorine  gas  ;  fumes  of  iodine  ;  watery  vapor  holding  in  solution 
various  narcotics  ;  sulphuret  of  iodine  ;  liquor  potassii  iodidi  concentratus  ;■  tinctures 
and  extracts  of  henbane  and  poison  hemlock,  with  camphor;  fumes  of  the  various  bal- 
sams, terebinthinates,  and  odoriferous  resins  ;  also  of  vinegar. 

5.  Drugs  and  Drug  preparations. — Antimony  in  full  do.ses  ;  antimonial  wine  ;  com- 
pound powder  of  antimony  ;  tartrate  of  antimony  and  potassa  ;  solution  of  potassio  tar- 
trate of  antimony  ;  James'  powder  ;  blue  pill ;  calomel ;  corrosive  sublimate  ;  mercury 
with  chalk  and  rhubarb,  followed  by  castor  oil  and  small  doses  of  ipecacuanha ;  Dover's 
powder  ;  wine  of  ipecacuanha  ;  opium  ;  camphorated  tincture  of  opium  ;  syrup  of  pop- 
pies ;  camphor  ;  camphor  mixture  ;  ammonia  ;  carbonate  of  ammonia  ;  liquor  of  the  ace- 
tate of  ammonia  ;  conserve  of  roses  ;  capsicum  ;  oliv.e  oil ;  white  willow  bark  ;  Iceland 
moss ;  Prussic  acid  ;  aloes  ;  senna  ;  creasote  ;  preparations  of  steel ;  carbonate  of  soda ; 
t^i-carbonate  of  soda  ;  bi-tartrate  of  potash  ;  compound  tragacanth  powder  ;  sulphur ;  bal- 
sam of  sulphur  ;  sulphuret  of  potassium  ;  sulphuric  acid  ;  sulphuret  of  ammonia  ;  sul- 
phuret of  copper  ;  sulphate  of  zinc  ;  sulphate  of  quinine  ;  sulphate  of  alumina ;  flowers  of 
sulphur  ;  sulphate  of  iron  ;  various  preparations  of  iodine  ;  extract  of  dandelion  ;  extract 
of  hops  ;  extract  of  conium  ;  extract  of  hyoscyamus  ;  extract  of  sarsaparilla  ;  extract 
of  gentian  ;  extract  of  poppy  ;  extract  of  lettuce  ;  belladona  ;  trisniti'ate  of  bismuth  ;  salt- 
petre ;  squills  ;  decoction  of  squills  ;  tincture  of  squills  ;  infusion  of  squills  ;  oxymel  of 
squills  ;  tincture  of  hyoscyamus  ;  colchicum  ;  infusion  of  colchiciim  seeds  ;  digitalis  ; 
chlorate  of  potash  ;  tarh'ate  of  potash  ;  chlorate  of  lime  ;  columbo  ;  decoction  of  Peruvian 
bark  ;  infusion  of  marrabium ;  chloride  of  calcium  ;  liquorice ;  mezeron  bark  ;  cinchona  ; 
uva  ursi;  gum  arable  ;  oil  of  turpentine  ;  myrrh  ;  vinegar;  marsh  mallows  ;  decoction  of 
polygala  ;  linseed  tea  ;  ammoniacum  ;  galbanum  ;  senega  ;  nitrous  spirit  of  ether  ;  kermes 
mineral ;  mixture  of  sweet  almonds  ;  and  syrup  of  tolu. 

Regimenal  Directions. — Barley  water;  tamarind  water;  lemonade;  vegetable  acids ; 
sulphureous  mineral  waters  ;  Brandish's  alkaline  solution  ;  ale  ;  beer  ;  imperial ;  red 
wines  of  Bordeaux  and  Burgundy  ;  decoction  of  Iceland  moss  ;  jellies  ;  mucilaginous  and 
emolient  soups  ;  new-laid  raw  eggs  ;  shell-fish  ;  and  white  fish,  dressed  with  olive  oil,  or 
the  oil  obtained  by  boiling  their  own  livers. 

There,  reader,  you  have  the  whole  apothecary  shop  and  most  of  its 
appurtenances  before  you.  I  submit  whether  these  evidences  of  cure 
do  not  prove  too  much? 

Before  dismissing  this  subject,  I  must  advert  to  the  cauterizing  prac- 
tice which  has  lately  become  so  popular  in  bronchial  and  throat  affec- 
tions. Some  physicians  are  doing  an  extensive  business  in  the  appli- 
cation of  nitrate  of  silver  to  all  sorts  of  affections  of  the  mouth  and 
throat;  and  some  kind  of  machinery  has  recently  been  invented  by 
which  the  dust  of  lunar  caustic  can  be  inhaled  into  the  lungs.  It  is 
true  that  caustics  will  often  cure  ulcers  in  the  mouth,  or  about  the 
fauces  or  tonsils ;  but  they  are  very  liable  to  reappear,  and,  moreover, 
they  can  be  better  cured  without  the  caustic  than  with  it.  But  where 
the  lungs  are  seriously  affected,  or  the  bronchial  ramifications  in  a  state 
of  actual  inflammation,  the  application  of  the  caustic  very  frequently 
aggravates  the  affection  of  the  pulmonary  tissues,  as  I  havf3  known  in 


'2-2'i  PATHOLOGY  AND  THERAPEUTICS.  ] 

very  many  cases.     This  practice  may  be  safe  in  purely  local  affectionu 
of  the  throat,  but  it  is  certainly  hazardous  where  the  lungs  are  also      : 
implicated. 

Sternalgia — SuFFocAxnE  Breast-Pang. — This  affection  is  de- 
scribed by  various  writers  under  the  varied  names  of  angina  pectoris^  ' 
syncope  anginosa,  orthopncea  cardiaca,  arthritic,  or  dolorous  asthma,  I 
and  stcrnocardia.  ' 

Symptoms. — The  disease  is  characterized  by  a  violent  pain  about  the  ; 
sternum,  or  breast-bone,  extending  toward  the  arms,  attended  with 
anxiety,  difficulty  of  breathing,  and  a  sense  of  suffocation.     Authors 
describe  two  varieties :  acute,  in  which  the  attack  comes  on  suddenly 

during  exercise,  with  a  tendency  to  faint,  and  which  is  relieved  by  I 

rest ;    and  chronic,  in  which  the  paroxysm  is  less  violent,  of  longer  I 
duration,  recurring  frequently,  and  excited  by  slight  causes,  attended 

with  palpitation,  and  not  relieved  by  rest.  j 

Special  Causes. — Corpulent,  gouty,  rheumatic,  and  debilitated  per- 
sons are  especially  the  subjects  of  its  attacks;  hence  the  usual  causes  ' 
of  obstruction  and  nervous  exhaustion  may  be  regarded  as  its  predis- 
posing influences,  and,  indeed,  it  is  always  symptomatic  of  some  gen- 
eral morbid  condition.     Laennec  regarded  angina  pectoris  as  a  species  i 
of  neuralgia  of  the  heart ;  and  some  authoi-s  have  imputed  it  to  ossifi-  | 
cation  of  the    coronary  arteries  of  the   heart — a  supposition    purely  | 
fanciful. 

Treatment. — The    paroxysms  can   be  relieved    by  a  warm  water  i 

emetic,  a  dripping-sheet  or  douche,  or  the  pouring  head-bath.     The  j 

cure  depends  on  a  well-regulated  diet,  and  a  dtiil}'  cold-batli.  ■ 

i 

Pleuralgia — Pleurodi'ne. — Both  of  tliese  terms  import  pain  in  ] 

the  side,  and  are  employed  to  denote  a  pungent  pain  in  the  side,  with  | 

diflficulty  of  breathing,  which  difficulty  is  owing  to  an  acute  disti-ess  or  j 

ache  produced  by  every  attempt  to  inflate  the  lungs.    It  is  distinguished  i 

from  pleurisy  or  pneumonia  by  being  unattended  with  fever  or  inflam-  i 

matory  symjrtoms.  \ 

Symptoms. — In  the  acute  or  severe  form,  which  is  called  stitch  in  \ 

the  side,  the  pain  is  sudden  and  temporary,  supervening  on  exercise,  I 

and  being  relieved  by  repose.     In  the  chronic  form  the  pain  is  per-  J 
manent,  augmented  by  pressure,  and  there  is  inability  of  lying  on  the 

side  affected.  ; 

Special  Causes. — The  first  vaiietA-  is  generally  occasioned  by  hard  i 
running,  jumping,  lifting,  or  other  violent  exertion,  but  is  sometimes 

symptomatic  of  flatulejice   hysteria,  hypochondriasis,  etc.    The  second  '• 


SPASMODIC    DISEASES.  225 

variety  is  in  some  cases  symptomatic  of  structm-al  derangements,  as 
aneurism,  malformations,  adhesions,  or  other  organic  lesions ;  more 
commonly  it  is  caused  by  plethora,  transferred  gout  or  rheumatism, 
chronic  inflammation  of  the  liver  or  spleen ;  and  more  frequently  still 
it  is  produced  by  the  barbarous  custom  of  lacing  the  chest,  and  the 
m  schievous  habit  of  leaning  against  a  hard  desk,  or  bending  the  trunk 
of  the  body  forward  while  writing,  reading,  sitting,  sewing,  etc. 

Treatment. — The  stitch  gradually  subsides  on  moderating  the  exer- 
cise, or  by  resting.  It  may  be  prom.pth'  relieved  by  a  handkerchief,  or 
light  bandage,  the  hot  fomentation,  or  warm  douche.  In  the  chronic 
term  we  must  have  regard  to  the  producing  cause,  or  the  primary 
malady.     The  abdominal  girdle  is,  however,  always  in  order. 

HrDROPHOBiA — Canine  Madness — Rabies — Entasia  Ltssa. — 
Hydrophobia  literally  means  water-dread,  a  symptom  which  generally, 
though  not  uniformly,  attends  the  disease,  and  is,  in  some  instances, 
found  in  other  diseases. 

Symptoms. — The  disease  generally  commences  with  pain,  uneasi- 
ness, or  some  unusual  sensation  in  the  wound,  o.r  bitten  part,  followed 
by  pains  darting  along  the  course  of  the  nerves.  But  in  some  few 
cases  these  local  symptoms  do  not  appear.  The  first  constitutional 
symptoms  are,  wandering  pains  in  different  parts  of  the  body ;  stiffness 
of  the  neck  and  throat;  restlessness  and  irritability;  the  patient  is 
drowsy  or  depressed;  he  is  observed  to  sigh  deeply  and  frequently;  a 
principal  feature  among  the  early  symptoms  is  a  sudden  and  deep  in- 
spiration with  which  the  patient  is  fi-equently  affected.  He  is  also 
severely  agitated  by  the  impression  of  cold  air,  the  glare  of  a  mirror, 
the  noise  of  a  pump,  the  sound  of  water,  etc.  As  the  disease  pro- 
gresses, its  true  nature  becomes  revealed  by  the  difficulty  of  sw^allow- 
ing  liquids,  which  increases  until  the  sight  or  sound  of  water  causes 
him  to  start  with  dread  and  horror ;  the  attempt  at  deglutition  is  hur- 
ried, accompanied  with  sobbing,  and  followed  by  convulsions.  The 
countenance  now  expresses  indescribable  alarm,  anxiety,  and  suspicion; 
the  eyebrows  are  contracted ;  the  eyes  are  wild,  staring,  and  glassy ; 
there  are  urgent  thirst,  hot  and  dry  skin,  painful  efforts  to  vomit,  and 
intolerance  to  light  and  sound.  The  sufferer  spits  out  the  frothy  mucus 
and  viscid  saliva  between  his  closed  teeth,  with  vehement  strainings, 
^vllich  occasion  a  singular  sound  ;  talks  in  a  loud,  important,  authoritative 
tone,  and  often  screams  violently.  In  some  instances  the  intellect  seems 
unaffected  to  the  last,  but  in  other  cases  he  is  wildly  delirious,  anJ 
ta]k-^  incoherently  and  incessantly.  Toward  the  end,  convulsions  be 
?on53   nnre  fre^quent,  ar.d   the  patien,'   dies  asphyxiated  or  exhausted 


22G  TATHOLOGY    AND    THERAPEUTICS. 


Tlie  durntion  of  the  disease  is  usually  two  or  three  days ;  in  some 
rare  instances  it  has  continued  eight  or  nine  days.  The  symptoms  also 
manifest  considerable  diversity.  Sometimes  the  wounded  part  exhibits 
nothing  more  than  a  slight  lividity,  and  sometimes  the  cicatrix  opens 
afresh,  and  oozes  forth  a  little  colored  serum.  In  some  cases  the 
patient  is  furiously  mad,  I  ^tes  himself  and  others,  also  the  bedclothes, 
and  whatever  else  is  withii  reach. 

Special  Causes. — This  disease  is  usually  communicated  by  the  bite 
of  a  rabid  animal ;  but  it  may  originate  spontaneously.  The  nature 
and  origin  of  the  virus,  or  infecting  principle,  are  unknown.  But  that 
putrid  flesh  and  decomposing  offal,  on  which  so  many  dogs,  cats,  hogs, 
etc.,  are  fed,  are  the  chief  producing  causes,  is  attested  by  the  fre- 
quency of  its  occurrence  in  those  animals.  But  this  cause  alone  does  not 
seem  capable  of  generating  the  poison.  Some  excitement,  or  feverish 
heat  of  the  blood,  must  co-operate.  It  is  well  known  that  violent 
passions  have,  in  the  human  being,  and  in  various  domestic  animals, 
changed  the  saliva  in  a  moment  to  an  absolute  virus,  which  has  com- 
municated disease  and  death  to  others.  Thus  the  bite  of  an  enraged 
man,  horse,  hog,  goose,  duck,  and  hen,  has  been  known  to  impart  a 
deathful  infection.  And  when  a  furious  exercise  of  the  passions,  or  an 
inflainmatory  state  of  the  blood  by  violent  exercise,  co-operates  with 
putrescent  food,  the  peculiar  abnormal  transformation  of  matter  may 
take  place,  which,  analogous  to  a  ferment,  as  I  have  previously  had 
occasion  to  intimate,  may  produce  in  the  saliva  a  virus  capable  of 
propagating  itself  under  favorable  circumstances.  This  view  is  cor- 
roborated by  all  its  historical  and  phenomenal  data.  Dogs,  cats,  and 
hogs  are  most  exposed  to  these  combined  influences,  and  these  animals 
are  most  subject  to  the  disease,  and  in  the  order  named.  Wolves  and 
foxes  have  been  noticed  as  more  frequently  afl*ected  than  the  herbivora 
— horses,  oxen,  cows,  sheep,  goats,  etc.,  and  the  manner  in  which  they 
are  exercised  and  fed,  still  strengthens  our  position. 

Prognosis. — Hooper  pronounces  judgment  in  the  following  words : 
"Fatal.  The  disease  has  hitherto  defied  all  remedies."  Some  few 
cases,  however,  have  recovered  under  different  and  even  opposite 
plans  of  treatment,  owing  probably  to  the  enduring  energies  of  a  good 
constitution.  Water-treatment  has  apparently  succeeded  in  two  or 
three  instances. 

Latent  Period. — The  time  which  elapses  between  the  bite  of  the 
rabid  animal  and  the  development  of  the  symptoms,  is  usually  from 
twenty  to  forty  days ;  but  it  may  be  less  than  a  week,  and  has  been 
Known  to  extend  to  three  and  four  years. 

Treaifxcnt. — l^he  indications  arr* — 1    1  ;  equa'ize  the  distribution  of 


SPASMODIC    DISEASES.  227 

tervous  influence ,  2.  To  deterge  the  system  of  its  virus.  In  the 
early  stages  the  cold  treatment  may  be  applied  in  almost  any  form, 
provided  it  be  powerful  enough  to  produce  a  decided  sedative  influence 
upon  the  whole  system,  followed  by  the  wet-sheet  or  dry  blanket  en- 
veloping, to  promote  perspiration.  Probably  the  preferable  processes 
are  the  douche  and  rubbing-sheet,  followed  by  the  wet-sheet  pack 
when  the  temperature  of  the  body  is  nearly  at  or  above  the  nonnnl 
standard,  and  by  the  dry  pack  when  the  circulation  is  low,  and  there 
is  an  inclination  to  chilliness.  These  processes  may  be  repeated  and 
alternated  as  long  as  the  spasmodic  condition  of  the  throat  exists. 
Meanwhile,  if  the  patient  cannot  swallow  sip«  of  cold  water,  \ve  may 
perhaps  be  able  to  chew  or  swallow  bits  of  ice  ;  and  he  may  be  in- 
dulged to  the  extent  of  his  inclination.  Very  cold  compresses  or  pow- 
dered ice  should  also  be  applied  to  the  thorax.  Very  cold  water  enemas 
I  should  decidedly  recommend,  although  I  am  not  aware  that  they 
have  ever  been  tried.  Hooper  tells  us  that  the  irritation  of  the  throat 
has  never  been  removed  except  by  the  use  of  ice  taken  internally. 

Priessnitz  has  repeatedly  cured  rabid  dogs  by  douching  them  perse- 
veringly  in  cold  water.  The  following  case,  treated  by  Dr.  Todd,  at 
King's  College  Hospital,  is  instructive :  The  patient  was  a  boy  seven 
years  of  age,  laboring  under  the  v/orst  form  of  the  malady,  and  refus- 
ing, with  horror  and  impatience,  every  thing  offered  him,  of  either  a 
solid  or  liquid  form.  After  having  taken  twenty  drop  doses  of  prussic 
acid  without  any  effect  on  the  spasms,  he  was  offered  a  fragment  of 
rough  ice,  which  he  seized  and  swallowed  with  avidity.  Fresh  pieces 
were  constantly  put  into  his  mouth,  which  he  seized  and  craunched 
Detween  his  teeth  with  remarkable  eagerness,  swallowing  them  with 
perfect  ease.  In  half  an  hour  he  had  taken  a  pound  and  a  half  of 
rough  ice ;  and  at  the  same  time  a  bladder  containing  a  mixture  of 
roughly-powdereJ  ice  and  common  salt  was  applied  the  whole  length 
of  the  spine  and  around  the  throat.  Under  this  treatment  all  the 
symptoms  referable  to  the  throat  and  chest,  with  the  exception  of  oc- 
casional hackings,  passed  away,  and  nothing  remained  but  extreme 
restlessness,  violent  excitement,  and  incoherence.  In  this  condition, 
and  in  Dr.  Todd's  absence,  the  cold  douche  was  unfortunately  applied 
by  the  directions  of  some  other  physicians,  "but  the  system,"  says  the 
phj'siciau  who  prescribed  the  douche,  " did  not  rally  from  the  shock." 

Dr.  Guy,  author  of  a  work  on  Medical  Jurisprudence,  remarks,  in 
relation  to  the  above  case  :  "I  am  inclined  to  attribute  more  benefit  to 
the  internal  than  to  the  external  use  of  ice  in  this  case ;  but  the  joint 
administration  seems  to  be  the  Jaosl  rational  treatment  yet  recom- 
mended." * 


228  PAJHOLOGY    AND    THERAPEUTICS. 


There  was  certainly  a  grave  mistake  in  the  application  of  the  cold 
douche  under  the  circumstances.  On  the  first  attack  it  would  have 
been  proper,  but  wh&n  the  violent  symptoms  are  subdued  by  cold 
treatment,  and  the  patient  is  in  a  state  of  partial  collapse,  a  very  cold 
shock  is  entirely  out  of  place.  But  there  is  another  very  important 
consideration.  The  patien^-  had  taken  enormous  quantities  of  a  pow- 
erful narcotic,  and,  although  he  did  not  manifest  any  symptoms  of  nar- 
cosis while  the  convulsive  paroxj'sms  continued,  yet  the  deadly  drug 
was  in  hira,  and  must  have  so  paralyzed  the  nervous  system  that  it 
could  not  possibly  react  or  rally  against  such  a  shock,  which,  in  an 
earlier  stage,  or  without  the  prussic  acid,  might  have  been  harmless 
and  salutar}-.  Patients  will,  in  no  diseases,  and  under  no  circumstances, 
bear  cold  sJwcks  as  well  while  under  the  influence  of  narcotics  ;  a  fact 
I  have  repeatedly  known  to  be  verified  in  actual  practice.  The  history 
before  us  sho^vs  also  the  danger  of  occupying  the  system,  and  prostrat- 
ing its  energies  by  a  drug-poison,  while  we  are  making  impressions  on 
the  system  by  another  and  very  different  set  of  agencies.  They  do 
not  work  well  together. 

The  cold  water-treatment  was  in  repute  for  hydrophobia  even  in  the 
days  of  Celsus ;  and  Dr.  Good,  who,  after  an  elaborate  examination 
of  all  the  methods  of  ti-eatment  known  to,  or  rather  practiced  by  mod- 
ern physicians,  confesses  the  utter  inutility  of  all  of  them,  adverts  to  the 
case  of  a  patient  who  was  cured  by  water,  as  though  it  was  a  wonderful 
escape  from  death  by  drowning.  "Thus,"  says  Dr.  Good,  "M.  Morin 
relates  the  case  of  a  joung  woman,  twenty  yeai's  of  age,  who,  laboring 
under  symptoms  of  hydrophobia,  was  plunged  into  a  tub  of  water  with 
a  busliel  of  salt  dissolved  in  it,  and  was  harassed  with  repeated  dippings 
until  she  became  insensible,  and  was  at  the  point  of  death,  wlien  she 
was  still  left  in  the  tub,  sitting  against  its  sides.  In  this  state,  we  are 
told,  she  was  at  length  fortunate  enough  to  recover  her  senses,  when, 
nmch  to  her  own  astonishment,  as  well  as  to  that  of  the  bj'standers, 
fihe  found  herself  capable  of  looking  at  the  water,  and  even  of  drinking 
it  without  choking." 

The  preventive  treatment  after  the  bite,  as  in  all  cases  of  poisoned 
wounds,  is  by  excision  of  the  part,  if  it  can  be  done  instantaueousl}" ; 
the  ligature;  cauterization;  suction;  and  perhaps  refrigeration.  Prob- 
abh'  the  immediate  application  of  a  ligature  above  the  bitten  part,  and 
the  employment  of  a  powerful  cupping-glass  over  the  wound,  Avould 
niTest  the  process  of  absorption  for  an  hour  or  two,  after  which  excision 
or  cauterization  maybe  resorted  to,  or  both.  In  all  cases,  it  would  be  a 
prudential  measure,  after  the  wound  has  been  attended  to,  to  undergo 
a  thorough  course  of  wet-sh  ^et  packings,  with  the  view  of  cleansing 


SPASMODIC    DISEASES.  229 

i'lie  body  as  much  as  possible  from  all  morbid  secretions  or  putrescent 
tic-cumulations  upon  which  the  virus  could,  as  it  were,  feed  and  prop- 
agate itself,  should  any  portion  of  it  happen  to  pass  into  the  circulation. 

AcROTiSMUs. — The  affection  called  acrotism,  pulselessness,  and  by 
some  asphyxia,  though  improperly,  is  a  failure  or  cessation  of  pulsation 
for  a  longer  or  shorter  period,  sometimes  affecting  only  particular  parts 
of  the  system,  and  sometimes  extending  over  the  whole  body,  often 
accompanied  with  paleness,  chilliness,  pain  in  the  epigastrium,  and  a 
sense  of  spasmodic  constriction  in  the  respiratory  muscles. 

It  is  often  precursive  of  palsy  and  apoplexy,  sometimes  symptomatic 
of  organic  derangements  ;  but  is  sometimes  puoduced  by  functional  de- 
rangement of  the  stomach,  liver,  or  spleen,  or  some  obstruction  to  the 
equable  radiation  of  the  nervous  energy.  Some  persons  have  possess- 
ed the  ability  to  produce,  by  voluntary  effort,  a  universal  deficiency  of 
pulsation,  and  of  simulating  natural  death. 

Treatment. — The  paroxysm  may  be  relieved  by  thorough  friction 
with  cold  wet  cloths,  followed  by  dry  flannel  or  the  dry  hand ;  the  cure, 
BO  far  as  practicable,  depends  on  a  strict  compliance  with  all  the  laws 
of  hygiene. 

Teta-Nus. — Several  forms  in  which  this  disease  presents  itself,  have 
been  designated  as  varieties  by  many  authors  ;  as  emprosthotonos,  when 
the  body  is  bent  rigidly  forward ;  pleurosthotonos,  when  it  is  rigidty 
bent.ljiterally  ;  episthotonos,  when  rigidly  bent  backward ;  ertctus,  when 
rigidly  erect,  etc. 

Symptoms. — The  character  of  the  disease  is  a  permanent  and  rigid 
contraction  of  many  or  of  all  the  voluntary  muscles,  with  incurvation 
of  the  body,  and  difficulty  of  breathing.  Generally  the  extremities  are 
firmly  extended,  the  abdominal  muscles  strongly  retracted,  the  eyes 
fixed,  the  forehead  drawn  up  into  furrow^s,  and  the  whole  countenance 
is  shockingly  distorted ;  the  violent  contractions  are  attended  with  ex- 
cruciating pain ;  the  pulse  is  accelerated ;  the  respiration  is  very  la- 
borious, or  almost  suspended  ;  and  the  skin  is  covered  with  a  profuse 
perspiration.  The  symptoms  frequently  remit  partially,  but  are  re- 
newed with  aggravated  torture  by  the  slightest  cause,  as  the  least  motion 
of  the  patient  or  slightest  touch  of  an  attendant.  Sometimes  the  tongue 
is  darted  spasmodically  out  of  the  mouth,  and  the  teeth,  spasmodically 
snapping  upon  it,  lacerate  it  severely,  unless  prevented  by  some  in- 
tervening substance.  In  fatal  cases,  death  is  preceded  by  frothy  or 
bloody  mucus  at  the  mouth,  small  and  imperceptible  pulse,  and  de- 
Urium. 

20 


£30  PATHOLOGY   AND   THERAPEUTICS. 


Special  Causes. — Sudden  exposure  to  damp  and  cold  when  the  body- 
is  overheated  ;  wounds,  punctures,  lacerations,  or  other  local  irritations 
of  nerves;  the  bad  air  of  crowded  hospitals  ;  exti-eme  terror,  or  violent 
passion ;  sympathy  ;  long  exposure  to  a  very  hot  sun  ;  various  narcot-. 
ics,  as  strychnine,  or  nux  vomica ;  intense  galvanic  excitement.  Hoop- 
er names,  among  the  predisposing  causes,  "the  male  sex,  robust  and 
vigorous  constitutions,  warm  climates,  the  period  of  infancy  !"  It  is  a 
singular  reflection  on  nature,  or  on  natm-e's  God,  that  one  cannot  be  a 
male,  nor  have  a  good  constitution,  nor  live  in  a  warm  climate,  nor  ex- 
ist during  infancy,  without  being,  from  either  of  these  circumstances, 
predisposed  to  tetanus. 

Duration.^-ln  fatal  cases  the  ordinary  duration  is  from  four  to  eight 
days.     Favorable  cases  linger  from  one  to  eight  or  ten  weeks. 

Prognosia. — When  ai'isiug  from  wounds,  the  disease  has  in  most 
cases  proved  fatal,  and  it  is  exceedingly  dangerous  when  existing  from 
any  cause. 

Treatment. — Water-Cure  has  not  yet  been  fairly  tested  in  this  for- 
midable affection,  but  the  principle  upon  which  the  treatment  should  be 
regulated,  seems  very  clear.  The  single  indication  is  to  abate  the  irri- 
tation ;  and  to  do  this  the  leading  measures  must  be  calculated  to  pro- 
duce and  maintain  a  relaxant  or  sedative  effect.  Horses,  and  even 
Wounded  soldiers,  have  been  cured  by  an  accidental  exposure  to  a  long 
and  drenching  rain ;  from  which  fact  we  may  derive  a  profitable  hint* 
As  the  patient  is  excessively  susceptible  to  impressions  of  all  kinds,  it 
would  not  »nswer  to  weaken  him  with  very  warm  water,  nor  shock  him 
with  veiy  cold.  The  wet-sheet  envelop — and  two  or  three  thicknesses, 
are  better  than  one,  especially  in  the  early  stage,  if  the  patient  has  taken 
little  or  no  narcotic  or  depleting  remedies — offers  the  best  resource.  As 
soon  as  the  patient  is  comfortably  warm,  a  part  of  the  bedding  should  be 
removed  or  the  bed-clothes  loosed,  so  as  to  keep  up  a  comfortable  glow 
ffnd  maintain  a  moist  state  of  skin  for  a  long  time,  even  hours  together. 
When  the  patient  becomes  too  warm,  or  the  wrapping-sheet  too  dry, 
it  should  be  wet  with  cool  or  tepid  water,  65°  to  75°,  without  being  re- 
moved, so  that  the  patient  may  continue  at  perfect  rest.  There  can 
be  no  danger  in  continuing  this  treatment  for  days,  provided  the  tem- 
perature of  the  patient  is  carefully  kept  near  the  natural  standard. 
When  caused  by  a  wound,  the  injured  part  should  be  covered  with  sev- 
eral folds  of  cold  wet  cloths — as  cold  as  can  be  borne,  without  increas- 
ing the  pain,  which  should  be  frequently  changed.  If  able  to  swallow, 
tl.i.e  patient  should  drink  rather  freely,  and  as  much  cold  water  should 
be  occasionally  thrown  into  the  bowels  by  a  pump-syringe  as  they  can 
conveniently  receive 


SPASMODIC    DISEASES.  231 

Locked-Jaw — Trismus. — This  disease  differs  from  tlie  former  in 
the  spastic  rigidity* of  the  muscles  being  chiefly  confined  to  the  lower 
jaw;  from  which  circumstance  many  authors  regard  it  as  a  mere  form  or 
variety  of  tetanus.  It  has  also  been  designated  as  traumatic,  when 
arising  from  wounds,  surgical  operations,  or  other  local  injuries ;  and 
catarrhal,  when  produced  by  colds.  Sometimes  it  attacks  infants  soon 
after  birth,  constituting  the  trismus  nascentium  of  Dr.  Good. 

Symptoms. — Sometimes  the  attack  is  sudden,  but  usually  the  symp- 
toms come  on  gi-adually:  there  is  moi'e  or  less  of  an  uneasy  sensation 
at  the  root  of  the  tongue,  and  some  degree  of  difficulty  of  swallowing. 
The  spasms  sometimes  extend  to  the  muscles  of  the  chest  or  back  ;  the 
breathing  is  nasal;  articulation  is  interrupted  and  slow;  the  muscles  of 
the  nose,  lips,  mouth,  and  of  the  whole  face  are  fixed  and  distorted,  and 
the  jaw  bone  is  often  so  firmly  set  as  to  break  before  the  muscles  will 
yield  to  mechanical  force. 

Sjyecial  Causes. — Mechanical  injuries,  especially  the  wounding  of 
nerves  in  bleeding  and  surgical  operations ;  gun-shot  wounds,  punc- 
tured wounds  by  nails,  splinters,  pieces  of  glass ;  extreme  vicissitudes 
of  temperature,  etc.  Obstructed  bowels  is  a  frequent  cause  of  the  in- 
fantile variety. 

Treatment. — The  general  plan  of  medication  is  similar  to  that  of  the 
former  variety.  Derivative  baths  may  be  here  employed,  in  addition, 
with  advantage,  of  which  the  tepid  shallow-bath,  accompanied  with 
active  hand-rubbing,  is  the  best.  The  bowels  should  be  freely  moved 
by  warm  water  injections. 

Cramp. — This  affection  is  often  symptomatic,  as  in  various  species 
of  colic,  cholera,  and  other  diseases.  Pregnant  women,  whose  habiti? 
are  too  sedentarjs  or  wlwse  diet  is  too  concentrated,  are  often  troublet 
with  fugitive  cramps  about  the  hips  or  in  the  muscles  of  the  lower  ex- 
tremities. 

Symjytoins. — The  disease  consists  of  a  sudden  contraction  and  convo- 
lution of  one  or  more  muscles,  attended  with  extreme  but  temporary 
pain.  The  stomach,  neck,  calves  of  the  legs,  and  toes,  are  the  parts 
most  frequently  attacked.  When  the  hollow  viscera  or  membranous 
nmscles  are  affected,  the  pain  is  agonizing,  a  violent  perspiration  usu- 
ally breaks  out,  and  the  part  feels  as  though  it  were  puckered  and 
drawn  to  a  point.  When  the  stomach  is  attacked,  the  breathing  is 
short  and  distressing. 

Special  Causes. — Sudden  exposure  to  cold  or  damp  wljen  the  body 
is  relaxed;  flatulence  of  the  stomach  or  bowels  ;  long-continued  pres- 
sure ;  overstretching  the   muscles      Acr'i  bile  is  a  frequent  cause  of 


£32  PATHOLOGY    AND    THERAPEUTICS. 

cramp  in  the  stomach,  and  acrid  drugs  are  a  common  cause  of  acrid 
bile  ;  hence  we  meet  with  the  most  obstinate  cases  among  obstinate 
drug-takers. 

Treatment. — The  paroxysm  can  be  relieved  in  a  variety  of  ways. 
The  warm  douche,  followed  by  the  cold  dash  ;  hot  fomentations  ;  the 
warm  hip-bath  and  foot-bath  are  applicable  to  cramp  in  the  stomach ; 
when  seated  in  the  external  muscles  or  extremities,  the  hot  or  cold 
douche  will  each  relieve  it ;  it  can  also  be  speedily  overcome  by  forci- 
bly pressing  the  affected  muscle  against  a  hard,  resisting  body,  as,  for 
example,  the  ball  of  the  toe,  or  the  heel  against  the  floor,  foot-board, 
or  upon  the  other  foot.  The  cramping  diathesis  may  be  entirely  erad- 
icated by  daily  bathing,  plain,  unconcenti'ated  food,  and  regular  and 
active  exercise. 

Muscular  Distortion  of  the  Spine — Spinal  Incurvation. — 
*'  Spinal  disease,"  "  spinal  weakness,"  "  spinal  irritation,"  etc.,  are 
among  the  rapidly-increasing  diseases  which  tell  of  our  enervating 
habits  and  consequent  physiological  degeneracy  Spinal  distortions  may 
result  from  organic  affections — caries  oi  injuries — of  the  vertebral  col- 
umn, or  from  osseous  malformation,  as  in  rickets  and  scrofula;  but  the 
great  majority  owe  their  existence  to  simple  muscular  debility. 

There  is  no  part  of  the  great  field  of  "  medical  science"  in  which  a 
more  blundering  pathology,  a  more  unfortunate  diagnosis,  and  a  more 
empirical  practice  prevail  than  that  relating  to  spinal  complaints.  All 
through  the  country  weakly  females  abound,  whose  backs  have  been 
blistered,  burned,  scarred,  cauterized,  leeched,  cupped,  scarified,  pus- 
tulated, and  otherwise  tortured,  with  the  view  of  counter-irritating  a 
Bpinal  disease,  when  in  fact  they  have  had  no  spinal  disease  at  all !  Any 
form  of  indigestion,  any  morbid  condition  of  the  liver,  kidnej-s,  and  any 
foi-ra  of  mismenstruation,  may  produce  a  sympathetic  irritation  of  some 
portion  of  the  spinal  colunan;  and  in  many  of  these  diseases  of  the  ab- 
dominal and  pelvic  viscera,  a  tenderness  will  be  found  by  pressing 
firmly  on  that  part  of  the  spine  from  which  the  nerves  are  sent  off  to  the 
organ  or  part  really  diseased.  This  symptomatic  tenderness  the  doc- 
tor mistakes  for  an  idiopathic  disease,  and  plies  his  destructives  accord- 
ingly. Again,  when  the  whole  body  is  debilitated  by  fine  food,  hot 
drinks,  close  rooms,  sedentary  habits,  etc.,  the  whole  muscular  system 
Id  necessarily  i-elaxed ;  it  has  not  sufficient  firmness  and  elasticity  to 
sustain  the  trunk  of  the  body  erect,  and  perform  its  varied  motions  with 
ease  and  energy  ;  hence,  like  the  masts  of  a  ship,  when  the  ropes  are 
weakened  or  destroyed,  the  vertebral  column  bends,  leans,  or  tips  back- 
wai-d,  forward,  or  to  ?ne  side — usually  the  latter  ;  and  again  the  med- 


SPASMODIC    DISEASES.  233 

ical  man,  again  misapprehending  the  state  of  affairs,  instead  of  attend- 
ing to  the  health  in  general,  and  strengthening  the  weak  muscles  in 
particular,  administers  his  internal  drugs  and  drastics,  and  puts  on  his 
external  liniments  and  plasters,  or  endeavoi's  to  give  support  to  the  fall- 
ing frame  by  binding  it  up  with  a  set  of  awkward  and  complicated  ma- 
chinery. Thousands  of  females  have  had  real  diseases  inflicted  upon 
them  by  the  physician's  attempts  to  cure  the  imaginary  one. 

The  "small  of  the  back"  is  the  center  of  the  whole  muscular  sys- 
tem ;  it  is  the  strong  or  weak  point  with  every  person,  and  no  less  than 
three  hundred  distinct  muscles  aro  concerned  in  the  com])licated  move- 
ments of  the  vertebral  colun  u  ;  hence  it  is  no*  lifficult  to  understand 
how  a  relaxed  or  vreakly  condition  of  the  general  s3-stem  should  be  es- 
pecially manifested  in  a  muscular  distortion  of  the  spine. 

Special  Causes. — Under  this  head  I  am  most  happy  to  quote  the  fol- 
lowing sensible  observations  from  a  standard  allopathic  book,  more  espe- 
cially as  I  have  so  frequent  occasion  to  dissent  from  the  sense  expressed 
in  the  works  of  that  school. 

"In  rustic  life  we  have  health  and  vigf,  and  a  pretty  free  use  of 
the  limbs  and  the  muscles,  because  all  are  left  to  the  impulse  of  the 
moment  to  be  exercised  without  restraint.  The  country  girl  rests 
when  she  is  tired,  and  in  whatever  position  she  chooses  or  finds  easi- 
est, and  walks,  hops,  or  runs,  as  her  fancy  may  direct,  when  she  has 
recovered  herself;  she  bends  her  body  and  erects  it  as  she  lists,  and 
the  flexor  and  extensor  muscles  are  called  into  equal  and  harmonious 
play.  But  instead  of  this,  let  the  child  of  the  opulent  be  compelled  to 
sit  bolt  upright  in  a  high,  narrow  chair  with  a  straight  back,  that  hardly 
allows  of  any  flexion  to  the  sitting  muscles,  or  of  any  recurvation  to  the 
spine  ;  and  let  the  whole  of  her  exercise  be,  instead  of  irregular  play 
and  frolic  gayety,  be  limited  to  the  staid  and  measured  march  of  Mel- 
ancholy in  the  Penseroso  of  Milton  : 

"  '  With  even  step  and  musing  gait ;' 

to  be  regularly  performed  for  an  hour  or  two  every  day,  and  to  consti- 
tute the  whole  of  her  corporeal  relaxation  from  month  to  month,  ghd- 
ed  moreover,  all  the  while,  with  the  paraphernalia  of  braces,  bodices, 
stays,  and  a  spiked  collar,  and  there  can  be  no  doubt  that  the  young 
heiress  will  exhibit  a  shape  as  fine  and  a  demeanor  as  elegant  as  fashion 
can  communicate,  but  at  the  heavy  expense  of  a  languor  and  relaxa- 
tion of  fiber  that  no  stays  or  props  can  compensate,  and  no  improve- 
ment in  figure  can  atone  for." 

Diagnosis. — In  organic  or  structural  derangements,  the  distortion  ia 
fi'om  within  outvv'ard,  forming  a  sharp  projection  of  the  bones,  called 


23i  PATHOLOGY    AND    THERAPEUTICS 


angular  curvature,  in  contradistinction  to  the  disease  before  us,  which 
is  usually  termed  the  lateral  curvature ;  and  this  may  be  right  or  left-, 
MS  rlie  muscles  on  the  right  or  left  side  of  the  body  are  more  debilita- 
ted from  peculiar  pei'soual  habits,  ordinary  bodily  positions,  etc.  The 
muscles  of  the  back  are  more  or  less  emaciated  ;  the  soreness  or  ten- 
derness upon  pressure  is  a  very  variable  s3-mptom ;  it  may  be  constant 
or  occasional,  severe  or  slight,  or  entirely  absent.  Parah'sisof  the  low- 
er extremities  is  a  common  symptom  of  the  organic  or  true  spinal  dis- 
ease, especially  when  the  displaced  vertebras  press  severely  on  the  spi- 
nal cord,  and  when  any  portion  of  the  cord  or  medulla  oblongata  is  af- 
fected with  a  softening  ■^amolUssement — or  other  abnormal  transforma- 
tion. Some  authors  have  imputed  the  lateral  or  muscular  curvature  to 
an  over-action  of  some  of  the  muscles  of  one  side;  but  the  exact  con- 
ti'ary — want  of  action — is  invariably  the  fact.  Some  authors  regard  the 
muscular  distortion  as  the  predisposing  cause  of  the  bony  distortion ; 
while  others  regard  the  disease  of  the  bones  and  a  relaxation  of  their 
ligaments  as  the  producing  cause  of  the  muscular  depressions.  Nei- 
ther hypothesis  is  correct:  for  both  affections,  as  already  intimated, 
oomme"  ;o  progress,  and  terminate  independently  of  each  other:  one 
being  strictly  organic,  and  primarily  affecting  the  bones ;  the  other 
purely  functional,  and  primarily  seated  in  the  muscles.  Sometimes  the 
miscuiTation  is  double,  forming  a  sigm.oid  flexure ;  and  the  contortion 
is  said  to  be  more  frequently  on  the  right  side  than  on  the  left,  prob- 
ably owing  to  the  more  fi-equent  extension  of  the  right  hand,  the  body 
being  thrown  toward  the  left  to  preserve  the  central  point  of  gravita- 
tion. 

Treatment. — First  of  all  in  iinportance  is  the  general  regimen.  All 
superfluous  clothing  must  be  thrown  off";  silks  and  flannels  next  the 
skin  must  be  eschewed;  all  artificial  support  must  be  withdrawn,  and 
every  thing  about  the  body  or  dress  which  iuterrapts  in  the  least  free 
and  varied  motion  is  to  be  removed.  Exercise  in  the  open  air  should 
be  frequently  tnken,  and  such  gj'mnastics  as  call  *^he  muscles  more  es- 
pecially debility  fed  info  action,  should  be  indulged  \vith  moderation,  and 
regularly  persisted  in.  The  bed  should  be  easy  but  not  heating.  A 
good  hair  mattniss  answei's  very  well,  and  a  bed  well  filled  with  new 
oat  straw  is  still  better;  the  patient,  during  sleep,  should  recline  as 
nearly  on  the  horizontal  posture  as  is  consistent  with  quiet  rest,  but  not 
put  on  an  uncomfortable  stretch,  as  some  authors  have  advised.  The 
dietetic  plan  should  consist,  to  a  large  extent,  of  plain,  unmixed,  solid 
and  (hy  articles  and  jireparations.  as  brown  bread,  with  baked  apples; 
wheaten  grits  and  sugar,  with  uncooked  apples;  wheat  meal  or  Indian 
cakes,  with  milk ;  roasted  potatoes  and  milk,  with  dry  crusts  of  good 


SPASMODIC    DISEASES.  235 

sweet  bread;  Graham  crackers,  with  ordinary  vegetal:  les  and  fruits, 
etc.  Cold  water  should  be  drank  in  the  foi-epart  of  the  day,  especially 
soon  after  rising,  as  freely  as  the  stomach  will  bear  without  decided 
discomfort;  and  if  the  bowels  are  in  any  degree  torpid,  a  daily  injec- 
tion should  be  employed. 

The  bathing  part  of  the  treatment  should  be  as  strictly  tonic  as  pos- 
sible. The  dripping-sheet,  followed  by  active  and  prolonged  rubbing 
with  the  dry  hand;  or  the  tepid  shallow-bath,  followed  by  the  pai. 
douche,  and  this,  succeeded  by  hand  friction,  should  be  employed  daily 
when  practicable,  and  the  towel-wash  substituted  when  both  are  im 
practicable.  The  douche  to  the  whole  surface  of  the  back  may  be  em 
ployed  once  or  twice  daily.  The  stream  should  be  of  moderate  force, 
and  applied  from  two  to  five  minutes.  The  hip-bath  will  also  be  highly 
serviceable,  by  constringing  the  relaxed  muscles  at  the  very  point  of 
their  greatest  relaxation.  The  air-bath  is  also  worth  recommending  in 
this  place,  and  its  advantage  would  be  gi^eatly  enlianced  by  manipula- 
ting or  shampooing  the  whole  back,  and  especially  in  the  immediate 
vicinit^  of  the  morbid  curvature. 

I  may  add,  in  conclusion,  that  Dr.  Jarrold,  who  once  wrote  an  elab- 
orate ti-eatise  on  this  complaint,  limited  his  medication  almost  exclu- 
sively to  burned  sponge  and  the  carbonate  of  soda,  from  which  treat- 
ment he  is  said  to  have  experienced  remarkable  success  ;  but  it  is 
worthy  of  note  that  his  hygienic  auxiliaries  were,  a  recumbent  posture, 
shampooing,  friction,  pure  air,  occasional  exercise,  and  careful  atten- 
tion to  diet.  I  am  of  opinion  his  hygiene  effected  the  cure,  while  the 
drugs  were  useless  or  nearly  insignificant. 

Muscular  Stiff  Joint. — This  aflfection,  which  consists  of  a  per- 
manent and  rigid  contraction  of  one  or  more  articular  muscles  or  their 
tendons,  may  arise  from  spasmodic  contraction  or  from  simple  atony : 
the  former  kind  cften  results  from  rheumatism,  and  the  latter  from 
long  confinement  or  neglect  of  use ;  colds,  strains,  and  inflammations 
occasionally  produce  it.  The  douche,  com.presses,  active  and  prolonged 
friction  with  soft  flannel  or  silk,  or,  better  still,  the  bare  warm  hand, 
are  the  "  methodus  medendi.^^ 

Wry  Neck. — A  permane»t  contraction  of  the  flexor  muscles  of  one 
side  of  the  neck,  or  a  loss  of  the  balance  of  action  between  the  flexors 
and  extensors,  by  which  the  head  is  drawn  obliquely  to  the  right  or 
left,  may  be  occasioned  by  a  natural  disparity  in  the  length  of  the  op- 
posite muscles,  and  only  curable,  if  at  all,  by  a  surgical  operation  ;  or 
by  a  spasmodic  fixation  of  one  or  more  muscles  on  the  contracted  side: 


236  PATHOLOGY    AND    THERAPEUTICS. 

or  from  debility  of  the  muscles  on  the  opposite  or  yielding  side ;  or 
from  the  two  last  conditions  combined.  The  first  variety  is  generally 
congenital,  but  sometimes  results  from  burns  and  other  injuries  ;  colds 
and  strains  are  the  usual  causes  of  the  last  three  varieties,  the  curative 
method  for  which  is  the  same  as  for  the  preceding  disease. 

Hiccough — Hiccup — Singultus. — The  disease  before  us,  and  all 
others  arranged  under  the  head  of  chronic  spasm,  are  frequently  symp- 
tomatic affections.  In  rare  instances,  how^ever,  they  seem  to  occur 
idiopathically ;  that  is  to  say,  without  any  other  apparent  and  well-de- 
fined primary  malady  to  which  they  can  be  imputed. 

S]imptoms. — Hiccough  is  defined,  a  convulsive  catch  of  the  respi- 
ratory muscles,  with  sonorous  inspiration,  iterated  at  short  intervals. 
The  spasmodic  action,  as  in  the  case  of  \omting,  is  principally  made  by 
the  diaphragm  and  external  abdominal  muscles. 

Special  Causes. — Bile  in  the  stomach,  acidity,  fiatiilence,  indigesti- 
ble food,  an  overloaded  stomach,  external  pressure,  narcotics,  intoxi- 
cating drinks. 

Treatment. — A  draught  of  cold  water,  the  foot-bath,  cold  compresses 
to  the  stomach.  When  occasioned  by  acrid  bile,  over-fullness  of  the 
stomach,  or  alcoholic  liquors,  warm  water-drinking,  thp  cold  abdom- 
inal bandage,  and  the  cold  injection. 

When  the  spasmodic  action  appears  to  be  merely  irritative,  it  can 
be  checked  at  once  by  holding  the  breath  as  long  as  possible,  and 
fixing  the  mind  intently  on  some  object  ;  violent  sneezing,  sudden 
fright,  or  almost  any  sudden  and  strong  emotion  of  mind,  will  general- 
ly arrest  it.  Baron  Dupuytren  once  cured  an  obstinate  case  by  apply- 
ing a  hot  iron  to  the  region  of  the  diaphragm  ;  but  whether  the  actual 
cautery  or  the  actual  fright  actually  cured  the  patient,  medical  gentle- 
men may  differ;  my  opinion  is  in  favor  of  the  fright. 

Snekzing — Clonus  Sternutatio. — Sneezing  is  a  convulsive  mo- 
tion of  the  resj)iratory  muscles,  by  which  air  is  driven  violently  and 
suddenly  through  the  nostrils,  producing  a  sonorous  expiration.  In  the 
natural  order  of  things  the  act  is  intended  to  eject  from  the  mucous 
membrane  nf  the  nostrils  any  irritant  or  offensive  material  which  ef- 
fects a  lodgment  there.  Snufl'-takers  frequently  so  obstruct  and  para- 
lyze tlje  nervous  sensibility,  that  it  is  impossible  to  excite  sneezing  by 
nil  the  pulvui-ulent  narcotic  the  nose  is  able  to  receive ;  while  the  un- 
depraved  instinct  will  raise  a  violent  commotion  against  the  smallest 
particle  of  obnoxious  dust  or  mephitic  vapor. 

Special  Cawses. — Pungent  dust    vapors,  gases,  or  other  local  irri- 


SPASMODIC    DISEASES.  237 


tai)ts  ;  indurated  mucous  and  acrimonious  secretions,  as  in  catarrh  and 
measles ;  morbid  sensibility  of  the  Schneiderian  membrane  from  acrid 
biie,  and  morbid  secretions  of  the  alimentary  canal. 

Treatment.— -Sniffing  cool  or  cold  water  frequently,  taking  care  to 
draw  the  fluid  into  the  nostril  by  means  of  a  moderate  but  prolonged 
inspiration,  rather  than  by  a  forcible,  jerking  motion;  in  severe  cases* 
derivative  baths — the  hip  and  foot — are  useful ;  and  in  some  cases  of 
dyspeptic  sneezing,  the  whole  face  requires  "packing."  I  once  had 
an  inveterate  dyspeptic  under  treatment,  who  was  afflicted  with  an 
eruptive,  erythmatic,  or  "  cankerous"  condition  of  the  mouth,  throat, 
stomach,  and  bowels ;  and  this  occasioned  such  an  excessively  irritable 
state  of  tlie  mucous  membrane  of  the  nose  that  the  most  trivial  ex- 
citing causes  would  excite  violent  and  painful  attacks  of  sneezing  ;  these 
would  continue,  unless  attended  to,  for  hours,  and  until  the  whole  face 
was  greatly  swollen,  the  eyes  injected  and  tearful,  and  the  sense  of 
tickling  and  irritation  incessantly  annoying  and  intolerably  distressing. 
The  sneezing  fit  was  several  times  stopped  by  placing  several  folds  of 
wet  cloths  over  the  whole  face,  leaving  a  small  aperture  for  breathing 
purposes,  and  covering  these  with  dry  flannel,  so  as  to  produce  what 
has  been  called  the  "poultice"  effect  of  the  wet  compress. 

Palpitation. — A  subsultory  vibrative  motion  may  be  limited  to  the 
lieart  aione,  or  the  trunks  of  some  of  the  larger  arteries  alone,  or  affect 
their  ramifications  in  the  viscera,  constituting  palpitation  of  the  heart, 
of  the  arteries,  and  complicated  or  visceral  palpitation. 

Symptoms. — Palpitation  of  the  heart  is  a  vibratory  and  irregular  ac- 
tion, sometimes  sharp  and  strong,  and  then  called  throbbing  of  the  heart, 
and  sometimes  soft  and  feeble,  when  it  is  termedi  fluttering  of  the  heart. 
In  some  instances  the  force  of  the  heart's  contraction  has  been  so  great 
as  to  shake  the  bed,  be  heard  across  the  room,  rupture  the  ventricles, 
and  even  fracture  the  ribs.  In  very  nervous  or  irritable  persons  the 
palpitation  often  shoots  from  one  arteiy  to  another,  and  sometimes  a 
preternatural  pulsation  pervades  every  part  of  the  body,  the  raoibid 
sensibility  being  so  acute  that  the  patient  not  only  feels  the  universal 
throbbing,  but  actually  hears  it.  The  temporal  and  carotid  arteries  are 
particularly  subject  to  a  migratory  throbbiig,  which  may  be  synchro- 
nous, or  alternating  with  the  beating  of  the  heart.  In  dyspeptics,  the 
descending  aorta  is  often  the  seat  of  a  most  disagreeable  throbbing,  not 
unfrequently  mistaken  for  aneurism. 

Special  Causes. — Palpitation  is  always  symptonyitic  of  some  organic 
or  functional  difficulty,  commonly  the  latter.  All  visceral  obstructions, 
and  every  form  of  indigestion,  are  liable  to  be  attended  with  this  sym[> 


238  PATHOLOGY    AND    THERAPEUTICS. 


torn.  The  use  of  tobacco,  strong  coffee,  green  tea,  or  ardent  spirits 
very  frequently  produces  the  worst  and  most  obstinate  attacKS.  Strong 
mental  emotions,  if  frequently  repeated,  or  continuous  mental  excite 
ments  of  any  kind,  tend  to  create  a  habitual,  disorderly  action  of  the 
heart  and  arteries.  Probably  constipation  of  the  bowels  is  the  cause 
of  the  most  violent  attacks  on  record.  The  most  common  structural 
derangements  of  which  palpitation  is  symptomatic,  are  eulai'gement  or 
induration  of  the  heart ;  aueurismal  dilatation  of  its  cavities ;  ossification 
of  its  valves,  or  its  connection  with  the  aorta ;  morbid  accum.ulation  of 
fat  around  the  pericardium ;  dropsical  collections  within  the  pericardi- 
um; adhesions  of  the  pericardium. 

Diagnosis. — It  is  often  exti-emely  difficult  to  distinguish  between 
functional  and  structural  causes  of  palpitation.  The  following  will  serve 
as  a  general  though  not  a  universal  rule  :  functional  palpitations  are  i?i- 
lermittenU  while  those  produced  by  organic  affections  are  continuous  ; 
and  to  this  T  may  add,  that  in  all  abnormal  pulsations  from  functional 
derangement  or  nervous  irritability,  the  character  of  the  pulse  is  ex 
ceeding  variable;  while  in  organic  affections  its  abnormal  character 
whatever  that  character  may  be,  is  nearly  uniform.  It  may  afforc? 
some  consolation  for  invalids  with  this  affliction  to  know  that  not  mor^ 
than  one  in  ten  of  those  who  are  suspected,  by  themselves  or  bj'  their 
physicians,  of  an  organic  cause,  ever  find  more  than  a  functional  de- 
rangement. 

Treatment. —  As  the  disease  is  merely  secondary,  all  we  have  to  do 
is  to  trace  it  to  the  primary  malady,  and  treat  that  according  to  its 
character. 

Nictitation. — A  rapid  and  vibratory  motion,  or  twinkling  of  tlie 
eyelids  is  named  as  a  distinct  disease  by  some  authors.  When  the 
eye  has  been  frequently  exposed  to  dust,  or  pungent  gases,  vapors,  etc., 
a  morbid  sensibility  sometimes  remains  after  the  cause  of  irritation  has 
been  removed,  producing  an  irregular,  convulsive,  and  unsightly  wink- 
ing. It  has  been  overcome  by  a  powerful  exertion  of  the  will,  and  by 
employing  only  one  eye  at  a  time.  Frequent  cold  bathing,  followed 
by  gentle  manipulation,  seems  well  adapted  to  restore  the  natural  tone. 

SuBSDLTUS. — Sudden  and  irregular  twitches  or  snatchings  of  the 
tendinous  extremities,  are  generally  indicative  of  extreme  debility,  and 
are  hence  common  in  low  fevers,  and  the  latter  stages  of  many  fatal 
disorders.  But  sometimes  a  feeble  convuisive  action  is  IoctiI  and  hab- 
itual. Nervous  and  imtabl^  persons,  of  otherwise  fair  health,  some- 
times ai'e  troubled  with  a  jerking,  spasmodic  action  of  the  muscles  of 


DISEASES    3F    GENERAL    TORPITUDE.  239 

the  shoulders,  hands,  feet,  etc.  Such  cases  almost  always  depend  on 
some  obstruction  of  the  skin,  or  bowels,  or  both,  and  are  curable  by 
a  daily  bath,  coarse  opening  food,  and  cool  injections. 

Stretching — PArfDicuLATiON. — It  requires  some  stretch  of  imag- 
ination to  regard  what  Dr.  Good  defines  "transient  elongation  of  the 
extensor  muscles,  usually  with  deep  inspiration  and  a  sense  of  lassi- 
tude," as  a  distinct  disease.  Yawning,  gaping,  and  stretching  are  in- 
stinctive efforts  to  recover  the  balance  between  the  flexor  and  exton- 
sor  muscles ;  and  ai"e  sometimes  excited  by  misposition,  and  at  others 
by  certain  morbid  conditions,  as  nausea,  the  shivering  stage  of  fever 
and  ague.  Most  frequently,  however,  that  kind  of  stretching  which  au- 
thors have  dignified  with  the  title  of  a  malady,  under  the  name  of  pan- 
diculation, is  symptomatic  of  indolence  ;  hence  it  is  rather  peculiar  tc 
loungers,  who  "  cannot  rise  from  the  sofa  without  stretching  their  limbs, 
nor  open  their  mouths  to  answer  a  plain  question  without  gaping  ii 
one's  face."     The  remedy  is  occupation. 


CHAPTER  XL 

DISEASES    OF   GENERAL    TORPITUDE 

The  diseases  constituting  the  present  chapter,  are  distinguished  hy 
general  muscular  immobility,  with  mental  or  bodily  stupor.  They 
form  a  striking  contrast  with  those  of  the  preceding  ( hapter,  and  em- 
brace the  following  species  : 

Asphyxia — Suspended  Animation 

Ecstasy — Spurious  Catale^osy.  (  Ilemiphlegia, 

Catalepsy — Trance.  Palsy  )  Paraplegia, 

Lethargy — Deep  Sleep.  (  PaHicular. 

Apoplexy. 

Asphyxia — Suspended  ANIMATlo^--Ap^ arent  Death. — The 
term  asphyxia,  or  asphyxy,  is  often  used  in  the  limited  sense  of  acro' 
iism  or  pulselessness,  and  is  generally  restricted  to  that  suspension  of 
all  the  powers  of  sensation  anc  voluntary  motion  which  is  immediately 
owing  to  non -arterial) zation  of  the  blood  from  mterruoted  r^wpirntion. 


240  TATHOLOGYAND   THERAPEUTICS 

But  in  a  more   comprehensive  sense  it  has  been,  and  in  the  present  | 

sense  is  employed  to  denote  all  cases  in  which  a  total  or  partial  suspen-  i 

sion  of  the  mental  and  corporeal  functions  chai'acterizes  the  access  of  j 

the  disease.  ' 

Symptoms. — These  vary  with  the  pi'oducing  cause.      In  asphyxia  ; 

from  suffocation,  as  in  hanging  or  drowning,  the  countenance  is  turgid,  ; 

and  suftused  with  livid  blood  ;  the  eyeballs  are  protruded,  i 

•■  -  turing  full  ghastly,  like  a  strangled  man  ;  j 

His  hair  upreared,  his  nostrils  stretched  vrith  sti-uggling."  ' 

i 
When  the  asphyxia  is  produced  by  inhaling  carbonic  acid — choke-   j 

damp — or  other  irrespirable  gas  or  mephitic  exhalation,  the  countenance    j 
is  paJlid,  the  whole  surface  is  also  pale,  and  death  oflen  takes  place  in-    j 
stantly,  save  when  the  deleterious  aura  is  largely  diluted  with  common    j 
air,  in  which  case  the  symptoms  more  or  less  resemble  apoplexy.    Of  the    ! 
gases  positively  pernicious  to  breathe,  are  the  carbonic  acid,  often  found    ' 
in  close  rooms  where  charcoal  has  been  burned,  in  the  bottom  of  wells, 
or  large  beer-casks,  and  in  natural  caverns;  the  carburetted  hydrogen,    ' 
and  various  compound  gaseous  products  evolved  from  decomposing  an- 
imal and  vegetable  substances,  and  from  the  puti-efjiug  corpses  of  cem 
etaries;  and  of  the  negatively  injurious  gases — those  which  do  not  sup 
port   respiration — are  hydrogen    and    nitrogen  ;   some    of  their  com-    j 
pounds,  however,  with   sulphur,  carbon,  and    phosphorus,  are    abso-    j 
lately  destructive.      The  fumes  of  mercury,  lead,  and  various  other    I 
metnllic  substances,  when  highly  concentrated,  operas  vrith  as  sudden 
facility  as  the  fumes  of  charcoal.  ' 

In  electrical  asphyxia,  which  is  produced  by  a  sti'oke  of  electi'icity  or 
lightning,  the  limbs  are  generally  flexible,  the  countenance  is  pale,  and 
the  blood  is  incoagulable  ;  usually  the  limbs  do  not  stiffen  after  death,    | 
and  the  body  becomes  rapidly  putrescent.     Sometimes  no  external  in-     j 
jury  whatever  is  observable  ;  but  in  other  cases  the  skin  is  vesicated,     I 
the  hair  is  scorched,  and  the  body  more  or  less  lacerated  and  torn. 

When  the  disease  results  from  intense  sold — frost-bitten  asphyxia — 
the  limbs  are  rigid,  the  countenance  pale  and  shrivelled ;  it  comes  on 
more  gradually  than  the  other  forms ;  there  is  a  tendency  to  sleep,     : 
which  increases  us  the  period  of  exposure  is  extended ;  and  when  this 
is  joined  with  fatigue,  the  torpor -and  drowsiness  often  become  irre-     j 
eistible. 

Various  narcotic  poisons,  as  cicuta,  tobacco,  and  Prussic  acid,  when 
taken  in  large  quantities,  and  also  the"  anesthetic  agents,  as  ether  and 
chloroform,  in  exti'eme  doses,  will  produce  asphyxia,  attended  with     | 
total  insensibility  and  universal  musr-ular  relaxation.  ! 


DISEASES    OF    GENERAL   TORPITUDE.  241 

Treatment. — This  must  vary  with  the  cause.  The  variety  produced 
by  hanging  is  hardly  a  medicable  case  ;  yet  if  the  strangulation  has  not 
continued  too  long,  nor  the  neck-joint  been  fractured  or  dislocated, 
there  is  a  chance  of  restoring  respiration  by  some  of  the  means  about 
to  be  mentioi  ed.  Death  from  submersion  does  not  result,  as  is  gen- 
erally supposed,  by  water  entering  and  filling  the  lungs,  but  from  suf- 
focation produced  by  a  spasmodic  constriction  of  the  glottis — an  instinct- 
ive effort  to  keep  the  surrounding  water  out  of  the  lungs.  How  long 
life  can  be  maintained  under  water  is  uncertain ;  and  the  time  probably 
depends  partly  on  the  natural  capacity  of  the  lungs,  and  partly  on  the 
extent  to  which  they  happen  to  be  inflated  when  respiration  ceases. 
Individuals  can  generally  be  resuscitated  if  not  submerged  more  than  five 
minutes  ;  very  often  after  having  been  ten  or  fifteen  minutes  under 
water ;  and  in  some  instances  persons  have  recovered  after  an  hour's 
submersion.  Recoveries  have  been  reported  after  a  much  longer  sub- 
mersion— several  hours,  and  even  several  days  ;  but  such  reports  seem 
to  challenge  human  credulity  rather  severely.  Be  this  as  it  may,  our 
duty  is  plain ;  it  is  to  endeavor  to  resuscitate  the  patient  so  long  as 
there  are  the  least  indications  of  a  spark  of  remaining  vitality.  Instan- 
ces are  well  authenticated  of  patients  having  recovered  after  a  perse- 
verance in  the  restorative  means  for  eight  or  ten  hours. 

The  remedial  plan  comprises  two  distinct. indications  ;  1.  To  restore 
warmth  and  circulation  to  the  surface.  2.  To  inflate  the  lungs.  In 
the  first  place,  the  patient  should  be  wiped  dry,  wrapped  in  clean  warm 
blankets,  and  conveyed  in  a  recumbent  posture  on  the  back,  with  the 
head  and  breast  raised,  to  a  warm,  dry,  welj-ventilated  room,  and  sur- 
rounded by  no  persons  except  the  necessary  attendants.  Dry  warm 
flannels,  and  bottles  or  bladders  of  warm  water,  or  bags  of  warm  grain 
or  sand,  are  to  be  applied  to  the  stomach,  feet,  and  sides,  and  the  sur- 
face should  be  thoroughly  and  perseveringly  rubbed  by  the  Avarm  dry 
hands  of  the  attendants.  The  mouth  and  nose  should  be  promptly 
cleansed  of  the  obstructing  mucus,  and  the  foul  air  may  be  sucked 
out  by  means  of  a  tube,  which  may  also  be  used  for  inflating  the  lungs, 
as  in  figure  187. 

The  inflation  of  the  lungs  is  the  most  important  of  all  the  curative 
processes.  This  may  be  done  by  repeatedly  forcing  into  the  patient's 
mouth — the  nostrils,  meanwhile,  being  held  close — a  full  expiration 
of  air  from  the  lips  of  an  attendant,  or  by  means  of  the  tube  repre- 
sented in  figure  187,  alternating  the  expiration  with  moderate  but 
firm  pressure  on  the  external  abdominal  muscles,  so  as  to  simulate 
all  the  motions  of  natural  respiration.  A  common  bellows,  when  well 
managed,  is  preferable,  because  it  will  convey  pure,  unrespired  air  to 
11-21 


242 


PATHOLOGY    AND    T  HE  K  APE  U  TICS. 


the  lungs ;  and  if  the  bellows  can  be  attached  to  a  tube,  and  this  in- 
troduced into  the  larynx,  the  effect  will  be  better  still. 

Fig.  187, 


INFLAIING  THE  LUNGS. 

It  may  excite  the  surprise  of  the  non-professional  reader  to  be  told 
chat  bleeding,  even  in  the  asphyxiated  state,  is  an  approved  allopathic 
remedy  in  this  disease.  Many  physicians  of  "high  authority"  recom- 
mend opening  the  jugular;  while  other  high  authorities  oppose  the 
practice,  not  on  the  gi'ound  of  its  impropriety,  but  because  the  blood 
will  seldom  tiow  if  the  jugular  is  opened.  Samuel  Cooper  dissents  in 
part.  He  says':  "Bleeding  ought  never  to  be  employed  m  this  stage 
of  the  process,  though  it  may  become  necessary  when  the  circulation 
has  returned,  and  reaction  has  taken  place."  This  means,  liberally 
interpreted,  that  after  the  patient  is  out  of  danger  it  will  not  kill  him  to 
lose  a  little  blood,  although  it  might  have  been  the  death  of  him  while 
the  danger  existed! 

When  the  disease  is  caused  by  deleterious  gases,  narcotic  or  metal- 
lic fumes,  etc.,  or  the  anaesthetic  agents,  the  treatment  chiefly  consists 
in  exposing  the  patient  freely  to  the  open  air,  dashing  co-Id  water  in  the 
face,  pouring  cold  water  over  the  head,  and  active  friction  with  pulmona- 
ry inflation,  as  in  the  preceding  variety.  Injections  of  cold  water  are 
also  serviceable  ;  sprinkling  or  dashing  cold  water  over  the  surface,  fol- 
lowing the  application  with  active  friction  with  the  bare  hand,  has  beer 
tried  with  evident  advantage. 

In  the  case  of  apparent  death  from  electricity,  all  the  appliances  just 
named  may  be  called  in  requisition;  but  as  far  as  experience  can  guide 
us,  dashing  cold  water  freely  over  the  breast,  face,  and  even  the  whole 
body,  and  the  prolonged  pouring  b>ath  to  the  head,  are  the  most  im- 
portant processes 


DISEASES    OF    GENERAL   TORPITUDE.  243 

Here  again,  mnny  of  the  shining  lights  of  allopathy  insist  that  the  pa- 
tient ought  to  lose  a  little  of  his  blood,  as  well  as  all  of  his  sensibility. 
M.  Portal  recommends  opening  the  external  jugular ;  Dr.  Doane  thinks 
the  absti'action  of  a  few  ounces  has  done  good ;  and  Dr.  A.  H.  Ste- 
vens, of  this  city,  has  recorded  a  case  of  injury  by  lightning  successful- 
ly treated  by  copious  venesection;  that  is  to  say,  the  amount  of  blood 
drawn  within  ten  days  was  about  one  hundred  and  twenty  ounces !  If 
a  patient  can  survive  a  sti'oke  of  lightning  long  enough  to  go  through  a 
ten  days  course  of  venesection,  it  is  conclusive  evidence  that  he  can 
live  better  without  the  remedy  than  with  it.  Dr.  Stevens  has  afforded 
another  demonstration  of  the  old  proverb,  that  many  patients  recover  in 
spite  of  the  disease  and  the  doctor. 

In  asphyxia  from  cold,  the  application  of  warmth  must  be  cautiously 
managed.  When  a  limb  or  part  is  frozen,  the  coldest  water  should  be 
employed  in  the  first  instance,  and  the  temperature  gradually  raised ; 
the  patient,  meanwhile,  should  be  kept  in  a  moderately  cool  atmosphere 
until  the  circulation  is  restored.  Rubbing  the  frost-bitten  part  with 
snow  until  sensibility  returns,  and  then  with  warm  water,  and  after- 
ward the  dry  hand,  is  an  excellent  plan.  In  cases  of  extreme  torpor 
from  cold  when  no  part  is  absolutely  frozen,  friction  with  wool,  flannel, 
or  the  dry  hand  is  appropriate. 

Ecstasy. — This  affection  is  peculiar  to  those  states  of  bodily  de- 
rangement of  which  mental  aberrations  or  extravagances  are  symptomat- 
ic ;  hence  it  attacks  chiefly  melancholic,  hypochondriac,  visionary,  and 
abstracted  persons. 

Symp)toms. — The  paroxysm  consists  of  a  sudden  and  total  suspension 
of  sensibility  and  voluntary  motion,  the  pulsation  and  breathing  contin- 
uing, with  rigid  muscles,  and  an  erect  and  inflexible  position  of  body. 
In  most  cases  there  is  also  a  complete  suspension  of  mental  power. 
The  dui'ation  of  the  fit  varies  from  two  or  three  hours  to  as  many  days, 
at  the  end  of  which  the  patient  rouses  as  from  sleep. 

Special  Causes. — A  morbid  state  of  the  liver  ;  powerful  menta 
excitement;  long-continued  meditation  on  a  particular  subject;  pro- 
longed suspense  of  mind ;  venereal  excesses  ;  self-pollution  or  ona- 
nism. 

Treatment. — Out-door  exercise  by  walking,  riding,  sailing ;  varied 
scenery  ;  lively  company  ;  cheerful  convei-sation  ;  amusements  of  the 
laughable  kind;  regular  employment  or  occupation,  with  a  daily  bath 
and  plain  food. 

Catalepsy.-— The  only  essential  distinction  authors  make  between 


244  PATHOLOOr    All  D    THER  APEU  TI  DS. 


ecstasy  and  trance  is  that  of  the  flexibility  or  inflexibility  of  the  mus- 
cles ;  in  the  disease  under  consideration  the  muscles  are  lax  and  yield- 
ing, and  the  body  yields  to  and  retains  any  given  position.  The  eyes 
remain  open,  and  are  fixed  intently  upon  some  object,  but  usually  no 
perception  accompanies  the  apparent  vision.  The  fit  generally  comes 
on  without  premonition,  and  in  most  cases  closes  w^ith  singing.  Its  du- 
ration is  from  a  few  minutes  to  several  days.  This  affection  is  some- 
times counterfeited,  and  the  real  disease  has  been  sometimes  mistaken 
for  actual  death,  '^he  causes  and  treatment  are  the  same  as  those  of 
the  preceding  disease. 

Lethargy. — Deep  sleep  does  not  perfectly  express  the  leading  char- 
acter of  this  disease,  as  it  is  sometimes  wanting.  Lethargy  is  distin- 
guished from  asphyxia,  ecstasy,  and  catalepsy,  by  the  apparent  general 
ease  and  quietude  of  the  body ;  and  from  apoplexy,  by  the  eyelids  be- 
ing closed  and  the  limbs  gently  reclining,  as  in  natural  sleep. 

Symptoms. — Sometimes  the  sleep  is  profound,  and  without  intervals 
of  sensation,  waking,  or  consciousness;  sometimes  the  sleep  is  remis- 
sive, and  the  patient  occasionally  a^vakens  and  recovers  sensation  and 
speech,  constituting  the  coma  somnolentum  of  authors ;  and  in  a  third 
variety — the  typliomania  and  coma  vigil  of  pathologists — there  is  a 
perfect  lethargy  or  insensibility  of  the  body;  while  the  mind  is  only 
imperfectly  lethargic,  manifesting  confused  and  w^andering  ideas,  and, 
during  sleep,  possessing  a  behef  of  wakefulness.  This  form  is  fre- 
quently a  symptom  in  various  fevers. 

Special  Causes. — Violent  menta  commotion,  fright,  furious  anger, 
excessive  mental  labor,  night- work,  lepelled  eruptions  or  exanthems, 
congestion  or  effusion  in  the  brain. 

Treatment. — Essentially  the  same  as  in  the  preceding  two  diseases, 
save  that  the  exercise  must  be  of  the  recreative  rather  than  laborious 
kind.  The  pouring  head-bath  is  a  promising  measure  during  the 
paroxysm. 

ApT-r,EXY. — This  disease  is  one  of  the  results  of  a  constipated,  ob- 
*l.  led,  plethoric,  and  overburdened  body.  Excessive  alimentation, 
with  defective  depuration,  and  some  internal  visceral  obstructions  or 
compressions,  are  the  obvious  conditions  on  which  the  apoplectic  fit  de- 
pends ;  and  hence  we  rarely  witness  the  disease  except  among  the 
full-fed,  the  corpulent  or  obese,  and  the  gross  or  high  livers  :  and  eveu 
then  we  almost  invariably  find  inattention  to  the  functions  of  the  ex- 
creting organs  or  outlets  of  the  body  among  the  predisposing  circum 
stances. 


DISEASES    OF    GENERAL    TORPITUDE.  245 

This  view  is  simple  enough,  and  not  difficult  to  understand.  But  in 
medical  books  we  find  a  world  of  confusion  on  the  whole  subject. 
Every  thing  relating  to  its  causes,  seat,  nature,  and  proper  treatment, 
is  there  hypothetical,  unsettled,  contradictory — a  mountain  mass  of  sci- 
entific absurdity  and  erudite  inconsistency. 

Some  authors  regard  it  as  a  disease  of  the  sanguineous  system ; 
others  as  an  affection  of  the  nervous  system.  Some  writers  contend 
that  the  immediate  cause  is  always  some  effusion,  extravasation,  or 
other  structural  derangement  in  the  brain;  while  others  declare  that 
such  circumstances  are  never  necessary  conditions.  Some  pathologists 
argue  that  compression  of  the  brain  is  the  universal  immediate  cause; 
while  others  as  ably  theorise  that  the  brain  is  incompressible.  And  in 
relation  to  treatment,  some  authors  rely  on  copious  bleedings  and  other 
depletory  processes  as  the  only  hopeful  treatment ;  others  condemn 
large  bleedings  as  injurious,  but  gc  for  small  ones ;  whilfe  others  con- 
demn all  bleeding  and  all  depletion  as  bad,  and  advocate  the  very  oppo- 
site treatment — brandy  and  general  stimulants ;  and  yet  others  con- 
sider bleeding  good  in  some  cases  and  bad  in  others,  the  great  point 
of  skill  in  the  physician  being  to  determine  when  to  employ  and  when 
to  withhold  the  lancet. 

Symptoms. — The  distinctions  which  authors  make  of  this  disease, 
into  sanguineous  and  serous,  entonic  and  atonic,  simple  and  congestive, 
etc.,  are  unimportant,  as  they  relate  only  to  the  gi'eater  or  less  debility 
of  the  patient  at  the  time  of  attack.  Sometimes  the  disease  comes  on 
suddeiriy  without  the  least  premonition  ;  sometimes  the  attack  is  pre- 
ceded by  a  sudden  paralysis  of  one  side  of  the  body,  and  sometimes  it 
is  ushered  in  by  acute  headache,  nausea,  faintness,  noises  in  the  ears, 
confused  vision,  incoherence  of  ideas,  loss  of  memory,  and  numbness 
of  the  extremities.  The  fit  is  characterized  by  complete  insensibility ; 
slow,  noisy,  and  usually  stertorous  or  puffing  breathing ;  impeded 
deglutition;  flushed  and  livid  countenance ;  prominent  and  motionless 
eye,  and  generally  a  fixed  or  contracted  state  of  the  pupil ;  the  limbs 
are  rigid,  motionless,  or  convulsed ;  the  bowels  are  obstinately  consti- 
pated, or  the  faeces  pass  involuntarily ;  the  urine  is  passed  uncon- 
sciously, or  retained  until  the  bladder  is  full,  then  dribbling  away.  The 
pulse  is  variable ;  it  may  be  full,  hard,  and  quick,  or  weak  and 
frequent. 

Diagnosis. — It  rnay  be  distinguished  from  the  stupor  of  drunkenness, 
by  the  alcoholic  odor  of  the  breath  in  intoxication,  and  from  the  narcosis 
produced  by  various  poisons,  by  the  capability  of  occasionally  rousing 
the  patient  in  the  latter  affection. 

T"eatment. — The  fii'st  thing  to  be  done  is  to  remove  the  patient  to  a 


246 


PATHOLOGY  AND  THERAPEUTICS. 


POSITION    IN    APOPLEXY. 


cool,  spacious,  well-ventilated  apartment,  hosen  all  the  clothing  about 
the  chesty  remove  eve~y  thing  from  around  the  neck,  and  place  him  iu 
ao  easy  and  nearly  uprght  posture,  as  in  fig.  188. 

Fig.  138.  Follow  the  prepai'atoiy 

measures  with  the  cura- 
tive processes,  which  con- 
sist mainly  of  the  pouring 
head  bath ;  Ava^'m  water 
and  warm  cloths  to  the 
feet,  and  occasionally  hot 
fomentations  to  the  n'oao- 
raen.  If  the  fit  continue, 
the  cold  stream  may  be 
applied  to  the  head  for  a 
quarter  to  half  an  hour, 
several  times  a  day ;  the 
cold  wet  girdle  to  the  ab- 
domen should  succeed  the 
hot  fomentation,  which  may  be  resorted  to  eveiy  two  or  three  hours, 
for  ten  or  fifteen  minutes  each  time  ;  and  friction  to  the  lower  ex- 
tremities with  a  cold  wet  cloth,  followed  by  the  warm  flannel  or  dry 
hand  rubbing,  is  a  valuable  auxiliary.  No  attempt  should  be  made  to 
give  any  thing  by  the  mouth,  until  the  breathing  is  materially  relieved, 
and  then  only  moderate  draughts  of  cold  water  should  be  administered. 
The  prophylaxis^  or  preventive  medication,  consists  in  a  daily  cold 
bath,  plain,  simple,  abstemious  diet,  regular  hours  for  eating,  laboring, 
and  I'esting,  and  a  careful  avoidance  of  all  violent  exertion,  strong  men- 
tal excitements,  depressing  passions,  etc. 

Palsy — Paralysis — Paresis. — The  same  general  causes  which 
tend  to  the  production  of  apoplexy,  are  among  the  most  efficient  pre- 
disponents  to  palsy.  The  disease  before  us,  however,  is  more  fre 
quently  dependent  on  organic  changes;  and  when  merely  functional, 
is  more  generally  connected  with  nervous  exhaustion.  The  ancients 
regarded  apoplexy  and  palsy  as  modifications  of  one  essential  disease  ; 
"  apoplexy  leing  a  universal  palsy,  and  palsy  a  partial  apoplexy." 

SympLoms. — Paralysis  mny  be  attended  v*'ith  a  total  or  partial  loss  of 
sensation  only  in  the  part  affected,  or  a  loss  of  voluntary  motion  only, 
or  of  both.  The  precursive  symptoms  are  sometimes  the  same  as 
those  of  apoplexy,  but  more  generally  the  disease  comes  on  gradually, 
an  ocrasional  sense  of  weakness,  and  troublesome  but  transient  feelings 
of  numnness  being  the  leading  adtnouit  ons ;  and  these  ai'e  often  ob- 


DISEASES    OF    GENERAL    TORPITUDK  2l7 

servable  in  a  single  finger,  in  one  eje,  the  tongue,  or  one  side  of  the 
face  alone. 

In  the  hemiplegic  variety  the  disease  is  confined  to  one  side  of  the 
body,  which  is  affected  from  the  top  to  the  bottom  of  the  mesial  line. 
This  form  is  often  a  sequel  of  apoplexy. 

In  the  ]ia,raplegic  variety  the  lower  part  of  the  body  is  paralyzed  on 
both  sides,  or  any  part  below  the  head.  When  not  caused  by  some 
local  injury,  it  is  almost  always  preceded  by  costiveness. 

Particular  or  local  palsy  is  confined  to  particular  limbs,  or  to  a  par- 
ticular part  of  the  body.  Wiien  it  affects  the  face,  the  expression  of 
countenance  is  peculiar,  the  features  are  drawn  to  one  side,  and  of 
course  the  two  sides  are  not  symmetrical,  and  the  deformity  is  in- 
creased when  the  patient  attempts  to  whistle,  speak,  laugh,  cry,  sneeze, 
or  cough. 

A  variety  of  local  paralysis,  to  w^iich  those  who  work  in  quicksilver 
mines,  at  water-gilding,  etc.,  are  subject,  called  mercurial  tremor,  comes 
on  with  weakness  and  convulsive  twitchings  in  the  arms,  gradually  ex- 
. tending  to  the  lower  extremities,  and  finally  to  the  whole  body;  and 
another  variety,  called  lead  palsy,  or  dropped  hand,  which  attacks  gla- 
ziers, plumbers,  oil-painters,  enamel  card-makers,  etc.,  begins  by  a 
feeling  of  weakness  in  the  fingers,  and  extends  to  the  wrist,  but  rare- 
ly beyond  it ,  shooting  pains  affect  the  arm  and  shoulder ;  the  parts 
affected  waste  and  emaciate,  and  the  hand  hangs  loosely  and  uselessly 
at  the  wrist. 

Special  Causes. — Most  of  the  causes  of  apoplexy  :  enlarged  or 
indurated  liver  or  spleen  ;  constipation  ;  venereal  excesses  ;  metallic 
fumes  :  narcotics  ;  alcohol ;  pungent  stimulants  ;  acrid  medicines,  as 
copavia,  turpentine  ;  sudden  and  extreme  alternations  of  temperature  ; 
pressure  upon  the  brain,  spinal  marrow,  etc.  ;  fever  tumors,  injuries, 
extravasations,  effusions  ;  loss  of  nervous  communication  from  structu- 
ral degeneration ;  intense  mental  emotion  ;  prolonged  wakefulness,  or 
excessive  night-work. 

Treatment. — The  prospect  of  cure  must  be  predicated  upon  the 
prospect  of  the  cause  or  causes  being  structural  or  fiinctional,  which 
point,  howevei-,  is  not  always  easy  to  determine.  But  in  either  case 
the  plan  of  medication  is  obvious,  and  the  same.  Some  few  cases  ar^ 
attended  with  a  difficulty  of  respiration,  and  the  indications  of  compres- 
Bion  of  the  brain,  resembling  apoplexy,  and  require  similar  manage- 
ment. For  bathing  purposes,  water  should  be  employed  as  cold  as  can 
be  borne  without  permanent  disco-mfort;  though,  as  a  general  rule,  the 
baths  should  be  of  short  duration.  In  paralysis  of  one  side,  the  ablution 
or  dripping-sheet  may  be  the  most  convenient  general  bath  ;  the  "«?ot- 


248  PATHOLOGY    AND    THERAPEUTICS 


sheet  pack,  followed  by  the  plunge,  is  still  better  when  there  is  a  good 
degree  of  remaining  vitality.  When  the  lower  part  of  the  body  or  low- 
er extremities  are  palsied,  the  shallow-bath  is  evidently  the  best  lead- 
ing water  process,  and  it  may  be  aided  by  frequent  hip  and  foot-baths. 
In  all  cases  thorough  friction  by  means  of  flannels,  flesh-brushes,  hand- 
rubbing,  shampooing,  etc.,  should  follow  the  application  of  water.  A 
moderate  douche  applied  generally  to  the  spine,  and  locally  to  the  part 
allected  is  serviceable  in  most  cases.  When  the  superficial  heat  is  too 
low,  or  the  general  torpor  too  great  to  admit  of  the  full-sheet  pack,  the 
half-sheet  may  be  beneficially  employed.  Whenever  the  extremities, 
or  any  portions  of  either  of  them  are  paralyzed,  the  wet  compresses, 
well  covered,  should  be  constantly  worn  and  frequently  renewed. 
Careful  attention  must  be  paid  to  the  diet ;  and  to  the  state  of  the  bow- 
els. Cool  injections  are  generally  necessary  daily;  the  patient  should 
drink  moderately  of  cold  water,  and  the  general  regimen  should  be 
precisely  on  the  plan  adapted  to,  and  recommended  for,  the  cure  of 
dyspepsia. 


CHAPTER  XII. 

VISCERAL   TURGESCENCE. 

A  SWELLING,  fiillness,  or  turgescence  may  exist  in  any  part  or  organ 
in  temporai-y  obstructions,  congestions,  or  inflammations;  but  the  pres- 
ent chapter  is  limited  to  those  afl^ections  of  the  internal  viscera  in  wdiich 
the  enlargement  is  chronic  or  permanent.  It  includes  the  following 
varieties,  which  make  the  species  of  Dr.  Good's  genus  parahysma  : 

Hepatic — Enlargement  of  the  Liver; 

Splenic,  "  "  Spleen: 

Pancreatic,  "  '  Pancreas; 

Mesenteric,  "  "  Mesentery; 

Intestinal,  "  "  Intestines; 

Omental,  "  "  Omentum; 

Complicated,  "  "  Various  Organs. 

Enlargement  of  thk  Liver.— The  sti-ucture  and  functions  of  the 
liver,  as  described  in  the  physiological  part  of  this  work,  explain  the 
reasons  why  lh«^  liver  is  more  snSject  to  chronic  enlargement  than  anv 


VISCERAL    TURGESCENCE.  24& 

other  organ  in  the  body.  The  morbid  alterations  of  structure  whicb 
constitute  its  intumescence  are  various,  as  simple  swelling,  tuberculai 
formations ;  hydatid  growths ;  hardening,  or  induration ;  softening,  oi 
fatty  degeneration  ;  and  that  result  of  bad  living  and  putrescent  blooo 
which  pathologists  have  called  black  ramollissement,  in  which  the  or- 
gan is  reduced  to  a  dark-colored  mass  of  very  little  consistence,  etc. — 
conditions  which  are  difficult  of  diagnosis  during  life.  Another  form  of 
structural  derangement  has  boen  called  gin-liver,  in  which  the  biliary 
portion  of  the  liver  is  both  hypertrophied  and  indui'ated,  as  well  as 
dropsical,  from  the  effect  of  the  free  use  of  ardent  spirits. 

Symptoms. — With  general  derangement  of  health,  and  various  symp 
toms  of  indigestion,  particularly  pale,  yellow  countenance,  irregular  and 
often  whitish  injections,  a  hard  tumor  may  be  found  in  the  right  hypo- 
chondrium,  verging  toward  and  often  appearing  at  the  pit  of  the  stom- 
ach. In  dropsical  persons  the  swelling  is  sometimes  enormous.  An 
enlarged  or  indurated  liver  is  common  to  persons  who  have  suffered 
frequent  or  prolonged  attacks  of  ague  and  fever,  and  has  then  been  de- 
nominated ague  cake. 

Special  Causes. — All  the  common  causes  of  vitiated  blood  and  impure 
secretions  tend  to  disease  the  liver ;  but  an  obstructed  skin,  by  which 
the  decomposing  and  putrescent  particles  of  the  body  are  retained  in 
the  system,  is  the  most  efficient  among  them.  Among  the  causes 
which  operate  indirectly  in  producing  obstruction  and  enlargement  of 
the  liver,  are  concentrated  food,  animal  oils,  or  greasy  matters,  swine- 
flesh,  shell-fish,  stale  meats,  old  cheese,  etc. ;  and  among  those  which 
operate  more  directly  to  produce  functional  disturbance,  followed  by 
organic  changes,  are  alcohol,  tobacco,  hot  drinks,  violent  passions,  etc. 
Treatment. — The  indications  are,  1.  To  promote  as  vigorous  absorp 
tion  throughout  the  entire  lymphatic  system  as  possible.  2.  To  purify 
and  invigorate  the  general  system.  For  flilfilling  the  first  indication, 
the  "hunger-cure,"  moderately  but  perseveringly  employed,  and  a 
moderate  douche,  frequently  applied  over  the  back,  especially  on  its 
upper  portion  and  over  the  shoulder-blades,  are  the  leading  measures ; 
and  for  the  second,  the  wet-sheet  nack,  or  shallov,'-bath,  or  both,  where 
the  external  temperature  is  considerable,  are  the  best  among  various 
useful  processes.  The  abdominal  compress  should  not  be  neglected ; 
and  when  there  is  pain  or  tenderness  about  the  epigastric  region,  or  in 
its  vicinity,  or  when  the  bowels  are  habitually  constipated,  the  warm 
stream  douche  to  the  whole  abdomen,  followed  by  the  cold  dash,  AvilJ 
be  advantageous. 

I  may  just  observe,  en  passant,  that  there  is  some  slight  discrepancy 
in  the  opini  ns  of  standard  medical  authors  regarding  the  tr-eatment  of 


260  PATHOLOGY    AND    THERAPEUTICS. 


the  .-nalady  under  consideratioi:  Thus,  Dr.  Elliotson  recommends 
iodFi  e  and  mercury  as  the  principal  remedies;  but  Abercrombie  says 
that  the  mercurial  practice  uniformly  sinks  the  patient  in  a  very  rapid 
manner. 

Enlargewe^t  or  the  Spleen. — Pathologists  seem  to  be  generally 
of  the  opinion  that  structural  disorders  of  the  spleen  occasion  but  very 
little  mischief  to  the  organic  economy.  I  think  differently.  It  is  ti-ue 
that  the  consequences  are  much  less  apparent;  but  if  the  opinion  I 
have  heretofore  advocated  respecting  the  functional  office  of  the  spleen 
is  correct,  a  derangement  of  its  function  must  be  followed  by  a  loss  of 
power,  to  some  extent,  throughout  the  entire  range  of  the  organic  or 
nutritive  functions ;  although  such  resul*"  would  not  be  manifested  by 
any  special  local  symptoms,  as  in  the  case  of  a  similar  morbid  condition 
of  the  liver. 

Baron  Dupuytren  found  that  dogs  maintained  apparent  good  health 
after  having  their  spleens  extirpated ;  but  medical  authors  generally 
confess  that  "  the  more  the  spleen  exceeds  its  natural  size  in  the  hu- 
man subject,  and  the  longer  it  retains  this  abnormal  condition,  the  more 
are  the  functions  of  respiration,  digestion,  etc.,  disturbed,  and  the  great- 
er is  the  impairment  of  the  general  health."  The  key  to  an  explana- 
tion of  all  these  facts  is  within  reach.  The  spleen  is  an  appendage  to 
the  higher  class,  or  brain-endowed  class,  of  animals  ;  and  its  especial  of- 
fice is  to  provide  in  part  for  the  additional  supply  of  organic  nervous 
influence  rendered  necessary  by  the  superstructure  of  the  encephalic 
mass,  while  it  performs  a  subordinate  duty  in  supplying  additional  ner- 
vous influence  to  the  general  nutritive  system.  Hence  the  importance 
of  the  spleen  in  the  animal  kingdom  has  a  direct  relation  to  the  size  of 
the  brain ;  which  fact  accounts  for  the  lesser  disturbance  its  disease  or 
removal  should  produce  in  the  small-brained  than  in  the  large-brained 
animal. 

Sifmpfoms. — It  is  known  by  an  indurated  tumor  in  the  left  hypo- 
chonh'ium,  verging  toward  the  spine  ;  as  with  the  preceding  disease, 
there  are  symptoms  of  general  ill  health ;  but  while  in  enlargements 
of  the  liver  these  symptoms  assume  the  forms  of  jaundice  and  dyspep- 
sia, they  will,  in  induration  of  the  spleen,  appear  in  the  shape  usually 
termed  nervous  debility.  The  patient  seldom  complains  of  pain  in  the 
region  of  the  organ  affected ;  his  appetite  is  good,  but  he  loses  flesh 
and  nmscular  sti'ength ;  his  features  have  a  dark,  bilious,  or  mahogany 
hue  ;  the  skm  is  dry,  the  lips  are  pale,  and  the  patient  is  not  infrequent- 
ly morose  and  desponding. 

Special  Causes.-    Thf  disease  often  appears  after  obstinate  intermit 


VISCERAL    TURGESCENCE.  261 

tent  or  remittent  fevers  ;  scrofulous  constitutions,  and  constitutions  de- 
bilitated by  intemperance  are  very  liable  to  it;  marshy  situations  and 
stagnant  waters  occasion  it ;  it  has  followed  suppressed  menstruation ; 
and  medical  authors  name  Peruvian  bark,  which  is  so  immodei*ate]y 
administered  in  interm.ittent  fevers,  as  a  cause  of  enlarged  spleen.  This 
affection  also  called  ague  cake. 

Treatment. — The  douche  should  be  frequently  applied,  with  as  much 
force  as  the  patient  can  comfortably  bear,  to  the  spine  and  left  hj^^o- 
chondriac  region;  and  in  all  other  resp*^cts  the  plan  recommended  for 
enlarged  liver  is  to  be  pursued.  ^ 

Enlargement  of  the  Pancreas  — This  is  a  rare  disease,  or  at 
least,  rarely  detected  in  the  living  subject,  but  occasionally  abscesses, 
ficirrhus  indurations,  tubercles,  calculous  depositions,  etc.,  have  been 
found  to  occupy  a  part  or  the  whole  of  its  structure. 

Symptoms. — These  are  obscure,  except  in  extreme  cases,  when  a 
hard,  elongated  tumor  may  be  detected,  extending  transversely  in  the 
epigastric  region,  and  accompanied  with  s^'mptoms  of  dyspepsia  and 
general  debility. 

Special  Causes. — From  the  analogy  existing  between  the  functions 
of  the  salivary  glands  and  pancreas,  authors  have  judged  the  habitual 
excitement  of  the  excretories  of  the  former  might  be  communicated 
sympathetically  to  the  latter ;  and  that  hence  tobacco-users  were  pe- 
culiarly liable  to  the  complaint ;  in  confirmation  of  which.  Dr.  Darwin 
relates  a  fatal  case  which  occurred  in  a  great  consumer  of  the  article — 
"  chewing  it  all  the  morning,  and  smoking  it  all  the  afternoon." 

Treatment. — As  in  the  preceding  varieties. 

Enlargement  of  the  Mesentery. — Enlargement  of  this  struc- 
ture may  be  in^the  form  of  hydatids,  of  tubercles,  scirrhus  induration  ; 
fleshy,  adipose,  or  fungus  excrescences,  or  calculus  deposits ;  or  sev- 
eral of  these  morbid  alterations  of  structure  may  be  coexistent. 

Symptoms. — The  affection  may  be  known  by  an  indurated  and  irreg- 
ulai"  mass  of  tumors  below  the  stomach,  yielding  to  the  pressure  of  the 
hand  ;  the  countenance  is  pale  and  bloated ;  the  appetite  is  irregular, 
often  voracious ;  and  general  atrophy  or  emaciation  attends. 

The  causes  and  treatment  are  similar  to  those  of  enlarged  liver. 

Enlargement  of  the  Intestines. — Tn  some  cases  the  induration 
IS  confined  to  the  coats  of  the  intestines;  and  in  others  adhesions  unite 
the  intestines  to  the  wals  of  the  abdomen  and  to  each  other. 

Syniptom.s. — The  int"  noscence  may  be  roimd  or  elongated,  hard  or 


252  PATHOLOGY    AJ^D    THERAPEUTICS. 

circumscribed  ;  but  is  movable  by  pressure  made  with  both  hands  ;  the 
action  of  the  bowels  is  irre^lar ;  there  is  usually  obstinate  vomiting, 
and  more  or  less  fever  and  emaciation. 

Treatment. — In  addition  to  the  general  remedial  plan  applicable  to 
all  varieties  of  visceral  turgescence,  the  peculiar  symptoms  of  the  af- 
fection before  us  demand  frequent  sips  of  iced  water,  cold  compresses 
to  the  stomach,  and  the  free  employment  of  tepid  injections. 

Enlargement  of  the  Omentum. — Turgescence  of  the  omental 
portion  of  the  peritoneum,  is  usually  of  a  complicated  character — indu- 
rated, scirrhus,  cartilaginous,  and  tuberculated ;  in  some  instances  the 
struc-ture  acquires  almost  a  stony  hardness. 

Symptoms. — The  tumor  is  indurated  and  diffused,  extending  fre- 
quently over  the  entire  abdomen;  it  is  accompanied  with  general  ema- 
ciation and  difficulty  of  breathing. 

The  treatment  does  not  differ  essentially  from  that  appertaining  to 
enlarged  liver. 

Complicated  Visceral  Enlargement. — This  is  merely  a  con- 
joint existence  of  several  of  the  diseases  we  have  already  considered. 
It  is  denoted  by  a  hard,  elevated,  and  distended  abdomen,  resembling 
that  of  pregnancy ;  the  belly  is,  however,  more  or  less  knott}'  and  un- 
equal ;  the  respiration  is  but  slightly  disturbed :  but  there  is  usually 
acute  pain,  thii-st,  nausea,  and  vomiting.  A  diseased  liver  is  the  com- 
mon starting-point  of  these  sti-uctural  monsti-osities :  and  our  only 
chance  of  cure  is  to  employ  assiduously,  in  the  infancy  of  its  malady,  all 
the  remedial  appliances  recommended  under  the  head  of  enlargement 
of  that  organ. 


CHAPTER   XIIL 

DROPSICAL  DISEASES. 


The  character  of  a  dropsical  affection  may  be  dehned:  a  pale,  indo- 
lent, and  inelastic  distention  of  some  part  or  of  the  whole  body,  from 
accumulation  of  a  watery  fluid  in  the  areolar  tissue  or  other  natuiTil 
cavities.  There  is,  hijwevcr,  one  exception  to  this  definition,  in  the 
case  of.  internal  hydrocephalus,  which,  though  usually  regarded  as  a 
dropsical  disease,  is,  ic  reality,  a  strumons  inflammation  of  the  brain 


DROPSICAL    DISEASES.  :253 

The  principal  forms  of  disease  belonging  to  the  chapter  before  us  may 
be  grouped  : 

Cellular  C  General — Anasarca,       Dropsy  of  (  External  Hydrocephalus, 
Dropsy  (  Local — CEdema.  the  Head  (  Internal  Hydrocephalus. 

Dropsy  of  the  Spine — Spina  Bifida. 

Dropsy  of  the  Chest — Hydrothorax. 

Dropsy  of  the  Abdomen — Ascites. 

Dropsy  of  the  Ovaiy — Hydrops  Ovarii. 

Dropsy  of  the  Fallopian  Tubes — Hydrops  Tabalis. 

Dropsy  of  the  Womb — Hydrops  Uteri. 

Dropsy  of  the  Scrotum — Hydrocele. 

(  Cellular, 

Wind  Dropsy — Emphysema  }  Abdominal, 

f  Uterine. 

<  Puerperal  Tumid  Leg, 
Inflammatory  Dropsy  ^  ^^.^^.^^j  ^^^.^  ^eg. 

It  is  amusing  to  read  the  lengthened  discussions  which  have  been 
carried  on  by  medical  theorists  respecting  the  proximate  cause  or  es- 
sential nature  of  dropsy  ;  one  party  regarding  it  as  a  disease  depending 
on  diminished  absorption,  and  the  other  as  ably  contending  that  the 
fault  consists  in  increased  exhalation.  The  practice  predicated  on  the 
former  theory  is  stimulation,  and  on  the  latter,  antiphlogistication.  But 
as  neither  quinine  nor  bleeding  eifected  a  cure,  a  third  party  has  lately 
entered  the  field  of  conti'oversy,  and  cut  the  Gordian  knot,  by  blending 
both  doctrines  in  one  ;  and  declaring  that  diminished  absorption  and  in- 
creased exhalation  produce  the  disease,  the  therapeutic  indication  be- 
ing to  balance  the  action  between  the  absorbents  and  exhalents.  To  this 
party  we  are  indebted  for  the  mercurial  ti-eatment  of  dropsy,  which 
has  proved  even  worse  than  its  bad  predecessors. 

Cellular  Dropsy. — This  atfection  is  called  anasarca  when  it  ex- 
tends over  the  whole  body,  and  oedema  when  limited  to  the  areolar 
texture  of  the  limbs. 

Symptoms.— Cold  and  diffusive  swelling  or  puffmess  of  the  skm, 
which  pits  beneath  the  pressure  of  the  fingers ;  the  intumescence  is 
greatest  in  depending  situations ;  and  around  the  feet  and  ankles  the 
accumulation  increases  toward  evening,  and  decreases  during  the  night 
The  skin  is  paler  than  natural,  and  when  the  distention  is  great  it  as- 
sumes a  shining  appearance,  which  often  becomes  livid  and  discolored,, 
and  not  unfrequently  bursts  in  extreme  cases. 


254  PATHOLOGY    AND   1  HER  APE  U  T  ICS. 


Special  Causes.— Ml  the  :auses  of  general  debility  predispose  to 
dropsy.  Intemperance,  repe  le'l  eruptions,  exhausting  discharges,  sup- 
pressed evacuations,  and  structural  or  functional  obstructions  of  the  kid- 
neys, skin,  and  liver,  are  among  thi  frequent  causes.  (Edematous 
swellings  of  the  limbs  are  uften  symptomatic  in  mismensti-uation,  preg- 
nancy, etc.,  and  frequently  a  result  of  mere  debility,  as  in  protracted 
fevers,  etc. ;  constitutions  broken  down  by  merjuvy,  are  very  liable  to 
this  disease. 

Treatment. — In  all  dropsical  affections  of  the  cellular  membrane,  the 
indications  are,  1.  To  promote  the  absorption  of  the  effused  fluid.  2. 
To  prevent  its  re-accumulation.  The  first  indication  is  accomplished 
by  promoting  the  activity  of  the  excretory  organs  generally ;  and  the  sec- 
ond by  strengthening  the  whole  system ;  and  either  indication  must  be 
made  the  leading  one,  as  obsti'uction  or  debility  is  the  leading  proxi- 
mate condition.  As  a  general  lule,  quite  cold  water  is  preferable  for  bath- 
ing purposes,  but  the  duration  of  baths  should  be  short,  and  succeeded  by 
active  and  prolonged,  yet  gentle  friction  with  silk  or  soft  flannel,  or  bet- 
ter still,  the  bare  hand.  The  moderate  douche,  followed  by  a  thorough 
rubbing  in  the  dry  blanket,  and  the  wet-sheet  pack,  with  warm  bottles 
to  the  feet,  and,  if  need  be,  the  armpits,  are  among  the  best  general 
baths.  But  as  no  two  cases  present  the  same  set  of  circumstances, 
the  practitioner  will  always  find  a  ^vide  field  for  the  exercise  of  judg- 
ment. The  diet  must  be  mostly  of  the  dry  and  unconcentrated  kind, 
and  water  should  be  drank  only  to  the  extent  demanded  by  actual  thirst. 
Tepid  injections  should  be  freely  employed  when  there  is  the  least 
tendency  to  constipation.  Tlie  warm  douche,  or  spray-bath,  followed 
by  the  cold  dash  or  pail  douche,  is  an  excellent  process  when  the 
swelling  is  tender  and  painful,  and  particularly  serviceable  if  applied  to 
the  lower  part  of  the  abdomen  when  the  kidneys  are  torpid  or  ob- 
structed, which  will  be  known  by  scanty  or  difficult  urination. 

A  great  deal  of  importance  is  attached,  by  most  medical  wi"iters  on 
dropsy,  to  the  chemical  ingredients  in  the  urine,  and  the  changes  this 
secretion  undergoes  in  hydropic  patients;  and  Dr.  Johnson  even  ad- 
vises patients  at  a  distance,  when  writing  for  advice,  to  send  along  a 
bottle  of  urine  for  the  purpose  of  chemical  analysis.  Now  people 
ought  to  know  that,  however  amusing  or  interesting  such  experiments 
may  be,  they  are  of  no  utility  whatever,  as  regards  the  cure  of  the 
disease  ;  for  whether  the  urine  is  a  little  more  or  a  little  less  alhumin- 
ous,  or  ammoniacal,  or  alkaline,  or  acid,  or  saline,  it  is  all  the  same  as 
fw  as  the  treatment  is  concerned. 

J)Rovsr  OF  THE  Hkaf — Htdi  3ps  Capitis. — External  dropsy  of 


DROPSICAL    DISEASES.  256 

the  head,  commonly  called  chronic  hydrocephalus,  consists  of  an  accu- 
mulation of  watery  fluid  in  the  ventricles  or  convolutions  of  the  brain, 
or  between  the  membranes,  or  between  the  bones  and  dura  mater ; 
and  internal  dropsy — acute  hydrocephalus — is  an  inflammation  of  the 
membranes  or  substance  of  the  lower  part  of  the  brain,  which,  in  its  pro- 
gress, runs  into  suppuration,  and  produces  effusion  into  the  ventricles. 

Symptoms. — In  the  first  variety  there  is  an  oedematous  intumescence 
of  the  head,  while  the  sutures  of  the  skull  are  usually  separated ;  the 
whole  head  appears  preternaturally  large,  and  the  fontanelles  are 
prominent:  in  its  a\anced  stages  it  is  attended  with  languor,  drowsi- 
ness, costiveness,  vomiting,  coma,  frequently  convulsions,  and  some- 
times sti'abismus.  The  second  variety — the  cephalitis  prof unaa  of  Good's 
nosology — comes  on  gradually  and  insidiously ;  the  precursive  disturb- 
ances are  languor,  inactivity,  loss  of  appetite,  feverishuess,  etc. ;  these 
are  followed  by  darting  pains  in  the  head,  great  sensibility  to  light, 
contracted  pupils,  extreme  restlessness,  frequent  sighing,  disturbed 
sleep,  from  which  the  patient  often  starts  with  a  scream ;  in  a  later 
stage  the  bowels  are  irregular,  the  pulse  small  and  frequent,  and  deli- 
rium and  convulsions  sometimes  occur ;  as  the  disease  progresses  the 
pupil  dilates,  the  eyes  usually  present  a  squinting  appearance,  and  a 
low  moaning  takes  the  place  of  the  shrieks  ;  and  near  the  fatal  termina- 
tion, double  vision  or  loss  of  sight,  with  lethargic  stupoi,  ^r  violent 
convulsions  occurs.  Hydrocephalus  is  peculiar  to  infancy,  an  '  some- 
times commences  in  the  fcetus. 

Special  Causes. — Scrofulous,  scorbutic,  or  syphilitic  taint;  re^  elled 
eruptions ;  injury  to  the  brain  during  labor ;  bad  dietetic  habits  ol  the 
mother  during  pregnancy ;  frequent  exposure  of  the  mother  during 
pregnancy,  or  of  the  child  soon  after  birth,  to  the  powers  of  narcotic 
poisons,  particularly  tobacco. 

Treatment. — We  can  promise  but  little  in  either  form  of  hydro- 
cephalus unless  detected  and  treated  in  the  early  stages.  The  general 
plan  of  management  is  the  same  as  for  the  preceding  disease,  save 
that  a  good  part  of  the  treatment  should  be  derivative — half,  hip,  and 
foot-baths,  and  the  wet  girdle  to  the  abdomen.  The  pouring  head- 
bath  is  advisable  in  the  chronic  or  internal  variety.  The  external  form 
has  in  some  instances  been  relieved  by  evacuating  the  water  with  a 
lancet,  couching-needle,  or  trochar. 

Dropsy  of  the  Spine. — This  affection  is  mostly  congenital,  it 
consists  of  a  soft  fluctuating  tumor  on  the  spine,  from  fluid  accuiuu- 
Inted  within  the  coats  of  the  spinal  cord,  protruding  externally  in  con- 
sequence of  some  portion  of  the  vertebra!  column  being  defective.     Ii 


256  PATHOLOGY    AND    THERAPEUTICS. 

is  generally  fatal,  although  a  cure  has  taken  place  spontaneously  in  a 
few  instances,  and  several  cases  have  been  reported  as  cured  by  re- 
peatedly puncturing  the  sac  with  a  fine  needle.  With  the  exception 
of  this  surgery,  if  deemed  advisable,  the  proper  course  is  to  attend  to 
the  general  heallh,  and  "  trust  to  nature." 

Dropsy  of  the  Chkst — Hydrops  Thoracis. — In  this  affection 
the  fluid  may  accumulate  in  the  cavity  or  cavities  of  the  pleura  on  one 
or  both  sides,  or  in  the  mediastinum,  or  pericardium,  or  even  the  cel- 
lular texture  of  the  lungs.  These  distinctions,  however,  are  neither 
possible  to  ascertain  during  life,  nor  important  practically. 

Sjjmptoms. — With  a  constant  sense  of  oppressiou  in  the  chest,  there 
is  difficult  breathing  on  exercising  or  reclining  ;  the  countenance  is 
more  or  less  livid ;  the  urine  scanty  and  high  colored ;  the  pulse  is  ir- 
regular; the  extremities  are  oedematous;  the  patient  is  often  troubled 
with  startings  and  palpitations  during  sleep  ;  a  distressing  feeling  of  suf- 
focation frequently  attends ;  and  the  patient  can  get  no  rest  but  in  the 
erect  posture.     It  usually  attacks  persons  in  advanced  life. 

Special  Causes. — Hyperti'ophy  of  the  heart,  aneurism,  scirrhus  of 
the  stomach  and  liver,  and  other  organic  derangements,  frequently  pro- 
duce hydrothorax.  When  idiopathic,  if  ever,  it  is  produced  by  the 
common  causes  of  dropsy. 

Treatment. — In  a  majority  of  cases  our  prognosis  must  be  unfavora- 
ble ;  the  derivative  baths,  and  the  principles  already  adverted  to  as  ap- 
plicable to  the  treatment  of  dropsy  in  geneml,  are  all  our  grounds  of 
hope  in  the  case  before  us.  Some  few  cases  are  reported  in  medical 
works  as  having  been  caused  by  paracentesis  thoracis — an  operation 
which  will  be  described  in  the  surgical  department  of  this  work. 

Dropsy  of  the  Abdomen. — Ascites,  or  dropsy  of  the  belly,  is 
called  encysted,  when  the  fluid  is  contained  in  a  cyst  or  sac  of  adven- 
titious formation,  instead  of  accumulating  in  the  cavitj'  of  the  abdomen 
itself. 

Symptoms. — It  is  known  by  an  equal,  tense,  and  heavy  intumescence 
of  the  whole  belly,  which  distinctly  fluctuates  to  the  hand,  upon  a 
slight  stroke  being  given  to  the  opposite  side. 

Diagnosis. — In  the  enrysted  form  the  size  of  the  abdomen  enlarges 
gradually  and  steadily,  without  experiencing  any  sudden  increase,  de- 
crease, or  change  in  the  swelling;  where;is  the  distention  is  often  tem- 
porarily diminished  by  treatment  or  accidental  causes,  when  the  accu- 
mulation is  within  the  cavity  of  the  abdomen:  from  ovarian  dropsy,  by 
the    intumescence  commencing  lower  down  and  on  one  side  in   the 


DROPSICAL    DISEASES.  257 

latter  disease;  from  tympanites,  by  the  dullness  on  percussion,  and  by 
the  f.uctuation ;  from  retention  of  urine,  by  the  dribbling  of  water  in 
the  lutter  affection  ;  from  'pregnancy,  by  the  fluctuation,  and  state  of  the 
menses  and  breasts ;  and  from  cysts  or  hydatids  of  the  liver,  by  the 
swelling  in  the  latter  case  being  more  circumscribed,  and  commencing 
on  one  side  of  the  upper  part  of  the  abdomen. 

Special  Causes. — Repelled  eruptions,  or  exanthems,  very  frequently 
produce  this  disease.  Mercurial  ointments,  lead  washes,  and  other 
discutient  and  repellent  lotions  and  medicaments,  have  often  changed 
the  morbid  action  from  an  external  skin  disease  to  an  internal  dropsy.. 
Suppressed  catamenia  and  metastatic  gout  are  also  frequent  causes;  and 
it  is  often  symptomatic  of  diseased  or  disorganized  liver,  kidneys,  and 
other  organs. 

Treatment. — The  encysted  variety  cannot  be  cured  without  the 
operation  of  tapping  the  abdomen.  The  general  health  should  always 
be  improved  as  much  as  possible  before  the  operation  is  performed, 
for  which  purpose  the  packing,  douche,  and  foot-baths  are  necessary. 
Surgeons  are  always  apprehensive  of  danger  from  inflammation  at- 
tacking the  punctured  part,  but  the  danger  chiefly  arises  from  the  in- 
flammatory or  feverish  state  of  the  body,  or  the  obsti'ucted  condition 
of  the  excretories  at  the  time  of  the  operation.  If  the  general  sys- 
tem is  put  in  good  condition,  the  simple  operation  of  drawing  off  the 
water  by  tapping  can  seldom  be  serious,  much  less  dangerous. 

When  the  watery  fluid  is  collected  within  the  peritoneum  an  opera- 
tion is  sometimes  necessary;  but  fiequently  it  can  be  cured  by  the 
general  plan  of  management  applicable  to  cellular  dropsy.  The  abdo- 
minal bandage,  well  covered  and  renewed  five  or  six  times  a  day,  and 
a  free  use  of  injections,  are  specially  desirable  in  this  form  of  dropsy. 

Ovarian  Dropsy. — Dropsy  of  the  ovary  is  always  of  the  encysted 
character,  and  the  cysts  are  generally  combined  with  enlargement  of 
the  ovary  itself,  which  becomes  converted  into  a  hard,  whitish,  cartila 
ginous  mass. 

Symptoms. — The  tumor  commences  on  one  or  both  sides  of  the 
iliac  region,  and  gradually  spreads  over  the  abdomen ;  its  surface  ia 
unequal,  and  its  fluctuation  is  obscure  and  feeble,  and  in  some  cases  en- 
tirely imperceptible.     The  general  health  is  at  first  but  little  impaired. 

The  causes  of  ovarian  dropsy  are  similar  to  those  of  ascites,  and  the 
remedial  processes  must  be  conducted  on  the  same  general  plan.  Tap- 
ping should  never  be  resorted  to  until  the  increasing  distention  begins 
seriously  ta  affect  the  general  health ;  the  operation  cannot  be  relied 
on  to  offet    a  permaiien-  cure,  but  with  attention  to  the  general  health, 


258  PATHOLOGY    A  ^"  B   THERAPEUTICS. 

may<keep  it  in  check  so  that  the  /atient  may  enjoy  comfortable  health  for 
an  indefinite  period.  In  many  cases  the  operation  requires  to  be  re- 
peated several  times.  Extirpation  of  the  ovary  has  been  successful  in 
a  few  cases  ;  but  the  majoiity  have  not  long  survived  it. 

Fallopian  Dropsy. — Dropsy  of  the  Fallopian  tube  is  extremely 
rare;  in  its  early  stage  it  is  known  by  a  heavy,  elongated  swelling  of 
the  iliac  region,  spreading  ti'ansversely,  with  obscure  fluctuation.  The 
quantity  of  fluid  is  generally  greater  than  that  accumulated  in  the  pre- 
ceding variety;  and  the  prospect  of  cure  is  still  less  promising,  although 
the  same  measures  are  applicable. 

Dropsy  of  the  Womb. — This  disease — the  hydrometra  of  the  old 
authors  is  generally  the  result  of  some  structural  affection  of  the  ute- 
rus. In  some  few  cases,  when  the  orifice  of  the  uterus  is  closed,  wa- 
ter collects  in  its  cavity  ;  sometimes  a  large  cyst,  or  cluster  of  hydatids, 
originating  bet"vveen  its  tunics,  is  discharged,  accompanied  with  severe 
flooding;  and  occasionally  the  fluid  accumulates  in  its  cellular  tissue,  by 
which  the  organ  is  distended  to  an  enormous  size,  while  the  whole 
abdomen  appears  anasarcous. 

Si/mjjtoins. — Heavy,  circumscribed  tumor  or  protuberance  in  the  hy- 
pogastric region,  attended  with  obscure  fluctuation,  and  progressively 
enlarging;  the  mouth  of  the  uterus  is  thin  and  yielding,  and  the  com- 
plaint is  unaccompanied  with  pregnaiicy  or  ischury. 

Treatment. — The  genei*al  remedial  plan  is  the  same  as  the  preceding 
varieties.  When  the  mouth  of  the  uterus  is  closed,  the  water  may  be 
evacuated  by  the  introduction  of  a  cauula. 

Dropsy  of  the  Scrotu3I — In  some  cases  the  fluid  is  contained  in 
the  tunica  vaginalis,  or  surrounding  sheath  of  the  testis  ;  sometiines  in 
the  cellular  membrane  of  the  scrotum ;  and  in  a  third  variety  the  fluid 
has  accumulated  in  the  tunica  vaginalis  of  the  spermatic  cord.  Con- 
genital  hydrocele  is  that  form  of  the  disease  in  which  the  communica- 
tion between  the  cavities  of  the  peritoneum  and  tunica  vaginalis  is  in- 
closed, the  fluid  collecting  within  the  latter. 

Symptom'!. — The  vagirial,  or  first  named  variety,  is  the  proper  hy- 
drocele. The  intumescence  is  soft,  transparent,  and  pyriform  ;  it  is 
unattended  with  pain,  and  enlarges  gradually.  In  some  cases  the  tu- 
nic is  so  distended  and  transparent  that  a  candle  may  be  seedM:hrough 
Us  contents. 

Treatment. — In  recent  cases,  very  cold  sitz-baths  and  the  ascending 
douche,  each  repeated  several  times  a  da)  ,  or  refrigerating  local  appli- 


DROPSICAL    DISEASES.  .  259 

cations  of  icea-water  or  pounded  ice,  in  connection  with  the  genera, 
treatment  recommended  for  the  preceding  cases,  will  often  etiect  a 
cure.  When  the  cast  has  teen  of  long  standing,  the  operation,  to  be 
described  hereafter,  will  be  necessary. 

Emphysema — Inflavigx — Wind-Dropsy. — This  affection,  which 
is  caused  by  an  accumulation  of  air  in  the  natural  cavities,  differs  from 
dropsy  proper  in  the  distention  being  elastic  and  sonorous.  Sometiraea 
the  disease  results  from  external  injuries  p*^netrating  the  lungs  ;  some- 
times the  air  is  formed  by  a  process  of  putiefaction  or  decomposition; 
and  sometimes  it  is  secreted  directly  from  the  blood. 

Symptoms. — In  the  cellular  variety — the  pneumatosis  of  Sauvages — 
the  distention  is  sometimes  limited  to  particular  parts  of  the  body,  and 
sometimes  extends  over  the  whole  surface.  It  is  marked  by  a  tense, 
glabrous,  diffusive  intumescence  of  the  skin,  which  crackles  beneath 
the  pressure  of  the  fingers.  When  arising  from  a  wound  in  the  chest, 
which  penetrates  the  lungs — traumatic  emphysema — the  inspired  air 
may  rush  into  the  cavity  of  the  chest,  the  cellular  membrane  of  the 
lungs,  and  even  become  diffused  throughout  the  areolar  tissue,  pro- 
ducing a  universal  nidation,  which  is  attended  with  violent  palpitation 
and  extreme  danger  of  suffocation.  Occasionally  the  inflation  is  con- 
fined to  one  side  of  the  chest ;  it  is  then  called pnemno-thorax  ;  and  th^ 
form  is  sometimes  produced  by  ulcerations  which  destroy  some  part  of 
the  pulmonary  structure.  When  arising  from  fish-poison,  mushrooms, 
or  other  venom,  the  disease  is  accompanied  with  extensive  signs  of  pu- 
ti'escence  and  impending  mortification. 

In  tho  abdominal  variet}- — tympany — there  is  a  tense,  light,  and 
equable  distention  of  the  belly,  which  distinctly  resounds  to  a  stroke  of 
the  hand. 

When  the  uterus  is  inflated  with  air,  there  is  light,  tense,  circum- 
scribed intumescence  in  the  lower  part  of  the  abdomen,  obscurely  son- 
orous, and  accompanied  with  occasional  discharges  of  wind  through  the 
mouth  of  the  womb. 

Treatment. — All  the  varieties  of  the  disease  before  us  are,  happily, 
very  rare,  with  the  exception  perhaps  of  tympany,  and  this  is  mostly 
a  symptomatic  caftection.  The  general  plan  of  treatment  is  the  same 
as  for  dropsy  of  the  same  structure  or  Oi'gans.  In  emphysema  from 
wounded  lungs,  the  operation  of  puncturing  between  the  ribs  is  some- 
times attended  with  benefit,  and  the  dripping-sheet,  followed  by  dry 
vubbing  or  hand  friction,  is  probably  the  best  of  the  strictly  hydrothera- 
peutic  processes.  When  occasioned  by  poison,  the  wet-sheet,  so  man- 
aged as  to  produce  moderate  diaphoresis  •  sips  of  iced-water,  copiouj 


J60  PATHOLOGY    AND    THERAPE  GTIOS. 

injections,  etc.,  on  the  plan  lecommeuded  for  anatomical  erythema^ 
should  be  resorted  to.  In  the  abdominal  and  uterine  varieties,  copious 
cold  injections  by  means  of  the  pump  and  vaginal  syringes,  are  to  be 
frequently  employed;  the  spray-bath  and  the  ascending  douche  ai-e 
also  valuable  assistants. 

Inflammatory  Dropsy. — This  term  is  rather  awkward,  but,  un- 
fortunately, I  cannot  find  in  the  whole  range  of  pathological  nomen- 
clature any  more  appropriate  one ;  and  I  do  not  care  to  invent  new 
technicalities,  especially  as  we  have  already  a  vast  superabundance. 
The  terra  comprehends  the  two  diseases,  elephant  leg,  which  is  pecu- 
liaj'  to  hot  climates,  and  phlegmasia  dolens,  which  is  peculiar  to  lying- 
in  women,  both  of  which  are  characterized  by  a  tense,  diliuse,  inflam- 
matory swelling  of  one  leg. 

Symptoms. — In  the  tumid  leg  of  childbirth,  which  has  been  variously 
denominated  puerperal  swelled  leg,  bucneraia  sparganosis,  phlegmasia 
dolens,  phlegmasia  lactea,  ecchymoma  lymphatica,  anasarca  serosa,  cru- 
ral phlebitis,  and  cruvitis,  the  attack  usuall}'  comes  on  in  the  second  or 
thh'd  week  after  parturition  ;  the  intumescence  is  pale,  glabrous,  equa- 
ble, elastic,  and  acutely  tender;  to  the  touch  there  is  a  sensation  of  nu- 
merous irregular  prominences  under  the  skin,  and  it  is  accompanied 
with  a  constitutional  febrile  disturbance  of  the  hectic  type.  In  a  ma- 
jority of  cases  the  attack  commences  with  pain  in  the  groin  of  one 
side,  accompanied  with  fever,  and  followed  by  a  swelling,  which  ex- 
tends down  the  thigh  and  leg  to  the  foot,  and  in  a  day  or  two  the  whole 
limb  is  double  its  natural  size,  hot,  smooth,  exquisitely  lender,  and 
moved  with  gi-eat  difficulty.  The  fever  usually  begins  to  decline  in 
two  or  three  weeks,  but  in  some  cases  runs  for  six  or  eight  weeks, 
causing  extreme  emaciation.  In  a  very  few  instances  both  limbs  are 
alfected  simultaneously  ;  and  in  still  rarer  instances  the  arms  have  been 
attacked ;  in  many  cases  the  affected  limb  has  remained  enlarged  and 
weak  through  life.  It  may  be  added  here  that  a  disecise  very  like  the 
one  before  us,  if  not  identical,  has  sometimes  affected  the  male  sex. 

The  second  variety,  the  Barbadoes  leg,  bucnemia  tropica,  elephant 
leg,  is  common  to  hot  climates,  especially  the  West  Indies,  Arabia,  and 
the  Polynesian  Isles,  where  it  is  called  yava-skin,  from  the  supposition 
that  it  is  caused  by  drinking  a  heating  beverage  called  yava  ;  "and  like 
the  gout  among  ourselves,"  says  Dr.  Good,  "is  regarded  in  a  sort  of 
honorable  light."  It  is  known,  however,  in  temperate  climates,  and  a 
few  cases  h;iv3  occurred  in  the  United  States.  The  limb  is  hard,  livid, 
and  enormously  misshapen  ;  the  skin  is  at  first  glabrous,  but  afterward 
becomes  thick,  scaly,  and  warty  ;  in  some  places  bulging  out,  and  m 


DROPSICAL    DISEASES.  26x 


others  deeply  indented ;  the  attending  fever  is  irregularly  erratic  and 
intermittent,  which  eventually  subsides,  and  the  disfigured  limb  be- 
comes insensible,  and  only  troublesome  from  its  weight  and  bulk,  which, 
however,  is  regarded  in  some  semi-civilized  countries  as  a  badge  of 
honor,  as  the  gout  is  in  places  where  the  inhabitants  pretend  to  be 
Vv'holly  civilized. 

Special  Causes. — The  puerperal  variety  is  unquestionably  owing  to  a 
condition  of  body  which  may  significantly  be  termed  the  constipated 
diathesis.  The  general  pressure  on  the  blood-vessels  and  lymphatics 
during  pregnancy,  and  the  inflammatory  condition  of  the  whole  system, 
which  are  the  common  consequences  of  the  ordinary  method  in  which 
females  are  fed  and  doctored  through  pregnancy  and  delivery,  are  ex- 
actly calculated  to  produce  this  and  many  other  diseases  of  the  lying-in 
period.  The  complaint  under  consideration,  though  very  common  in 
allopathic  practice,  has  never  been  known,  and  probably  never  will  be, 
where  the  patient  has,  through  the  term  of  gestation,  lived  and  bathed 
hydropathically. 

The  second  variety  is  as  clearly  among  the  penalties  which  merci- 
less and  unrelenting  nature  has  attached  to  the  use  of  debilitating  stim- 
ulants, and  impure,  unhealthful,  and  obstructing  food,  with  inattention 
to  the  subject  of  a  clean  skin. 

Treatment. — Puerperal  swelled  leg  must  be  treated  precisely  as  an 
acute  inflammation.  The  wet-sheet  pack,  or  frequent  tepid  ablutions 
of  the  w^hole  body,  and  the  constant  employment  of  cold  wet  com- 
presses to  the  local  aifection,  are  the  leading  measures  of  treatment ; 
cold  water  may  be  freely  drank;  and  cool  injections  are  generally  nec- 
essary.    The  food  must  be  of  the  kind  called  "  fever  diet"  in  this  work. 

Medical  authors — and  they  have  elaborated  many  ponderous  treat- 
ises on  the  subject — are  singularly  at  variance,  and  as  it  appears  to  me, 
m^g\x\(iv\y  foolish,  in  their  notions  of  the  nature  and  treatment  of  this 
disease ;  while  their  practice,  or  the  disease  under  their  practice,  or 
the  patient  under  both,  has  been  singularly  unfortunate. 

The  second  variety  can  only  be  successfully  medicated  in  its  early 
stage.  The  pack  and  dripping-sheet,  the  leg-bath  and  leg-douche  are 
the  most  important  processes,  with  due  attention  to  simplicity  and  pu- 
rity of  food.  Amputation  has  been  tried,  but  in  most  cases  tetanus,  or 
a  gangrenous  ulcer  has  followed  ;  perhaps,  however,  because  tlie  P'en- 
eral  healtfi  was  uoi  duiy  carea  lur  previously  to  perrorming  rne  opera- 
tion. 


2e2  PATHOLOGY    AND    THERAPEUTICS 


CHAPTER  XIV. 

DISEASES  OF  MIS-OSSIFICATION. 

The  title  of  the  present  gi-oiip  of  diseases  is  taken  from  the  most 
prominent  symptom,  which,  though  indicative  of  an  excess,  deficiency, 
or  mal-assimilation  of  the  bony  structure,  does  not  very  well  express 
the  essential  nature  or  proximate  cause.     It  includes  • 

Rickets — Pwachia — Rachitis. 
Cretinism — Cyrtosis — Cretinismus. 
MoUities  Ossium — Softening  of  the  Bones. 
Fragilitas  Ossium — Brittleness  of  the  Bones. 
Osthexy — Ossification  of  soft  Structures. 
Exostosis — Bony  Tumor. 

Rickets. — This  disease  is  probably  of  modern  date.  The  first  ac- 
count we  have  of  it  was  published  by  Glissoh,  as  it  occurred  in  EnglanJ 
m  the  middle  of  the  seventeenth  century. 

Sy7npto7ns. — The  malady  sometimes  exists  at  birth,  but  more  fre- 
quently the  first  indications  are  observed  from  about  the  eighth  month 
to  the  third  year.  It  is  preceded  by  a  paleness  and  puffiness  of  the 
countenance,  and  a  yellow,  sulphur  hue  of  the  cheeks ;  the  body  at 
length  emaciates,  the  flesh  becomes  flaccid,  the  lower  limbs  grow  thin, 
while  the  head  increases  in  bulk,  the  forehead  becomes  prominent,  the 
spine  bends,  the  belly  is  tumid,  and  the  joints  are  loose  and  spongy 
The  mental  faculties  are  usually  clear  and  often  precocious. 

Special  Causes. — Hooper  says  the  causes  of  this  disease  are,  "bad 
nursing,  bad  air,  bad  food,  want  of  cleanliness."  It  is  certainly  the 
most  philosophical  discourse  on  oetiology  I  have  ever  read  in  an  allo- 
pathic book.  He  might  have  gone  farther  back,  and  told  us  as  truth- 
fully that  bad  air  and  bad  food,  and  inattention  to  personal  cleanliness  on 
the  part  of  one  or  both  parents,  produce  the  predisposition  to  it — the 
rachitic  diathesis. 

IreatmpnL — One  or  two  dailv  ablptions.  Dure  air.  olentv  of  sun- 
shine, good  mother's  milk,  abundant  cold  water-drinking,  and  brown 
bread,  hominy,  wheaten  grits,  potatoes,  and  good  fi-uits,  are  all  that 
need  be  named  among  the  remedial  agencies.  More  or  less  deformity 
will  always  exist. 


DISEASES    OF    M  IS- 0  SSIF  IC  ATION.  263 

Crktinism. — The  essential  differences  between  this  disease  and  the 
m'eceding,  are  the  tendency  to  goitre  or  enlargement  of  the  thyroid 
gland,  and  the  small  size  of  the  brain,  with  thick  skull  bones,  which 
characterize  the  present  affection. 

Symptoms. — The  bony  derangement  chiefly  affects  the  head  and 
neck ;  the  body  is  stinted ;  the  skin  is  wrinkled ;  the  complexion  ia 
wan;  the  countenance  is  vacant  and  stupid;  the  cranium  bulges  out, 
particularly  in  the  occipital  region,  while  the  crown  and  temples  are 
depressed  ;  the  sensibility  is  blunted  ;  all  the  mental  faculties  are  feeble 
or  idiotic;  the  moral  affections  seem  to  be  wholly  wanting;  and  a  ma- 
jority of  the  miserable  sufferers  are  both  deaf  and  dumb. 

Special  Causes. — Cretinism  was  first  noticed  about  the  same  time 
that  rickets  first  appeared ;  it  has  pi-evailed  severely  in  the  low  lands 
of  Switzerland,  in  the  secluded  valleys  of  the  Alps,  and  other  damp, 
shaded,  or  confined  places ;  hence  the  causes  of  rickets  and  cretinism 
cannot  be  essentially  different,  nor  need  we  add  any  thing  to  the 
treatment  named  for  the  former. 

MoLLiTiES  OssiUM. — A  general  fiexihility  of  the  bony  structure, 
formerly  denominated  sjiina  ventosa,  is  commonly  found  in  the  early 
periods  of  life,  as  fragility  or  hrittleness  is  peculiar  to  later  age.  Its 
immediate  cause  is,  of  course,  deficient  assimilation  of  osseous  mate- 
rials, but  its  more  remote  and  more  important  cause  must  lie  farther 
back,  in  some  derangement  of  the  primary  nutritive  functions. 

Symptoms. — A  bending  or  crooking  of  the  bones  in  different  parts 
of  the  body,  on  slight  exertion,  with  little  or  no  pain. 

Treatment. — Medical  books,  in  consideration  of  the  deficienc}^  of 
earthy  matter  in  the  bones,  have  undertaken  to  remedy  the  difficulty 
by  introducing  phosphate  of  lime,  alkaline  carbonates,  etc.,  in  libera? 
doses,  into  the  stomach;  and,  although  such  practice  may  seem  very 
reasonable  to  those  who  cannot  look  beyond  a  chemical  fact  to  a  phy- 
siological law,  it  has  never,  to  my  knowledge,  been  productive  of  the 
least  benefit.  The  rational  curative  measures  are  the  same  as  for 
rickets. 

Fragilitas  Ossium. — In  this  affection  the  substance  of  the  bones 
becomes  so  brittle  that  it  is  apt  to  break  on  slight  exertions.  The  im- 
mediate cause  is  a  deficiency  of  the  materials  of  the  gelatinous  struc- 
ture; and  the  general  treatment  is  the  same  as  for  the  preceding 
variety. 

UsTHExr. — This  term  imports  an  ossijic  diathesis,  a  bony  habit  of 


2M  PATHOLOGY  AND  THERAPEUTICS. 

body.  The  disease  consists  in  a  superfluous  secretion  and  deposit  of 
ossific  matter,  by  which  thw  soft  parts  are  more  or  less  indurated  or 
obstructed. 

Autliors  divide  this  affection  into  the  jmrenc/iymatous  and  vascular 
varieties,  as  the  bony  material  accumulates  in  the  substance  of  organs 
or  in  the  coats  or  membranes  of  vessels.     The  kidneys  and  bladder  are      i 
most  liable  to  calculus  concretions,  for  the  reason  that  they  are  espe-     : 
cialiy  designed  to  secrete  from  the  blood  and  expel  from  the  body  the 
greater  portion  of  effete  alkaline  and  saline  matters ;  hence  gravel  and 
stone  may  result  from  too  great  a  portion  of  earthy  material  in  the     : 
food,  or  from  deficient  elimination  of  its  excess  in  consequence  of     i 
functional  obstruction  or  debility.     Ossific  deposites  are  also  occasion-     ' 
ally  found  in  the  brain,  lungs,  thymus  gland,  substance  of  the  heart, 
structures  of  the  eye,  muscles,  etc.     The  vascular  form  most  fre-     \ 
quently  affects  the  aorta  or  other  large  arteries,  and  the  mitral  valves ;     | 
but  in  some  instances  the  pleura  and  other  membranes,  the  trachea,  and     I 
various  cartilaginous  structures  ossify.     In  all  these  cases  the  symp-     j 
toms  aj'e  exceedingly  obscure,  and   the   treatment  cannot  be  better     j 
expressed  than  by  the  general  phrase — attention  to  the  general  health,     j 

Exostosis. — Calculous  or  bony  tumors  may  be  seated  immovably  ' 
on  a  bone,  or  on  the  periosteum,  or  pendulously  in  a  joint,  or  fixed  or 
movable  in  some  fleshy  part  of  the  body.  These  affections  are  gen-  ' 
erally  sequelae  of  gout,  rheumatism,  syphilis,  etc.,  but  sometimes  appear  j 
in  persons  o-f  ordinary,  though,  of  course,  not  perfect  health.  They  are  I 
all  cases  for  surgical  treatment,  and  are  only  to  be  cured  by  extirpation 
or  amputation.  ' 


CHAPTER  XV. 

DISEASES  Ol-  3ENSATION 

The  diseases  of  the  present  group  are  somewhat  incongruous  in  a 
nosological  point  of  view;  but  as  they  are  susceptible  of  a  generic 
definition,  no  direct  violation  of  pathological  propriety  is  committed  in 
the  arrangement.  They  may  be  distinguished  by  darting  or  local 
pains,  occurring  in  paroxysms  with  irregular  intervals,  or  by  perverted 
sensation,  without  fever,  inflammation,  or  structural  change. 

They  are  all  symptomati:  of  nervous  exhaustion,  functional  obstruc 


DISEASES    OF    SENSATION.  266 


tion,  malformation,  or  local  accident  or  injury  ;  and  it  is  only  when  the 
primary  morbid  condition  is  too  obscure  to  be  recognized,  that  they 
are  to  be  treated  as  idiopathic  maladies.  The  following  are  all  that 
require  special  consideration : 

Cephalalgia,  Syncope, 

Neuralgia,  Morbid  Sight. 

Sleeplessness,  Morbid  Hearing, 

Restlessness,  Morbid  Smell, 

Antipathy,  Morbid  Taste, 

Vertigo,  Morbid  Touch. 

Cephalalgia — Cephal-ea  —Headache. — The  unbiassed  and  in- 
telligent student,  who  will  diligently  labor  through  the  various  attempts 
which  have  been  made  by  medical  authors  to  define,  describe,  arrange, 
classify,  expound,  and  medicate  the  single  and  seemingly  simple  sub- 
ject of  headache,  will  find  enough  of  confusion  confounded  to  convince 
him  that  a  system,  as  baseless  as  the  fabric  of  a  vision,  has  engaged  the 
minds  of  many  medical  philosophers,  rather  than  a  careful  and  correct 
observation  and  arrangement  of  the  phenomena  of  truth,  nature,  and 
common  sense.  The  ordinary  and  eveiy  day  causes  of  headache  are, 
indigestible  food,  overloaded  stomach,  constipated  bowels,  torpid  liver, 
inactive  kidneys,  obstructed  skin,  oppressed  lungs,  acidity,  flatulence, 
violent  passions,  suppressed  natural  evacuations  of  all  kinds,  and  their 
consequences,  thick  blood,  irregular  circulation,  etc.,  etc.,  to  which 
may  be  added  the  direct  effect  of  stimulating  drinks  or  nervines,  or 
their  sudden  withdrawal  after  the  system  has  been  accustomed  to  their 
use.  And  the  pain  of  headache  will  be  acute,  chronic^  periodic^  throb- 
bing, local,  or  general,  etc.,  according  to  a  multitude  of  circumstances 
which  bear  upon  each  individual  case.  All  this  is  plain  and  straight- 
forward. But  let  us  see  what  the  books  say.  Much  learning  has 
surely  made  them  mad.  Thus  Sauvages  divides  headache  into  acute, 
chronic,  and  jjcirtial ;  the  acute  he  subdivides  into  plethoric,  catamenial, 
kamorrhmdal,  dyspeptic,  febrile,  throbbing,  intermittent,  puerperal,  in' 
JiammaLory,  catarrhal,  nervous,  hysterical,  and  the  metallic  !  the  chronic 
he  subdivides  into  syphilitic,  scorbutic,  arthritic,  remittent,  melancholic^ 
l^licose,  and  serous  ;  and  the  partial  he  subdivides  into  2^ains  in  eyes,  sock- 
ets, and  frontal  sinuses, purulent,  nephralgic,  and  the  lunatic  hemicrania. 
Frank  divides  headache  into  four  species,  cephalalgia,  cephalaa,  hemi- 
crania, and  clavus ;  and  in  respect  to  their  nature  he  subdivides  these 
into  inflammatory,  rheuinatic,  gastric,  arthritic,  scorb  ■itic,periodic,  scrofu- 
lous, carcinomatous,  syphilitic,  and  nervous.  Dr.  Good  divides  head- 
ache into  stupid,  chronic,  throbbing,  7negri/>H,  and  sick.     Dr.  Burder 


566  PATHOLOGY    A!TD    THERAPEUTICS 


divides  headache  into  muscular,  periosteal,  congestive,  organic,  dyspep- 
tic, and  periodic.  Dr.  Weatherhead  divides  headache  into  dyspeptic^ 
nervous,  plethoric,  rheumatic,  arthritic,  and  organic.  Dr.  Copland 
divides  headache  into  nervous,  congestive,  plethoric  and  inflammatory, 
dyspeptic  and  bilious,  cerebra%  pericranial  or  neuralgic,  rheumatic  and 
arthritic,  periodic,  hypochondriacal,  and  the  sympathetic.  Dr.  Hooper 
divides  headache  into  internal  and  external  ;  the  former  being  subdi- 
vided into  congestive,  sympathetic  or  dyspeptic,  and  organic  ;  and  the 
latter  into  muscular,  periosteal,  and  neuralgic   etc.,  etc. 

The  same  confusion  prevails  among  medica  authors  with  respect  to 
the  pathology  and  treatment  of  this  complaint. 

Treatment. — Whether  idiopathic  or  symptomatic,  all  severe  head- 
aches require  prompt  and  special  palliative  medication,  although  the 
cure  must  be  sought  in  the  removal  of  the  morbid  condition  on  which 
they  depend.  The  majority  of  cases  can  be  relieved  at  once  by  put- 
ting the  feet  in  warm  water,  and  applying  cold  wet  cloths  to  the  head. 
The  hot  fomentation  to  the  abdomen  is  often  sufficient.  When  arising 
from  suppressed  menstruation  the  warm  hip-bath  is  advisable.  When 
the  cause  is  a  sudden  oold,  the  wet-sheet  pack  should  be  employed. 
If  the  stomach  is  exceedingly  irritable,  and  troubled  with  obstinate 
nausea  and  vomiting,  warm  waler-drinking  and  the  pouring  head -bath 
constitute  the  most  efficacious  practice.  When  arising  from  the  sud- 
den abstraction  of  stimuli,  as  of  wine,  tea,  coffee,  tobacco,  etc,  the 
patient  should  keep  very  quiet  for  several  days,  and  walk,  sit,  or  lie 
down,  as  he  finds  most  comfortable,  and  take  frequent  warm  foot  and 
cold  head-baths,  waiting  patiently  for  nature  to  restore  the  natural  sen- 
sibility and  tone  of  the  organism,  so  that  its  machinery  can  work  again 
without  the  lash  of  artificial  stimulation. 

Neuralwia — Nerve-ache. — Neuralgia  is  another  of  those  dis- 
eases which  are  among  the  growing  evils  of  the  increasingly  enervat- 
ing customs  of  civilized  society.  Until  a  very  modern  date,  the  only 
form  of  this  disease  known  to  medical  men  was  the  tic  doloreux,  or 
neuralgia  of  the  face ;  now,  however,  neuralgic  pains,  in  almost  all 
parts  of  the  body,  are  very  common  afflictions.  The  face,  jaws,  feet, 
and  breast,  are,  however,  most  frequently  the  parts  afiTected. 

Symptoms. — The  disease  is  recognized  by  acute  lancinating  pains, 
along  the  course  of  one  or  more  nervous  branches  of  the  organ  or 
part  affected,  which  recur  in  short  pRrox>sms,  with  irregular  intervals  ; 
usually  there  is  more  or  less  twitching  or  irregular  convulsive  motion 
of  the  adjoining  muscles.  In  facial  neuralgia  the  pain  shoots  from  the 
region  of  the  mouth  to  the  eyes,  ears,  cheek,  palate.,  fauces,  and  teeth. 


DISEASES    OF    SENSATION.  267 

sound  teeth  have  sometimes  been  extracted  on  the  suj3f osition  that 
some  concealed  ulcer  or  caries  occasioned  the  pain.  When  the  foot 
is  attacked,  there  are  racking  pains  about  the  heel,  darting  toward  the 
ankle  and  bones  of  the  tarsus.  In  nerve-ache  of  the  breast  the  sharp 
darting  pains  usually  divaricate  from  a  fixed  point  in  tho  breast,  and 
shoot  down  the  course  of  the  ribs  and  arm  to  the  elbow.  When 
other  parts,  organs,  or  particular  muscles  are  attacked,  the  disease  is 
easily  recognized  by  the  sharp,  darting,  cutting,  and  intermitting  char- 
acter of  the  pain. 

Special  Causes. — All  the  causes  of  dyspepsia,  and  every  thing  con- 
ducive to  nervous  debility,  are  among  the  causes  also  of  neuralgia. 
Those  enervating  influences  which  more  especially  predispose  to  this 
disease  are  tea,  coifoe,  alcohol,  tobacco,  excessive  brain  labor,  and  de- 
pressing emotions,  as  grief,  fear,  anxiety,  suspense,  disappointment,  etc 

Treatment. — I  know  not  upon  what  principle  our  allopathic  friend 
propose  all  the  most  virulent  poisons  of  their  materia  medica  for  the 
treatment  of  neuralgia,  unless  it  is  that  the  more  powerful  the  pain  the 
more  potent  should  be  the  poison  ;  or  in  other  words,  the  more  a  pa- 
tient suffers  from  disease,  the  more  he  should  be  made  to  suffer  from 
drugs.  Arsenic,  beiladona,  Prussic  acid,  henbane,  strychnme,  opium, 
quinine,  etc.,  etc.,  in  terrific  doses,  are  put  forward  as  the  most  prom- 
ising remedies,  while  surgery  comes  in  and  kindly  offers  to  interrupt 
the  morbid  sensibility  by  dividing  the  affected  nerves  between  their 
point  of  disti'ibution  and  the  common  sensorium. 

The  disease  before  us  appears  under  so  many  complications  that  the 
most  experienced  hydropath  will  have  to  feel  his  way  in  the  majority 
of  cases.  Every  circumstance  affecting  the  general  health  must  first 
be  inquired  into  and  placed  under  organic  law.  Usually  some  one  of 
the  excretories  will  have  been  for  a  long  time  toi-pid,  and  frequently 
the  bowels,  skin,  kidne3's,  and  liver  are  all  obstructed.  The  majority 
of  patients  we  meet  with,  too,  will  be  worn  down  with  suffering,  and 
poisoned  through  and  through  with  drugs,  or  farther  reduced  by  de- 
pletions, as  bleedings  and  blisterings  ;  hence  they  will  generally  be  ex- 
ceedingly tender  and  susceptible. 

The  treatment  should  generally  begin  with  gentle  bathing  in  tepid 
or  warm  water,  followed  by  moderate  friction  or  hand-rubhing.  The 
temperature  of  the  water  should  be  reduced  as  fast  as  possible — taking 
care,  however,  to  avoid  aggi'avating  the  pain  by  a  sudden  chill — consist- 
ently with  securing  a  comfortable  glow  after  each  application.  In  some 
few  cases,  where  the  external  heat  and  capillary  circulation  are  not 
materially  deficient,  cold,  and  even  very  cold  water,  is  more  sedative  and 
agreeable  than  tepid  or  wai*m.     Local  baths,  as  compresses,  half,  hip, 


76S  PATHOLOGY    AND    THER A P£  CJTICS. 

nnd  foot-barlis,  should  be  first  employed,  followed  by  the  half  or  full 
pack,  dripping-sheet,  plunge,  and  douche,  as  the  morbid  sensibility 
diminishes  and  the  sti-ength  improves.  In  many  cases  there  is  a  kind 
of  sub-paralysis  of  the  limbs,  or  a  rheumatic  lameness  and  rigidity  of 
the  muscles  of  the  affected  part ;  in  these  cases  the  warm  douche,  fol- 
lowed by  the  cold  dash,  is  excellent. 

Sleeplessness. — This  affection,  which  is  characterized  by  a  dififi- 
culty  or  inability  of  sleeping,  is,  when  not  symptomatic,  produced  by 
some  mental*  excitement  or  bodily  disquiet.  In  the  former  case  the 
mind  is  listless  to  surrounding  objects ;  and  in  the  latter  the  attention  is 
alive  to  them.  Severe  study,  intense  attention  to  business,  and  pro- 
tracted watching,  are  common  causes  of  the  former  variety,  and  cold 
feet,  eating  near  bed-time,  taking  stimulating  drink  in  the  evening 
wtieo  unaccustomed  to  it,  or  abstaining  after  having  been  habituated 
to  it,  are  the  ordinary  causes  of  the  latter.  The  remedies  are  a  hip- 
bath or  dripping-sheet  at  bedtime,  when  the  trouble  arises  from  men- 
tal causes ;  and  the  warm  foot-bath,  abdominal  girdle,  active  out-door 
walkmg,  and  exercising  in  a  cold  room  while  in  a  state  of  nudity — a 
form  of  air-bath — when  the  causes  are  corporeal. 

Restlessness. — There  are  two  states  of  general  bodily  disquietude, 
which  authors  have  regarded  as  distinct  diseases.  One  is  familiarly 
called  fidgets,  and  distinguished  by  a  perpetual  desire  to  change  the 
bodily  position;  and  the  other,  called  anxiety,  is  known  by  an  equally 
restless  desire  of  perpetual  locomotion.  The  common  cause  of  the 
fidget}''  variety  is  too  long  confinement  of  the  whole  body,  or  any  part 
of  it,  in  a  nearly  motionless  position.  Children  at  school,  writers  at 
the  desk,  females  with  the  needle,  especially  those  of  active  brains  and 
iiTitable  temperament,  often  suffer  severely  for  want  of  free  and  fre- 
quent exercise  of  the  whole  muscular  system.  Worms  and  some  kinds 
of  jkin  diseases  sometimes  produce  this  complaint. 

The  anxious  form  of  restlessness  is  peculiar  to  persons  of  a  highly 
nervous  temperament,  and  is  attended  with  a  distressing  or  uneasy 
sensation,  particular!}' about  the  praecordia.  Constipation  is  a  frequent 
cause  in  acutely  irritable  persons,  and  difficult,  local,  or  pecuniary  cir- 
cumstances, or  projects  in  relation  to  the  future,  on  which  the  mind 
dwells  intensely,  are  among  the  most  frequent  of  the  mental  causes  ; 
and  our  medicjition  must  be  directed  to  the  removal  of  the  existing 
cause,  whatever  that  may  chance  to  be. 

Antipathy. — A  feeling  of  internr-    repugnance   or  horror  at  the 


T)ISEASES    C5    SENSATION.  269 

presence  of  particular  objects,  or  the  introduction  of  particular  sub- 
jects, constitutes  one  of  the  many  singular  infirmities  of  our  fallen  na- 
ture. Some  persons  will  sicken  at  the  sight  or  taste  of  cutter  or  cheese ; 
some  find  the  smell  of  roses  and  mint,  or  the  sound  of  music,  painfully 
disagreeable ;  some  will  detect  the  presence  of  a  cat  in  the  room  with- 
out the  use  of  the  external  senses  ;  some  are  ready  to  faint  at  the  sight 
of  blood,  wounds,  sores,  crabs,  lobsters,  toads,  vipers,  and  other  un 
sightly  animals ;  and  some  will  scream  frightfully  at  the  appearance  of 
a  mouse  or  spider.  Probably  these  peculiar  traits  of  idiosyncrasy  may 
be  produced  by  frights  or  other  accidents  in  early  life,  or  by  some  pow- 
erful and  perhaps  forgotten  mental  impression  of  the  mothei-  during 
the  period  of  gestation.  The  only  chance  of  cure  seems  to  be,  in 
gradually  accustoming  the  patient  to  the  object  of  antipathy. 

Vertigo. — Different  forms  of  vertigo  are  known  by  thf*  terms  diz- 
ziness, swimming  of  the  head,  blind  headache,  niid  nervous  Jd.nting  Jit ; 
it  is  a  frequent  accompaniment  of  headache,  and  is  owing  tj  the  same 
exciting  and  predisponent  causes. 

Symptoyns. — The  patient,  while  at  rest,  experiences  an  illusory  gy- 
ration, or  objects  around  him  seem  affected  with  a  whirling  motion  ; 
there  is  also  a  sense  or  fear  of  fiilling,  with  some  degree  of  mental  con- 
fusion. In  some  instances  the  dizziness  is  combined  with  illusory 
Bounds,  as  whispering,  murmuring,  ringing  of  bells,  beating  of  drums, 
roar  of  cannon,  etc. 

Special  Causes. — The  immediate  cause  or  proximate  condition  is  a 
preternatural  pressure  of  blood  upon  the  nervous  substance  of  the 
brain  ;  and  this  is  owing  in  most  cases  to  a  morbid  viscidity  of  the  blood 
from  retained  bile,  perspirable  matter,  or  other  effete  material. 

Extreme  debility,  whether  from  hard  labor,  starvation,  hemorrhage, 
or  protracted  diseases,  favors  the  condition  of  the  brain  from  which  ver- 
tigo results,  for  the  reason  that  the.  action  of  the  heart  being  weakened 
and  the  capillaries  contracted  or  paralyzed,  the  blood  is  pressed  with 
disproportionate  force  upon  the  brain.  The  exciting  causes  are  usually 
Budden  exertion  or  hurried  motion,  as  raising  the  head,  stooping,  etc. 
Any  considerable  motion  to  which  the  bod)-  has  never  been  accustomed, 
AS  sailing,  swinging,  walking  circularly,  sitting  backward  in  a  carriage, 
etc.,  may  occasion  vertiginous  sensations  in  healthy  persons.  Intoxica- 
tion,  narcosis,  and  violent  fear  also  produce  dizziness,  which  is  experi- 
enced on  every  attempt  at  motion. 

Treatment. — When  the  body  is  full  and  plethoric,  or  there  are  evi- 
dences of  biliary  accumulations,  a  warm  water  emetic  is  advisable.  In 
all  cases  the  bowels  must  be  kept  entirely  free  by  plain,  coarse  food. 


270 


PATHOLOGY    AND   THERAPEUTICS. 


Biid  injections  if  necessary ;  and  the  skin  kept  open  by  one  or  two 
thorough  daily  ablutions.  In  other  respects  regard  must  be  had  to  the 
idiopathic  condition.  When  connected  with  great  debility,  emaciation, 
Joss  of  blood,  or  inanition,  quiet  and  ?leep  are  among  the  leading  reme- 
dial agencies. 

Syncope. — Sivooning  and  fain  ling -Jit  are  the  princiir,il  varieties  of 
the  malady  before  us,  which  is  distinguished  by  diminished  sensibility, 
inability  of  utterance,  with  feeble  or  imperfect  motion  of  the  heart  and 
lungs.  The  general  causes  are  the  same  as  those  of  the  preceding 
disease,  although  to  the  exciting  causes  may  be  added  extreme  pain, 
violent  passions,  sympathy,  sudden  fright,  sudden  abstraction  of  blood, 
rapid  evacuation  of  fluid  accumulated  in  the  cavities  of  the  body,  as  in 
dropsy,  sudden  discharge  of  the  matter  of  extensive  abscesses,  retro- 
cession of  arthritic  and  eruptive  diseases,  excessive  fatigue,  etc.  The 
treatment  consists  of  a  free  current  of  cold  air ;  sprinkling  cold  water 
in  the  face ;  and  if  the  syncope  is  prolonged,  pouring  cold  water  over 
the  head,  and  applying  the  cold  compress  to  the  stomach;  to  which 
may  be  added  the  recumbent  position,  fig.  189,  and  warm  water  with 
friction  to  the  lower  extremities.  As  soon  as  the  patient  can  swallow 
a  draught  of  cold  water  should  be  administered. 

Fig.  189. 


POSTURE    IN    SYNCOPE. 

Dr.  Good  says — T  quote  to  contrast,  not  to  commend  his  h-eatment : 
*'  As  soon  as  the  patient  is  capable  of  swallowing,  some  spirituous  cor- 
dial, a  glass  of  wine,  brandy  and  water,  fetid  tincture,  or  the  aromatic 
ppirit  of  ammonia,  or  of  ether,  should  be  administered."  The  reader 
need  not  be  told  that  a  half  gill  of  pure  soft  water  is  an  ample  substi- 
tute for  i*^  of  the  above  allopathic  notions. 


MoRBin  Sight. — Ingenious  nosologists  have  certainly  displayed 
more  analytical  than  philosophical  talent  in  giving  us  a  list  of  nearly 
six  hundred  jisoases  of  the  ove  I     Dr.  G  )od  has  reduced  the  formida- 


DISEASES    OF    SENSATION.  271 

b.'  -ist  to  twelve  ;  but  I  think  one  will  answer  just  as  well  for  all  the 
forms  of  depraved  vision  which  do  not  properly  belong  to  the  special 
chapter  on  diseases  of  the  e\'e. 

Symptoms. — In  false  sight  or  illusory  vision — the  only  species  com- 
ing within  our  generic  definition — imaginary  objects  float  before  the 
eye,  or  real  objects  appear  with  imaginarj'  qualities,  constituting  the 
ocular  specters  and  the  771usccb  volitantes  of  authors.  In  many  cases  of 
false  sight,  objects  appear  of  unusually  large  or  small  sizes,  or  multi- 
plied in  number  ;  one  color  is  mistaken  for  another;  sparks  and  flashes 
of  light  appear  before  the  eyes.  etc. 

Special  Causes. — Excess  of  light,  plethora,  local  injuries,  as  blows, 
bruises,  congenital  malformations. 

Treatment. — But  Uttle  can  be  done  therapeutically  beyond  attention 
to  the  general  health.  Gentle  friction  and  manipulation,  frequently 
holding  the  eyes  in  cold  water,  etc.,  as  in  the  case  of  weak  eyes,  or 
sore  eyes  from  debility,  are  occasionally  serviceable.  It  is  especially 
important  in  all  cases  of  depravity  of  the  speci-al  senses,  that  grease, 
salt,  and  all  earthy  or  saline  matters  be  excluded  from  the  food  and 
drink. 

Morbid  Hearing. — Preternatural  acuteness  or  obtuseness,  or  dis- 
ordered perception  of  sound,  results  from  a  variety  of  inflammatory 
states  or  structural  changes  of  the  ear.  But  in  some  instances  the 
hearing  has  been  so  keen  as  to  render  the  ordinary  whispering,  and 
even  the  respiration  of  persons  present  highly  distressing,  and  to  render 
real,  imaginary,  or  illusory  noises  exceedingly  troublesome,  or  so  dull  as 
to  disable  the  patient  from  taking  part  in  common  conversation,  without 
any  apparent  local  aff'ection  of  the  auditory  apparatus ;  although  in 
most  cases  it  is  presumable  that  a  deficiency  of  the  ceruminous  secre- 
tion, or  an  unnatural  irritability  or  torpor,  resulting  from  powerful 
noises,  violent  passions,  etc.,  are  the  conditions  on  which  the  depravity 
of  the  function  depends.  In  some  cases  of  semi-paresis,  or  partial 
palsy  of  the  auditory  nerve,  the  ear  is  only  sensible  of  articulate 
sounds,  when  excited  by  louder  sounds  intermixed  with  them ;  and  in 
some  cases  particular  sounds,  as  the  beating  of  a  drum,  the  rattling  of 
carriage  wheels,  the  tones  of  a  shrill  pipe,  the  ringing  of  bells,  etc., 
will  excite  the  function  and  enable  ordinary  conversation  to  be  recognized. 

Treatment. — Remedially,  we  can  only  attend  to  the  secretion  of  the 
external  ear,  and  to  the  general  health.  Frequently  syringing  the  ex- 
ternal meatus  with  warm  or  tepid  water,  followed  by  cool  or  cold,  and 
the  occasional  employmertt  of  the  head-bath,  with  a  moderate  douche 
to  the  upper  portion  of  the  spine,  are  the  appropriate  local  measures- 


PATHOLOGY   AND   TIIERAPEUTICS 


Morbid  Smell. — Acrid,  obtuse,  and  absence  of  smell  are,  like 
analogous  conditions  of  the  other  senses,  usually  among  the  symptoms 
of  fevers  and  local  affections.  But  with  some  an  exti'eme  and  painful 
keeness  or  total  deprivation  of  the  sense  exists  from  birth.  Some  per- 
sons find  the  smell  of  roses,  and  various  odors  and  perfumes  which  are 
agreeable  to  the  majority,  intolerably  offensive  and  sickening.  A  tern 
porary  loss  of  smell  may  result  from  a  slight  cold  ;  and  a  permanent 
depravation  or  depi-ivation  of  the  sense  is  often  produced  by  irritantS; 
pungents,  eirhines,  and  poisonous  vapore,  as  "cephalic  snuffs,"  tobacco 
dust,  cigar  smoke,  etc.  Catarrhal  affections,  when  long  continued, 
always  deteriorate  the  sense,  and  all  high-seasoned  dishes  and  compli- 
cateu  preparations  of  animal  food,  are  especially  injurious. 

Treatment. — The  head-bath,  and  the  frequent  sniffing  of  cold  water 
up  the  nostrils,  with  a  rigidly  simple  diet,  constitute  the  special  thera- 
peutic measures. 

Morbid  Taste. — The  tongue  and  palate,  which  in  the  norma 
state  distinguish  the  chemical  and  gustatory  qualities  of  substances,  as 
sour,  sweet,  bitter,  rough,  aromatic,  saline,  etc.,  are  sotnetimes  so 
malformed  originally,  or  so  perverted  by  disease  or  bad  dietetic  habits, 
as  to  be  j;)ainfully  acute  or  morbidly  obtuse;  to  remedy  which  nothing 
is  more  appropriate  than  fi*equently  holding  cold  water  in  the  mouth, 
and  employing  ;;n  exclusively  farinaceous  and  fruit  diet,  tl^e  farinaceous 
part  to  be  as  simple  and  dry  as  possible,  of  which  unleavened  brown 
bread  is  the  best  specimen. 

Morbid  Touch. — The  hand,  and  especially  the  extremities  of  the 
fingers,  possess  the  nicest  power  of  discriminating  the  tangible  proper- 
ties of  bodies,  although  the  whole  skin  belongs  to  the  organ  of  feeling, 
or  sense  of  touch;  and  this  sense,  like  all  the  others,  may  be  preter- 
naturaily  acute,  or  insensible,  or  illusory.  Its  principal  deviations  from 
the  normal  condition  are  known  as  soreness,  itching,  heat,  and  coldness. 
The  first  vanity  is  usually  the  result  of  a  cold,  or  a  symptom  of  fever 
or  inflammation  ;  the  second  is  dependent  on  irritation  in  the  stomach, 
bile  in  the  blood,  or  imperfect  depuration  from  the  skin;  and  the  third 
and  fourth  are  caused  by  exercise,  and  alternations  of,  or  exposures  to, 
extreme  temperature.  Beyond  a  daily  cold-bath,  and  attention  to  any 
particular  local  derangement  that  may  chance  to  exist,  we  have  nothing 
to  say  remedially,  except  advise  a  regulation  ;f  all  the  voluntary  habit» 
according  to  the  laws  of  health. 


MENTAL  DISEASES. 


27S 


CHAPTER   XVI. 


MENTAL  DISEASES. 


Thk  I  elation  between  mina  and  body  is  so  intricate  and  intimate  that 
a  morbific  impression  upon  either  may  produce  a  manifestation  of  mor- 
bid ])henomena  in  the  other.  The  majority  of  cases  of  insanity,  luna- 
cy, hallucination,  or  mental  aberration,  have  their  origin  in  bodily  dis- 
ease ;  yet  there  are  some  cases  in  which  the  producing  cause  is  pure- 
ly mental.  The  present  chapter  comprises  a  group  of  maladies  whose 
most  prominent  symptoms  are  abnormal  manifestations  of  the  mental 
operations,  irrespective  of  the  nature  of  the  predisponent,  proximate, 
or  exciting  causes.     They  may  be  arranged  in  tabular  form  as  follows : 


<  Melancholy, 
Insanity  J  badness. 

Ungovernable  \  ^    ^'     , 

Passion       <  Despondency, 


r  Absent-Mindedness, 
Revery  }  Mental  Abstraction, 
(  Brown  Study. 


Hallucination 


(  Hair-Brained. 
<  Sentimentalisra, 
(  Hypochondriacism. 


Sleep  Dis- 
turbance 

Fatuity 


Somnambulism, 
Sleep-Talking. 

Irrationality, 
Imbecilit3^ 


Insanity — Craziness. — Nothing  in  the  whole  range  of  pathology 
is  more  difficult  than  a  nosological  arrangement  of  the  abnormal  states 
of  mind ;  for  the  vast  diversity  of  human  intellect,  and  the  varied  cir- 
cumstances of  excitement,  depression,  and  mis-direction  to  which  it  is 
subjected  by  individual  and  social  uses  and  abuses,  make  it  sometimes 
impossible  to  say  where  sanity  ends  and  insanity  begins;  while  among 
the  unquestionably  insane  we  ^nd  every  conceivable  shade  and  degree 
of  mental  peculiarity,  from  a  disproportionate  activity  of  a  single  fac- 
ulty or  propensity,  constituting  a  one-ideaism  or  an  all-ahsorhijig  2^cls- 
sion,  whose  possessor  is  merely  a  monomaniac,  to  the  most  violent  and 
extreme  derangement  of  several  or  of  all  the  mental  powers,  consti- 
tuting ci'aziness,  lunacy,  or  idiocy. 

The  malady  before  us  presents  two  distinct  features,  which  authors 
have  ranked  as  species  of  disease  :  melancholy,  in  which  there  is  u  to- 
tal or  partial  hallucination,  accompanied  with  extreme  dejection,  fear, 
and  filse  apprehensions,  while  the  will  is  way A'ard  and  domineering* 


274  PATHOLOGY    AND    THERAPEUTICS. 


and  mania  or  madness,  in  which  all  the  mental  powers  are  greatly  ex- 
cited, and  the  discrepance  between  perception  and  judgment  general. 
Melancholy  is  subdivided  into  many  varieties,  as  gloomy  melancholy, 
when  the  patient  is  mute  and  retiring ;  errallc,  when  he  v&  roving  and 
restless ;  malevolent,  when  he  is  morose  or  mischievous,  and  disposed 
to  injure  himself  or  others  ;  and  complacent,  when  he  is  quiet,  affable, 
and  visionary.  Madness  is  characterized  as  furious,  when  the  patient 
is  violent,  runs,  jumps,  mutters,  cries,  shrieks,  etc. ;  elevated,  when  he 
is  gay,  lively,  hurried,  exulting  in  his  own  imaginary  importance,  which 
may  make  bim  a  president,  king,  prophet,  or  the  Messiah;  despond- 
ent^ when  he  is  abjected  and  depressed;  and  demented  or  chaotic, 
when  the  mind  sinKs  into  insensibility  and  forgetfulness,  with  an  entire 
abolition  of  the  faculty  of  judgment,  yet  possessed  of  unconnected  and 
evanescent  emotions,  and  perpetually  active  in  acts  of  extravagance 
without  object  or  design. 

Special  Causes. — It  is  natural  enough  that  physicians,  considering 
how  few  are  the  sound  physiological  prmciples  known  in  the  schools  of 
medicine,  should  suspect  some  morbid  condition  of  the  brain  or  its  ap- 
pendages as  the  special  cause  of  all  diseases  which  are  characterized 
by  disorderly  manifestations  of  the  mental  functions.  But  says  Dr. 
Goiod  :  "  Concerning  therefore  the  remote  or  even  proximate  cause  of 
the  disease,  we  have  yet  much  to  learn.  From  the  view  we  have 
taken  in  the  proem  of  the  close  connection  between  the  mind  and  the 
brain,  it  seems  reasonable  to  conceive  that  the  remote  cause  is  ordina- 
rily dependent  upon  some  misconstruction  or  misaffection  of  the  cere- 
bral organs ;  and  hence  every  part  of  them  has  been  scrutinized  for 
proofs  of  so  plausible  an  hypothesis,  but  litherto  to  no  pui-jiose  what- 
ever. The  form  of  the  cranium,  its  thickness,  and  other  qualities  ;  the 
meninges,  the  substance  of  the  brain,  the  ventricles,  the  pineal  gland, 
the  commissures,  the  cerebellum,  have  all  been  analyzed  in  turn  by 
the  most  dexterous  and  prying  anatomists  of  England.  France,  Germa- 
ny, and  Italy,  but  with  no  satisfactory  result." 

As  well  might  we  expect  to  find  the  proximate  cause  of  a  disorderly 
communication  or  action  of  the  telegraphic  macliinery,  by  a  chemical 
analysis  of  the  wire  between  the  batteries  or  at  the  stations,  as  to  seek 
the  cause  of  diseased  mental  manifestation  in  an  analysis  of  the  anatom- 
ical character  of  the  brain.  The  nervous  influence  and  the  electi'ic 
fluid  will  probably  forever  elude  all  attempts  at  material  analysis. 

That  the  phenomena  of  insanity  immediately  depend  on  some  excess 
or  defect,  or  mal-distribution  of  nervous  influence,  is  sufficiently  obvi- 
ous ;  nor  is  it  difficult  to  ascertain  the  ordinary,  remote,  or  disturbing 
causes;  thpse  are  generally  strong  menta    en  otions.  operating  in  con- 


MENTAL    DISEASES.  275 


nectiou  with  an  organism  physiologically  unsound.  Intemperance  is 
the  most  fi-equent  cause.  Gluttony,  self-abuse,  powerful  stimulants, 
religious  excitement,  grief,  fear,  disappointment  in  objects  of  love,  am- 
bition, or  property,  reverse  of  fortune,  etc.,  are  named  by  authors 
among  the  ordinary  causes. 

Treatment.- — The  moral  management  will  be  readily  suggested  by 
the  circumstances  of  each  case.  Undoubtedly  a  well-ordered  public 
asylum  is  the  proper  place  for  the  majority  of  becrazed  invalids.  But 
there  the  medical  part  of  the  management  could  be  vastly  improved. 
Instead  of  bleeding  and  drastic  purgatives,  which,  as  the  late  Dr.  Brig- 
ham,  of  the  Utica  Asylum,  testified,  only  serve  to  fasten  the  insanity  upon 
the  patient,  he  should  be  put  upon  a  bland  and  simple  diet,  and  a  plan 
of  derivative  and  soothing  bathing.  In  all  the  appliances  of  water,  es- 
pecial pains  must  be  taken  to  keep  the  feet  warm,  the  head  cool,  and 
to  avoid  all  sudden  shocks  or  strong  impressions  which  would  produce 
cerebral  excitement.  The  tepid,  shallow,  hip,  and  foot-baths  are  the 
leading  processes.  When  the  patient  is  manageable,  the  wet-sheet 
pack,  followed  by  tlie  dripping-sheet,  is  appropriate  ;  but  when  these 
or  any  other  general  cold  bath  is  employed,  care  must  be  taken  to  have 
the  feet  warm  ;  if  they  are  in  the  least  inclined  to  coldness,  they  should 
be  put  in  warm  w^ater  both  before  and  after  the  bath. 

In  our  public  institutions,  insane  persons  are  allowed  flesh-meat,  cof- 
fee, tea,  condiments,  and  sometimes  ardent  spirits  and  tobacco — all  of 
which  is  clearly  wrong. 

Ungovernable  Passion. — This  affection,  in  which  the  judgment 
is  overpowered  by  some  predominant  or  ruling  passion,  accompanied 
with  a  marked  change  of  the  features  and  countenance,  is  seen  under 
tlie  forms  of  excited,  depressed,  and  fitful  or  eccentric  passion.  The 
divisions  of  the  first  are  innumerable,  as  ungovernable  joy,  self-love  or 
self-conceit,  2^'ride,  ambition,  anger,  jealousy,  etc.,  all  of  which  are 
marked  by  a  lively,  quick,  daring  eye,  and  a  flushed,  tumid  face.  In 
the  second  variety  the  patient  is  anxious,  pensive,  inclines  to  solitude, 
and  his  countenance  is  pale  and  furrowed  ;  the  ruling  passion  is  mani- 
fested in  ungovernable  love,  avarice,  anxiety,  longing,  heartache,  des- 
pair, etc.  The  third  variety  is  commonly  called  hair-brained  passion^ 
and  is  characterized  by  wayward  and  unmeaning  passion,  indiscriminate 
acts  of  violence,  and  a  hurried  and  tumultuous  manner  ;  it  is  usually  the 
result  of  an  ill-directed  education. 

SjJecial  Causes. — Ail  the  causes  of  insanity  may  be  among  the  pre- 
disposing or  exciting  causes  of  the  species  of  mental  pravity  under  con- 
sideration ;  to  wdiich  may  be  added  debauchery,  gambling,  ingratitude, 


176  PATHOLOGY     AND    THERAPEUTICS. 


domestic  trouble,  loss  of  friends,  crushed  hopes,  love-sickness,  home- 
sickness, impending  calamities,  successive  misfortunes,  social  disgrace, 
incurable  secret  diseases,  bodily  imperfection  or  deformity,  contumely, 
imprisonment,  banishment,  remorse,  etc. 

Treatment. — To  all  the  remedial  measures  named  as  applicable  to 
insanit)%  should  bea  dded  as  far  as  practicable,  recreation,  occupation,  and 
society.  Probably  nothing  is  more  reforming  to  the  mind  or  renovating 
to  the  body,  in  all  forms  of  the  malady  before  us,  than  regular,. steady 
employment  in  some  useful  calling. 

Hallucinatio> — Illusion — Alusia. — la  this  affection  the  imag- 
ination overpowers  the  judgment.  It  embraces  two  varieties,  one  of 
which  is  called  sentimcntalisra,  or  mental  extravagance ;  and  the  other 
is  termed  hypochondriacism,  or  low  spirits.  The  former  is  character- 
ized by  romantic  or  fantastic  ideas  of  real  life,  ardent  fancy,  excited 
and  pleasurable  feelings,  and  animated  countenance;  it  embraces  those 
forms  of  mental  illusion,  called  heroic  or  chivalrous,  facetious^  ecstatic, 
and  fanatic;  in  other  words,  romantic  gallantry,  crack-brained  wit, 
false  inspiration,  and  fanaticism.  The  hypochondriac  variety  is  distin- 
guished by  gloomy  ideas  of  real  life,  dejected  spirits,  anxiety,  indispo- 
sition to  exercise,  an  oblique  and  scowling  eye,  sad  and  sullen  counte- 
nance, with  a  languid  pulse,  and  prominent  dyspeptic  symptoms;  it 
comprehends  the  mental  states  known  as  vapors,  weariness  of  life,  and 
misanthropy,  or  spleen. 

Symptoms. — Morbid  sentiraentalism  manifests  eveiy  conceivable 
form  of  extravagant  mis-judgment,  as  uncalled-for  acts  of  gallantry, 
rampant  and  uurestrainable  jesting,  ecstasy,  visions,  belief  in  appari- 
tions, or  in  some  preternatural  endowment,  etc. 

Hypochondriacism  perceives  a  thousand  evils  and  accidents  which 
have  no  existence,  and  imagines  the  most  whimsical  and  groundless 
causes  of  disquiet,  as  personal  danger,  poverty,  frogs  or  geese  or  other 
animals  in  the  stomach;  all  sorts  of  diseases;  one  perceives  himself 
transformed  into  a  giant;  another  into  a  dwarf;  one  is  as  heavy  as 
lead,  and  the  other  as  light  as  a  feather;  some  suspect  their  friends  of 
an  intention  to  nmrder  them,  and  others  suspect  themselves  of  having 
murdered  their  friends ;  they  are  peevish,  pleased  and  displeased 
with  the  veriest  trifles,  and  are  often  unwilling  either  to  live  or  die. 

Special  Causes. — The  first  variety  is  often,  if  not  generally,  attributa- 
ble to  a  superficial  and  ornamental  instead  of  a  substantial  and  useful 
education.  Novel  reading  is,  perhaps,  the  most  potent  and  most  com- 
mon cause.  "  Periloi.s  adventures,  love-lorn  catastrophes,  the  stories 
of  magicians,  knights,  enchanted   castles,  imprisoned  damsels,  melting 


MENTAL    DISEASES.  277 

minstrelsy,  tilts  and  tournaments,  and  all  the  magnificent  imagery  of 
the  same  kind  that  so  peculiarly  distinguished  the  reign  of  Elizabeth, 
became  a  very  frequent  source  of  permanent  hallucination."  Thf> 
second  variety  is  'Inore  especially  connected  with  indigestion  and  dis- 
ease of  the  liver ;  and  among  the  common  causes  are  alcohol,  tobacco 
and  intemperance  and  stimulation  generally. 

Treatment. — In  addition  to  the  measures  requisite  to  recover  and 
maintain  general  bodily  health,  the  moral  or  mental  medication  should 
consist  of  pleasant,  cheerful,  and.  sensible  company,  with  a  light  and 
easy,  yet  regular  and  steady  business  occupation,  occasionally  diversi- 
fied by  reading  sound,  scientific,  useful,  and  practical  books  and  news- 
papers. 

Note. — Some  authors  name  displacement  of  the  transverse  colon  as 
a  cause  of  various  forms  of  insanity  ;  and  the  French  pathologists  are 
said  to  have  frequently  found  this  condition  to  exist,  on  post-orbit  dis- 
sections, more  especially  in  subjects  who  have  died  of  the  varieties  of 
hallucination  called  weariness  of  life  and  misanthropy.  I  am  of  opinion 
some  kind  of  sti'uctural  derangement  of  some  portion  of  the  intestinal 
tube  is  a  much  more  frequent  cause  of  mental  aberration  than  is  gen- 
erally supposed.  I  have  very  often  noticed  a  less  degree  of  the  same 
misaffections  of  mind,  and  also  many  extreme  cases  of  those  forms  of 
hallucination  termed  fidgets,  anxiety,  vapors,  etc.,  in  persons  suffering 
from  a  displacement  of  the  lower  bowel — prolapsus  of  the  fundament. 
This  is  generally  induced  by  piles ;  piles  are  uniformly  caused  by  cos- 
tiveness,  and  the  ordinary  dietetic  habits  of  civilized  society  are  exactly 
calculated  to  produce  this  diseased  condition.  Hence  there  is  good 
reason  to  apprehend  that  a  great  proportion  of  those  cases  of  menta! 
disorder  coming  under  the  present  head,  are  owing  to  diseases  or  dis- 
placement of  some  portion  of  the  digestive  canal. 

But  I  have  noticed  another  still  more  frequent  cause  of  still  severer 
forms  of  "a  mind  diseased,"  and  I  wish  to  give  it  particular  prominence 
here,  for  the  reason  that  it  is  scarcely  alluded  to  in  any  medical  work 
with  which  I  am  acquainted,  in  connection  with  the  general  subject  of 
insanity.  I  mean  displacement  of  the  uterus.  The  reasons  already 
assigned  show  us  why  this  malady  should  be  of  frequent  occurrence 
among  females.  They  are  more  sedentary  and  in-door  in  their  habits 
and  occupations,  and  hence  more  liable  to  constipation,  piles,  prolapsed 
bowels,  etc.,  and  the  general  debility  and  relaxntion  of  fibre  often  ex- 
tends to  the  uterus  and  its  appendages,  producing  prolapsus,  antever- 
sion,  retroversion,  and  a  variety  of  other  local  complaints.  Theso 
cases  require  the  special  treatment  which  will  be  mentioned  here- 
after. 

24 


278  PATHOLOGY    AND    THERAPEUTICS. 

Revert. — Absence  of  inind^  mental  abstraction,  and  brown  study^ 
are  the  usual  forms  in  which  the  misaffection  of  mind,  termed  revery, 
is  exhibited.  They  are  sometimes  induc&d  by  bodily  infirmity,  but  are 
more  frequently  the  acquired  habits,  resulting  from  a  loose,  uTegular, 
and  superficial  education — an  education  in  which  the  mind  is  stufted 
with  words  instead  of  being  taught  to  think  and  form  ideas  for  itself. 
This,  combined  with  corporeal  inactivity  or  indolence,  is  the  principal 
renson  why  so  manj-  college-bred  sons  of  distinguished  men,  after  re- 
ceiving the  highest  finish  of  a  formal  education,  and  being  "  put 
through"  a  learned  profession — law,  physic,  or  divinity — in  the  ofifices 
of  the  most  eminent  professors,  turn  out  wordy  blockheads  or  profes- 
sional automatons,  instead  of  thinking  men  and  intelligent  citizens. 
These  remarks  apply  mainly  to  the  first  variet}'^  of  revery. 

It  should  be  remarked,  however,  that  some  overwhelming  passion,  and 
intense  study,  especially  upon  the  principles  of  mathematics  and  other 
abstruse  subjects,  are  not  unfrequently  causes  of  mental  abstraction, 
while  these  causes,  coupled  with  the  pursuit  of  some  object  of  ambi- 
tion or  emulation,  in  whicli  the  mind  is  kept  for  some  time  in  a  state 
of  distraction  between  hope  and  fear,  frequently  induce  the  variety 
called  brown  study — the  studium  inam,  of  Darwin. 

The  treatment  will  be  readily  inferred  from  the  general  principles 
of  cure  indicated  in  the  preceding  remarks. 

Sleep-Disturbance. — Sleep-walking,  somnambulijm,  and  sleep- 
talJcing  are  terms  which  denote  the  forms,  and  sufficiently  express  the 
nature  of  the  chief  varieties  of  mental  disorder  connected  with  sleep. 
There  is  in  all  cases  an  imperfect  and  disquiet  rest,  in  which  some  of 
the  mental  powers  are  but  partially  asleep.  The  usual,  and  perhaps 
only  causes,  are  an  irritated  or  overloaded  stomach,  and  an  overexcited 
bniin.  Profound  or  natural  sleep  is  never  accompanied  with  walking, 
talking,  or  even  dreaming ;  hence  all  the  phenomena  resulting  from 
disturbed  sleep  are  so  many  symptoms  of  abnormal  bodily  or  mental 
irritation.  Worms  in  the  alimentary  canal,  and  diseases  of  the  brain, 
are  peculiarly  distinguished  by  somnarabulific  manifestations.  In  some 
cases  of  somnambulism,  which  have  been  clearly  ti-aced  to  morbid,  di- 
gestive, or  cerebral  excitement,  and  cured  by  appropriate  remedies ; 
the  mental  powers  have  been  wrought  up  to  high  intensity  of  power, 
and  have  solved  problems  too  difficult  for  the  waking  state  ;  and  per- 
sons in  such  conditions  have  even  been  known  to  exer<;ise  clairvoyant 
powers,  as  in  reading  with  the  eyes  shut  and  closely  bandaged,  hear- 
ing and  conversing  coherently  while  entirely  unconscious,  etc.,  while 
(he  voluntary  muscles   unaided  by  the  external  senses,  have  performed 


MENTAL    DISEASES.  279 

r.irious  feats  of  locomotion,  as  climbing,  walking  secm'ely  in  the  most 
dangerous  places,  etc.,  which  could  scarcely  have  been  accomplished 
unless  the  "interior  sense"  had  predominated  over  the  special  senses. 

Our  success  in  medicating  these  affections  will  depend  entirely  on 
our  skill  in  tracing  each  individual  case  of  disturbed  sleep  to  its  particu- 
lar cause  or  causes,  and  applying  our  remedial  measures  according  to 
the  principles  already  explained. 

Fatuity. — The  defkiition  of  this  affection  by  Dr.  Good,  "defect  or 
hebetude  of  the  understanding,"  is  rather  too  diffuse ;  for  some  people 
are  considerably  prone  to  regard  all  others  as  in  some  way  or  other  de- 
fective or  foolish  in  judgment,  who  happen  to  feel,  think,  or  act  other- 
wise than  according  to  their  own  standard  of  a  sound  understanding. 

That  form  of  mental  hebetude  which  is  known  as  imhecility,  is 
divided  by  authors  into  various  forms,  the  chief  of  which  are  stupidity, 
for getf allies s,  credulity,  and  feebleness  ;  wliile  irrationality  or  witless- 
ness  comprehends  those  manifestations  of  defective  reasoning  faculties 
we  call  folly  or  silliness,  dotage  or  superannuation,  and  idiotism.  Of 
course  we  must  all  humbly  and  modestly  confess  to  some  degree  of 
some  one  or  more  of  these  "  hebetudes ;"  but  it  is  only  when  they 
are  found  to  form  a  very  prominent  feature  of  a  very  small  minoiity, 
that  we  are  to  name  them  as  leaves  or  branches  of  the  great  arhor 
morborum. 

Stupidity  may  arise  from  ignorance,  from  gross  food  or  gluttony, 
from  idleness,  from  intoxicating  drink,  from  tobacco,  etc.  A  celebra- 
ted author  remarks,  "Idleness  in  conjunction  with  wine  and  fermented 
liquors,  has  a  proverbial  power  in  besotting  the  understanding."  For- 
getfulness  affords  many  curious  examples  of  oblivious  reminiscence. 
Some  forget  the  place  or  street  they  live  in  ;  others  cannot  always  pro- 
nounce then"  own  name  at  the  post-office  ;  and  instances  are  recorded 
m  which  individuals  have  forgotten  their  mother  tongue,  and  been 
obliged  to  re-learn  the  language  from  the  alphabet.  Credulity  may  re- 
sult from  misdirection  or  original  malformation ;  and  it  exhibits  all  de- 
grees of  imbecility,  from  a  trifling  gullibility  to  a  disposition  to  take  hold 
of  subjects  with  a  fervency  of  faith  proportioned  to  their  intrinsic  ab- 
surdity. Silliness  is  sometimes  a  natural  infirmity,  and  frequently  the 
fruit  of  bad  company  and  low  associates  in  early  life.  Dotage  is  usual- 
ly considered  as  a  mere  consequence  of  old  age,  but  is  generally  hast- 
ened on  and  aggravated  by  riotous  living  or  excessive  labor,  or  the  hab- 
itual indulgence  of  violent  passions.  Idiotism  generally  results  from 
defective  organization,  or  a  want  of  that  portion  of  the  brain  which  man- 
ifests the  reflective  faculties      It  may,  however,  be  induced  by  a  V3- 


eao 


PATHOLOGY  AND  THERAPEUTICS. 


riety  of  accidental  circunisrances  or  voluntary  habits,  as  habitual  drunk- 
enness, excessive  indulgence  in  enervnting  pleasures,  onanism,  or  self- 
iwilulion  violent  and  protracted  emotions  of  mind,  external  injury  of 
the  brain,  loss  of  blood,  etc.  It  has  been  produced  by  the  excessive 
ns.^  of  the  lancet  in  females  after  delivery,  in  brain  diseases,  and  in  va- 
rio  8  fi)nns  of  insanity. 

.  Treatment. — So  far  as  moral  treatment  can  be  of  any  avail,  the  prin- 
ciples which  should  regulate  it  have  already  been  indicated.  In  rela- 
tion to  the  medical,  much  may  be  done  to  alleviate  or  cure  those  cases 
not  depending  on  congenital  or  organic  causes.  In  general  terms,  the 
treatment  should  be  rather  of  the  rousing,  stirring,  animating  kind  ;  as 
the  dripi)ing-sheet,  douche,  shower,  plunge,  spray,  or  fountain,  cata- 
rart-baths,  etc.,  combined  with  active  out-door  exercise,  or  regular  oc- 
cupation. The  diet  should  always  be  simple,  bland,  rather  abstemi- 
ous, and  strictly  vegetable.  An  irrational  mind,  or  one  predisposed  by 
organization,  accident,  or  bad  habits,  to  imbecility  in  any  form,  should 
avoid  flesh -meat  as  if  it  were  a  very  bohon  upas. 


CHAPTER  XVII. 


DISEASES  OF  THE  VOCAL  AVENUES. 

All  the  diseases  which  make  up  the  present  chapter,  have,  as  their 
most  prominent  symptom,  some  misaffection  of  the  voice  or  speech, 
although  some  of  them  differ  very  greatly  in  every  other  particular. 
Thoy  may  be  thus  grouped  : 


.    I  Acute, 
(/hronic  i  ,,, 

\  Cinonic, 
(  atarrh  I  ,^ 

{  U/.irna. 


Polypud 


Dissonant  Voice 


Jv 


ii'Miciins 


Compressible, 
Cartilaginous. 

Snoring, 

Wheezing.         Di«su"ant  Speech 


(  Elingual, 
Speecftlessness  }  Atonic, 

(  Deaf-Dumbness. 
Whispering, 


Immelodious, 
Of  Puberty. 
Stammering, 
Misenunciation. 


(mtarrh— r-iRYZA.— When  this  affeition  is  confined  to  that  part 


DISEASES   OF   THE    VOCAL  AVENUES.  281 

of  the  mucous  membrane  which  lines  the  nasal  cavities,  it  is  called 
cold  in  the  head ;  and  when  the  inflammation  fixes  permanently  upon 
the  same  membrane  in  the  cavities  of  the  frontal  bones,  it  is  called  ca- 
tarrh in  the  head 

Symptoms. — In  the  acute  form  there  is  a  defluxion  of  acrid,  pellucid, 
mucous,  or  ropy  matter  from  the  nostrils,  with  a  sense  of  irritation,  and 
some  degree  of  general  fever.  In  the  chronic  variety  the  discharge  is 
limpid,  without  acrimony  or  irritation,  and  unattended  with  febrile  dis- 
turbance. The  third  variety,  which  is  produced  by  an  ozcena,  or  na- 
sal ulcer^  is  denoted  by  an  offensive,  purulent,  or  ichorous  defluxion;  it 
is  often  connected  with  caries  of  the  spongy  bones. 

Special  Causes. — Sudden  exposures  to  cold  and  damp,  hot  drinks,  ir- 
ritant dust  or  vapors,  snuff",  smelling  salts,  strong  aromatics,  mercurial 
salivation,  often  induce  this  disease.  Some  authors  give  us  a  senile 
variety,  owing  to  "  the  natural  paresis  of  old  age  ;"  but  I  hold  that  any 
local  palsy  before  death  is  entirely  unnatural. 

Treatment. — ^The  acute  form  requires  a  few  packs  to  reduce  the 
general  feverishness,  which,  if  the  diet  is  rigidly  abstemious,  and  the 
patient  kept  in  a  moderately  warm  room  of  uniform  temperature,  will 
effect  a  cure  in  a  very  few  days.  The  chronic  variety — as  also  does 
the  nasal  ulcer — requires  a  persevering  employment  of  derivative  as 
well  as  local  treatment.  The  pack  occasionally,  frequently  sniflfing  cold 
water  up  the  nostrils,  the  hip-bath,  and  one  or  two  foot-baths  daily, 
with  as  much  exercise  in  the  open  air — avoiding,  however,  chilling  and 
damp  winds — as  the  patient  can  comfortably  bear,  comprise  the  reme- 
dial course. 

Polypus. — Polypus  tumors  in  the  nostrils  are  of  two  kinds ;  the 
soft,  or  compressible,  and  the  hard,  or  cartilaginous.  Both  are  proba- 
bly morbid  growths  of  the  mucous  membrane,  although  the  latter  va- 
riety is  generally  connected  with  caries  of  the  ethmoid  or  inferior  tur- 
binated bones. 

Symptoms. — Nasal  polypi  present  the  appearance  of  fleshy,  elongj 
ted  excrescences,  attached  by  a  slender  neck  to  some  part  of  the  Schnei- 
derian  membrane,  extending  in  different  directions,  and  affecting  the 
speech  by  obstructing  the  nasal  cavities.  The  soft  kind  is  unattended 
with  pain ;  its  color  is  a  pale  red,  having  some  resemblance  to  a  com- 
mon oyster;  and  it  generally  shrivels  in  dry  and  enlai-ges  in  weX 
weather.  The  hard  polypus,  is  firm,  of  a  highly  red  or  dark  color, 
progresses  gradually  without  alternate  diminution  and  enlargement, 
and  causes  pain,  with  a  very  disagreeable  sensation  in  the  nostril  and 
forehead,  on  coughing,  sneezing,  blowing  the  nose,  etc. 


282  PATHOLOGY   AND   THERAPEUTICS. 


Treatment. — In  the  eaily  stage  frequent  sniffing  ot  the  coldest  wa- 
ter Will  often  urre^t  the  tumor.  When  it  becomes  troublesome  fron: 
bulk,  extirpation  is  necessary. 

The  soft  kind  may  be  retnoved  with  the  ligature  or  forcei>s ;  the  lat- 
ter is  getierullv  the  most  convenient  method.  The  hard  polypus  can- 
not always  be  meddled  with  without  endangering  the  life  of  the  pa- 
tient. When  attached  to  or  connected  with  the  si:ougy  bones,  these 
may  be  removed  by  a  skillfu  surgeon. 

J^„„^^n,>. — Rattling  in  the  Throat. — Snoring  o^ndi  wheezing, 
which  are  the  chief  varieties  of  this  affection,  are  symptomatic  of  other 
diseases,  as  a|X)plexy  and  asthma,  or  of  gross  feeding,  a  plethoric  habit, 
en  ■  .  or  obesity,  or  of  an  obstructed  skin,  by  which  the  lungs  are 
oj';  with  vicarious  duty,  or  of  atony  or  debility  of  the  abdom- 

inal muscles,  which  are  important  agents  in  the  respinitory  movements. 
The  cure  will  be  found  in  a  restoration  of  that  equilibrium  in  the  bulk 
and  action  of  the  bodily  organs  and  functions  which  is  correctly  termed 
liealth.  Dr.  Good  recommends  "taking  off  the  obesity,"  in  fat  per- 
sons, "  by  repeated  venesections,  active  purgatives,  vigorous  exercise, 
and  a  low  diet."  I  will  guaranty  a  perfect  cure  in  everj'  case  of  obe- 
sity on  earth,  by  proper  exercise  and  diet,  sans  all  the  bleedings  and  the 
purgatives. 

Speechlessness — Aphoxta — Dumbness. — Inability  of  speech  may 
result  from  destitution  of  tongue — and  this  may  be  congenital  or  accident- 
al— constituting  the  clingual  variety :  or  from  paralysis  of  the  nen'es  of  the 
tongue  or  glottis,  in  consequence  of  some  violent  injur}' or  shock,  form- 
ing the  atonic  variety ;  or  from  congenital  deafness,  or  deafness  ac- 
quirer! in  early  life,  making  the  variety  called  deaf-dumbness. 

Sjxrial  Causes. — When  the  inability  is  not  organic,  its  most  fre- 
quent causes  are  severe  and  proti-acted  colds;  violent  shocks,  as  of 
lightning  or  electricity  ;  vehement  emotions,  as  of  terror,  anger,  fright; 
narcotics  ;  mephitic  exhalations  ;  ix)isoning  from  eating  mushrooms, 
and  sometimes  shell-fish;  metallic  vapoi-s;  mercurial  medicines,  etc. 
There  are  also  many  cases  of  partial  or  complete  loss  of  voice,  the 
cause  of  which  is  almost  always  overlooked  or  unthought  of  by  the  at- 
tending physician  :  I  mean  cases  of  weak  voice  resulting  from  mere  debil- 
ity of  the  nui8cles  of  the  loins  and  abdomen.  In  these  cases  there  maybe  a 
mo<lenite  degi-ee  of  general  health,  with  an  extreme  relaxation  or  ri- 
gidity of  these  muscles,  so  that  the  bilance  of  action  between  them,  the 
diaphragm,  and  the  laryngeal  nmscles,  is  lost ;  the  diaphragm  descend- 
ing when  it  should  ascend,  and  vice  ve^sa. 


DISEASES   OF    THE    VOCAL   AVENUES.  283 


Treatment. — We  have  no  special  remedial  resources  in  the  majority 
of  cases  which  depend  on  incurable  malformations  or  structural  le- 
sions ;  nor  can  we  in  the  majority  of  cases  dependent  on  functional 
derangement,  do  more  than  attend  carefully  to  the  general  health, 
trusting  nature  for  the  local  medication.  In  that  form,  however,  de- 
pendent on  muscular  debility,  we  can  invigorate  the  aifected  muscles  by 
the  wet  CO?  jpress,  frequent  hip-baths,  various  manipulations,  as  knead- 
ing, pounding,  thumping,  and  a  variety  of  exercises  which  call  the 
weakened  muscles  into  vigorous  play,  as  dancing,  jumping,  riding  a 
hard-trotting-horse,  and  vocal  gymnastics,  as  reading,  speaking,  and  de- 
claiming by  the  elementary  sounds  of  the  letters  or  words,  etc 

Dissonant  Voice. — The  chief  depravations  of  voice  have  been 
ranked  under  the  heads  of  ivhispering,  in  which  the  voice  is  weak  and 
scarcely  audible ;  immclodiouSj,  when  it  is  habitually  rough,  nasal, 
squeaking,  whizzing,  guttural,  or  palatine  ;  and  the  irregularly  alter- 
nating harsh  and  shrill  voice  which  is  peculiar  to  the  period  o^ puberty. 

S}')ecial  Causes. — The  last  named  variety  can  hardly  be  regarded  as 
a  disease,  save  when  complicated  with  some  accidental  abnormity. 
The  other  varieties  are  caused  by  most  of  the  circumstances  which 
produce  the  atonic  loss  of  voice,  to  which  may  be  added  over-exerting 
the  vocal  apparatus,  as  in  loud  speaking  or  singing,  or  in  sti'aining  the 
voice  while  the  bodily  attitude  is  crooked  or  distorted,  or  when  the 
abdominal  muscles  are  so  weakened  that  the  main  effort  at  expulsion  is 
thrown  upon  the  muscles  of  the  throat,  chest,  and  diaphragm.  In- 
deed, a  misuse  of  the  respiratory  muscles,  or  in  other  words,  a  vicious 
habit  of  exercising  the  voice  in  early  life,  whicli  has  its  origin  in  bad 
training  or  bad  health,  is  the  most  common  cause  of  unharmonious,  un- 
musical, and  unpleasant  voices  in  after  life. 

Treatment. — The  special  management  in  all  forms  of  voice  wherein 
there  is  no  "  concord  of  sweet  sounds,"  consists,  in  addition  to  sucb 
appliances  as  particular  complications  may  demand,  in  a  regular  system 
of  voice-training  or  vocal  gymnastics.  Ordinary  ingenuity  will  suggest 
a  thousand  variations  of  the  general  plan  to  suit  individual  cases  ;  but 
this  general  .plan  is,  1.  An  erect  bodily  position ;  2.  Opening  the 
mouth  freely  and  fearlessly  in  every  attempt  to  read  or  speak ;  3. 
Reading  and  speaking  slowly,  and  pronouncing  every  syllable  distinctly, 
and  even  giving  every  letter  its  full  and  appropriate  sound  ;  4.  Pro- 
nouncing the  different  elementary  vowel  and  consonant  sounds  of  our 
language,  at  first  slowly,  and  then  as  rapidly  a&  possible,  taking  care  to 
have  every  sound  distinctly  enunciated;  5.  Hallooing  with  a  full  pro- 
longed   sound,   as   by  the  woi'd    over ;     6.    Laughing   by    pronouno- 


ZM  PATHOLOGY    AND    THERAPEUTICS. 

« ■ ■ 


ing  hnh-hah-hah  as  rnpidly  as  possible,  observing  that  the  abdominal 
muscles  contract— that  is,  spring  out,  as  it  were — at  every  enunciation: 
7.  Decliiiniitig  on  the  sea  shore  in  the  face  of  a  strong  wind,  with  peb- 
bles in  the  mouth,  a  la  Demosthenes,  etc. 

Dissonant  Spekch. — Stammering  has  been  called  a  sort  of  St. 
Vitus's  dance  of  the  vocal  organs.  Its  principal  varieties  are  called 
hfsitatwfr,  in  which  there  is  an  involuntary  and  tremulous  retardation 
in  the  articulation  of  peculiar  syllables;  and  stuttering,  which  is  an  in- 
vttjuntary  re-pronunciation  of  some  sj'llables  or  words,  alternating  with 
a  hurried  and  convulsive  pronunciation  of  those  which  follow. 

Misenunciation  is  that  form  of  imperfect  speech  in  which  the 
sounds  are  articulated  freely,  but  inaccurately  pronounced  ;  the  princi- 
pal varieties  of  this  aflrctiou  are  vicious  or  incorrect  pronunciation  of 
the  lettei-s  r  and  I ;  substitution  of  soft  for  harsher  letters  ;  multiplica- 
tion or  omission  of  labials,  or  exchanging  them  for  other  letters  ;  mis- 
employment  of  dentals,  and  mispronunciation  of  gutturals. 

All  of  these  errors  and  imperfections  of  voice  are  sometimes  the 
result  of  organic  malconformation  ;  occasionally,  as  in  the  case  of  stam- 
mering, of  a  constitutional  irritability  of  some  of  the  muscles  concerned 
in  articulation ;  more  frequently  of  a  want  of  correct  education;  and 
ptill  oftener  of  a  careless  or  depraved  habit ;  and  even  in  some  cases  of 
an  exceedingly  silly  affectation.  Many  stammerers  who  talk  with 
great  dithculry,  read  with  gi'e^  facility,  and  all  of  them  stammer  most 
when  they  undertake  to  speak  most  deliberately,  and  least  when  their 
attention  is  so  engrossed  with  the  subject  that  they  think  nothing  about 
picking  out  single  words,  or  arranging  sentences  with  a  view  of  obviat- 
ing the  infirmity  of  speech. 

Treatment. — All  that  has  been  said  in  relation  to  the  vocal  treatment 
of  the  preceding  disease,  appli^  with  equal  force  to  this.  The  stam- 
merer cannot  weH  be  too  slow  and  deliberate  in  his  voice  exercises, 
nor  shonld  he  attempt  much  conversation  while  under  the  remedial 
disriprmc,  and  he  must  exercise  also  the  mental  qualities  of  firnmess 
and  perseverance.  Every  expedient  which  he  can  devise  to  expand 
the  lungs  and  augment  their  retentive  capacity,  will  facilitate  his  im- 
provement; as,  for  example,  deep,  full,  and  prolonged  inspirations  and 
expirations,  during  which  he  may  to  advantage  count  one— two- 
three— four,  etc.,  taking  pains  to  op'nwide  the  mouth,  and  "speak 
loud  and  plain"  each  monosyllable  he  attempts  to  utter.  The  various 
forms  of  misenunciation,  besides  the  vocal  exercises  herein  intmiated, 
could  with  propriety  be  referred  to  a  judicious  course  of  lectures  on 
elocution,  nor  would  the  lessors  of  the  singing  master  be  without  value. 


DISKASES    OF    THE   SEXUAL    FUNCTION.        285 


) 


CHAPTER  XVIII. 

DISEASES   OF  THE   SEXUAL   FUNCTION. 

The  integrity  of  the  function  whose  morbid  affections  we  are  about 
to  consider,  in  its  importance  to  the  progressive  improvement  and  well- 
being  of  the  human  race,  cannot  be  over-estimated;  yet,  unfortunately, 
with  regard  to  several  diseases  comprised  in  the  present  chapter,  we  have 
to  regret,  as  in  the  case  of  several  preceding  maladies,  that  they  aj-e 
alarmingly  on  the  increase.  This  is  especially  the  fact  in  regard  to 
those  female  diseases  known  as  mismenstruation  and  prolapsus — 
diseases  of  rare  occurrence  in  the  days  of  our  grandjnothers,  and 
then  scarcely  known,  except  in  the  married  relation ;  but  now  pre- 
valent among  all  classes  and  all  ages  of  females  above  mere  infanc}'-. 
These  complaints  are  attributable  to  four  general  classes  of  causes ; 
sedentary  habits,  concentrated  and  stimulating  food,  enervating  drinks, 
and  unphysiological  dress ;  and  as  the  refinements,  and  luxuries,  and 
bad  fashions  of  society  increase,  these  natural  and  necessary  conse- 
quences must  extend  correspondingly. 

It  is  a  painful  reflection,  too,  on  the  popular  medical  system  of  the 
day,  that  its  professors,  who  claim  to  be  the  conservators  of  the  public 
health,  content  themselves  wifh  dosing  and  drugging,  bleeding  and 
poisoning,  and  talking  technicalities  to  this  class  of  invalids,  instead  of 
teaching  them  how  to  live  healthfully.  Soundness  and  purity  in  the 
reproductive  organism  are  indispensable  to  a  perfect  and  vigorous  or- 
ganization in  the  offspring  of  sexual  intercourse;  and  if  mothers  and 
daughters  could  be  imbued  with  the  right  moral  principles  and  physio- 
logical truths,  there  would  soon  be  an  end  to  these  artificially  produced, 
but  not  the  less  afflictive  and  lamentable  disorders,  which  are  presented 
in  the  following  tabular  aiTangement : 

'  Obstructed  Mensti'uation — Amenorrhoea, 

Laborious  Menstruation — Dysmenorrhcfa, 

__,  .       ,  Excessive  Menstruation — Hemorrhagic, 

Misraerstruation «{  ^r-      •        a/t      ^      .- 

I  Vicarious  Menstruation, 

Irregular  Cessation  of  the  Menses, 

[  Chlorosis — Green  Sickness, 

Leucorrhea.     Spermatorrhoea. 


W6 


PATHOLOGY    AND   Til  ER  APEt  TI  €S. 


\     ^  P  ^'  '  '  Inordinate  ^  Satyriasis, 

Venereal  Diseases  j  Gonorrhoea,  ^  Nymphomania. 

(  Gleet.  ^      J     f 

C  Prolapsus, 
1  Anteversion, 

Genital  Displacement  <!  Retroversion, 
Inversion, 
Excrescence. 

MisMENSTRUATiON  — The  catamenia  secretiofj  may  be  obstructed 
in  its  discharge,  laborious  and  painful  at  the  usual  period,  excessive  in 
quantity,  vicarious  in  its  locality,  irregular  in  its  final  cessation,  or  at- 
tended with  general  derangement  of  health  at  the  period  of  its  first  ap- 
pearance, which  several  circumstances  constitute  the  several  species  of 
the  disease  before  us. 

SymjHoms. — Obstructed  menstruation — ^the  amenorrhea  of  authors — 
is  distinguished  into  retention  when  the  menstrual  flux  is  obstructed  at 
tho  period  of  its  accession;  and  suppression,  when  the  obstruction  occurs 
regularly  at  the  usual  periods  of  recurrence.  The  former  variety  is  char- 
acterized by  an  oedeinatous  swelling  of  the  feet  and  ankles  at  night,  and  a 
swelling  of  the  eyes  and  face  in  the  morning;  the  latter  is  attended 
with  headache,  difficult  breathing,  and  palpitation.  Both  varieties  are 
attended  with  general  languor  and  many  dyspeptic  symptoms,  particu- 
larly a  capricious  appetite,  and  not  unfrequently  a  longing  for  innuti'ient 
and  injurious  substances,  as  clay,  slate-stone,  charcoal,  etc.  In  many 
cases  there  is  a  harassing  cough,  with  symptoms  of  a  general  decline. 

In  laborious  or  painful  menstruation — dysmenorrhea — the  flux  is  ac- 
companied with  great  and  sometimes  excruciating  pain,  not  unlike  the 
bearing-down  pain  of  labor,  generally  attended  with  some  degree  of  ac- 
tual hemorrhage,  and  frequently  with  an  expulsion  of  fragments  of  a 
membranous  concretion,  like  that  of  croup  or  tubular  diarrhoea.  In 
some  iiisnmcos  this  membranous  concretion  is  thrown  off  from  the  en- 
tire surface  of  the  uterus  at  once,  in  the  shape  of  a  small  bag  filled  with 
a  fluid  wiiich  has  been  mistuken  for  an  early  abortion. 

In  excessive  menstruation  the  catamenial  secretion  is  superfluous  in 
quantity,  and  attended  with  an  actual  hemorrhage  from  the  menstrual 
vessels.  The  hemorrhage  is  known  by  the  fact  that  the  fluid  discharg- 
ed is  coagulable,  which  is  not  the  cas0  with  the  pure  catamenial  flux. 
it  exhibits  two  subvarieties,  in  one  of  which  the  discharge  is  excessive, 
from  too  frecjuent  recurrence,  and  in  the  other  from  too  copious  a  flow 
at  the  proper  menstrual  period      The  ordinary  flux  may  be  from  foui 


DISEASES    OF    THE   SEXUAL    FUNCTION.        '287 


to  six  ounces,  but  it  is  subject  to  much  diversity,  and  can  only  be  re- 
garded as  morbidly  in  excess  when  accompanied  with  marked  symp- 
toms of  general  debility,  as  paleness,  cold  extremities,  oedematous  feet, 
fatigue  on  slight  exercise,  etc. 

Vicarious  menstruation  is  characterized  by  a  transfer  of  the  catarae- 
nial  secretion  to  a  more  distant  part  or  organ.  The  eyes,  nostrils,  ears, 
sockets  of  the  teeth,  nipples,  stomach,  lungs,  rectum,  bladder,  and 
abraded  or  ulcerated  surfaces,  have  been  the  seat  of  the  transferred 
flux. 

The  irregular  cessation  of  the  menses,  at  the  term  of  its  natural  ces- 
sation— usually  called  the  turn  of  life — which  in  this  climate  is,  on  the 
average,  at  about  the  forty-fifth  year,  is  accompanied  with  symptoms 
of  spurious  pregnancy,  dropsy,  or  glandular  tumors  ;  the  menstrual  dis- 
charge is  irregular;  sometimes  profuse  with  long  intervals;  and  at 
others  trifling  in  quantity,  but  returning  every  ten  or  twelv^  days,  and 
often  succeeded  by  leuco^-rhoea. 

Chlorosis,  or  green-sickness,  though  elevated  to  the  rank  of  a  gen- 
c^ric  term  by  some  authors,  is  merely  a  condition  of  imperfect  or  defi- 
cient menstruation,  occurring  about  the  age  of  puberty,  and  complica- 
ted with  so  great  general  debility  that  the  sexual  power  or  propensity 
is  partially  or  completely  lost.  The  name  is  derived  from  the  pale, 
livid,  and  greenish  cast  of  the  skin,  which  all  chlorotic  patie'^ts  mani- 
fest more  or  less. 

Special  Causes. — In  addition  to  the  general  causes  already  intima- 
ted, mismenstruation  maybe  induced  by  repeated  colds,  especially  from 
an  exi)osure  of  the  feet  while  the  rest  of  the  body  is  w-eii  clad,  pro- 
tracted anxiety,  grief  or  fear,  local  injury,  masturbation,  excessive  ve- 
nereal indulgence,  repeated  miscan'iages,  etc.  Retention  of  the  men- 
ses is  sometimes  o%ving  to  an  imperforate  hymen,  requiring  for  its  cure 
u  transverse  section  of  the  membranous  obstruction. 

Treatment. — Fortunately  almost  every  form,  state,  and  stage  of  mis- 
menstruation  is  curable  by  the  thorough  application  of  our  wdiole 
system.  The  majority  of  cases,  however,  require  several  months', 
and  many  of  them  two  or  three  years'  treatment  to  complete  the  cure. 
r5ut  fortunatel}'',  again,  those  cases  whiv'h  require  a  long  ti'eatraent,  can 
be  managed  mostly  at  home,  and  with  very  little  expense  or  neglect  of 
ordinary  duties  or  labors.  The  general  p!an  applicable  to  all  forms  of 
the  disease  except  excessive  menstruation  18,  a  morning  full-bath,  as 
the  plunge,  dripping-sheet,  or  towel-wash,  two  or  three  hip-baths  daily, 
one  or  two  foot-baths,  the  abdominal  bandage,  frequent  and  varied  out- 
door exercise,  and  a  plain,  solid,  rather  dry,  and  unstimulating  dietary. 
The  water  should  in  all  cases  be  as  cdd,  yet  no  colder,  than  is  followed 


^88  i»ArflCLOGY    AXD    I  HER  APEUTICS. 


by  quick  ronction  and  a  comfortable  glow ;  and,  as  a  general  rule,  short  ' 
baths,  frequently  repeated,  are  more  efficacious  than  long  ones  with  ] 
greater  iiitervals.  Hip  and  foot-baths  should  always  be  preceded  and  ; 
succeeded  by  active  yet  not  exhausting  exercise,  and  tlie  walking  foot-  J 
bath,  when  practicable,  is  always  to  be  preferred.  A  great  variety  of  \ 
exercises  can  be  advantageously  employed,  as  walking,  riding,  jump- 
ing the  rope,  dancing,  shuttle-cock,  graces,  etc.  And  those  who  can  | 
find  the  sftme  recreation  and  entertainment  in  light  worii,  as  sweep-  i 
ing,  dusting,  spinning,  washing  dishes,  picking  berries,  milking  the  cows, 
etc.,  will  find  exactly  the  same  remeiial  effects  as  from  amusing  and  ; 
ogreenble  plays.  i 

When  the  body  is  full,  sanguine,  and  plethoric,  the  wet-sheet  pack 
should  be    employed  daily  or  tri-weekly  for  a   month  or  two  ;   and     i 
when  the  whole  system  is  in  the  opposite  condition,  called  atonic,  an-     ! 
hseniic,  torpid,  etc.,  the  tepid  shallow-bath,  followed  by  active  and  pro-     ! 
longed  rubbing,  should  be  substituted.     In  cases  of  excessive  menstru-      j 
ation,  the  hip-baihs  should  be  colder  than  in  eitlier  of  the  other  varie-     ! 
ties,  genenilly  from  56°  to  45^.     In  the  variety,  irregular  cessation,  care 
must  be  taken  not  to  disturb  the  circulation  with  any  powerful  shock  ; 
the  treatment  in  the  main  should  be  mild,  the  water  generally  tepid  or 
but  modenitely  cold.     The  exercises,  too,  in  the   last  two   varieties, 
should  be  very  moderate. 

Vaginal  injections  are  useful  in  all  cases  attended  with  considerable 
relaxation,  hejiiorrhage,  or  leuorrhcea;  while  in  all  other  varieties,  the      j 
horizontal  douche  or  spray,  applied  to  the  hips,  abdomen,  and  loins,  is 
n  vnluai)Ie  auxiliary.  i 

When  the  catamenial  periods  are  attended  with  much  pain,  as  in  j 
dysmenorrh<Ea,  warm  applications  must  be  employed  until  relief  is  ob-  ; 
laincd,  after  which  the  regular  treatment  may  be  resumed.  These 
should  consist  of  llie  warm  foot-bath,  warm  sitz-balh,  hot  fomentations  \ 
to  the  abdomen,  the  ftill  warm-hath  or  even  hot-bath,  followed  by  the  ' 
dry  pack,  according  to  the  seveiity  of  the  pain.  In  some  cases  the 
pnirj  is  agonizing  for  one,  two,  or  three  days,  and  the  only  endurable  j 
tondition  for  the  patient  is  to  remain  dry-packed,  or  closely  covered  up  j 
m  bed,  su  as  to  keeip  tlip  body  warm  and  perspirable  until  the  secretion  l 
takes  place.  Drinking  warm  water  very  freely  often  proves  relaxant  i 
and  sedative  in  these  cases.  I 

The  propriety  of  suspending  a  part  or  the  whole  of  the  ti-eatment      ! 
during  the  menstrual  period,  not  only  in  the  complaint  before  us,  but 
in  nil  cases,  is  somewhat  unsettled  in  the  code  of  hydrotherapia.     Some 
practitioners,  at  least  in  all  ordinary  cases,  pay  no  regard  to  the  monthly 
flux    while  others  suspend  all  active  or  very  cold  treatment.     It  is  Ijue       i 


DISEASES   OF    THE    SEXUAL    FUNCTION.        289 

the  menses  are  frequently  partially  suppressed  or  wholly  suspended 
for  several  months  by  the  former  practice,  yet  it  seldom  happens  that 
any  permanent  injury  comes  from  it.  My  own  opinion,  derived  from 
considerable  attention  to  the  practical  point  under  consideration  is,  that 
patients  who  are  not  much  reduced  in  flesh,  blood,  or  temperature, 
can  take  full  treatment  through  the  catamenial  disturbance,  not  only 
without  injury,  but  often  with  benefit ;  but  that  those  who  are  emaciated, 
pale,  and  cold,  with  torpid  livers  and  clogged  up  skins,  and  a  tendency 
to  headache  or  "  rush  of  blood  to  the  head,"  will  be  better  off  to  take 
no  treatment,  save  a  tepid  wash-down  daily,  and  such  local  soothing 
appliances  as  particular  exigencies  call  for,  from  the  first  decided  indi- 
cations of  the  menstrual  effort,  until  it  has  nearly  or  quite  subsided. 
There  are  few  diseases  ia  which  regimen  should  have  a  greater 
prominence  among  the  curative  measures.  With  respect  to  water- 
drinking,  I  have  always  recommended  those  of  full  habit  and  well  ex- 
panded lungs  to  drink  rather  freely — four,  six,  or  eight  tumblers  daily — 
and  the  thin  and  feeble  to  take  two  or  three  tumblers  in  the  fore  part 
of  the  day,  and  at  other  times  only  according  to  actual  thirst.  The 
diet  cannot  well  be  too  strict,  and  as  constipation  is  almost  always 
connected  with  mismenstruation,  it  should  have  especial  reference  to 
this  circumstance. 

Brown  bread,  unfermented  bread  or  cakes,  cracked  wheat  or  rye  meal 
mush,  with  a  moderate  allowance  of  the  best  vegetables  and  good 
fruits,  constitute  the  best  dietetic  plan.  Very  little  animal  food,  if  any, 
should  be  taken,  and  even  eggs,  butter,  and  milk,  had  better  be  avoided. 

Leucorrh(ea, — This  disease  is  indiscriminately  called  Jiuor  albus  and 
whites  in  medical  books.  It  affects  more  or  Itss  nearly  all  females  who 
are  the  subjects  of  mismenstruation,  and  sometimes  exists  antecedently, 
and  at  others  subsequently  to  the  menstrual  period  of  life.  It  is  most 
frequently  the  immediate  result  of  local  irritation.  It  has  been  for  a 
long  time,  and  is  yet  a  question  among  medical  authors,  whether  this 
disease  is  ever  infectious,  and  communicable  to  the  male  urethra  by  the 
act  of  copulation.  Two  years  ago,  a  "  professor  of  diseases  of  women 
and  children,"  in  one  of  our  city  colleges,  and  an  ex-professor  of  the 
same  branch  in  ancther  orthodox  school,  were  called  upon  in  a  court 
of  justice,  to  give  testimony  on  this  very  point.  The  latter  professor 
testified  that  he  had  actually  known  such  infection  to  result  from  leu- 
corrhoea,  in  his  own  emphatic  language,  "  again,  and  again,  and  again  ;" 
while  the  former  declared  that  he  did  not  believe  it  was  possible  !  Both 
medical  gentlemen,  of  course,  swore  conscientiously.  It  is  a  general 
law  in  pathology — so  general  that  I  believe  there  are  no  exception?  ~ 
IT— 'i5 


290  r  A  TUG  LOGY   AND  THERAPEUTICS. 


that  nil  abnormal  secretions  are  bland  or  acrid,  precisely  according  to 
tlu"  less  or  greater  grossness  or  impurity,  or  inflammatory  condition  of 
tlie  general  system  ;  all  morbid  discharges  from  mucous  surfaces  may 
bec(»me,  as  is  often  seen  in  the  case  of  catarrh  or  cory^,  so  acrimo- 
nious as  to  excoriate  the  surface  wherever  they  come  in  contact  with 
it;  and  the  mucous  surface  of  the  vagina  may  readily,  under  circum 
fttances  of  extreme  irritation  and  high  inflammatory  excitement,  se- 
crete an  iclierous  or  infectious  matter,  which  will  produce  in  the  mala 
urethra  a  running  analogous  to  gonorrhoea  or  gleet,  though,  of  course, 
not  as  violent  nor  inflammatory  as  in  true  gonorrhoea,  nor  infectious  like 
it.  I  have  known  cases  of  this  kind  under  such  circumstances  as  pre- 
cluded all  idea  of  impropriety  on  the  part  of  the  wife,  by  whom  the 
husbmd  became  diseased.  These  facts  ought  to  be  well  understood  by 
tlie  practitioner,  so  that  the  woman,  though  she  may  not  be  an  exam- 
ple of  strict  personal  cleanliness,  may  be  exempted  from  the  charge  of 
moral  impurity. 

Symptoms. — The  discharge  is  usually  of  a  yellowish-white  color, 
verging  to  green;  but  sometimes  it  is  brownish,  or  slightl}'  red,  vary- 
ing in  consistence  from  a  thin  limpid  fluid,  to  a  thick,  tenacious,  ropy 
mucus.  It  is  usually  accompanied  with  weakness  or  pain  in  the  back, 
and  some  degree  of  "spinal  irritation;"  when  of  long  standing,  it  is 
attended  with  a  sense  of  heat,  and  itching  or  smarting ;  and  in  still 
more  advanced  stages,  the  discharge  is  highly  acrid  and  oflensive,  often 
excoriating  the  whole  surface  of  the  vagina. 

In  the  form  called  labor,  the  discharge  is  slimy  and  tinged  with  show 
of  blood,  and  is  only  regarded  as  morbid  when  excessive.  The  whites  of 
advanced  life  generally  appear  soon  after  the  cessation  of  the  menses ; 
the  dischaigo)  is  thin,  acrid,  fetid,  and  excoriating,  and  is  sometimes 
combined  with  incipient  cancer  or  polypus. 

Special  Causes. — The  same  general  range  of  morbid  influences 
which  |)redisposc  to,  or  excite  mismenstruation.  contribute  to  the  pro- 
duction of  leucorrhoen,  to  which  may  be  added  mechanical  injuries  and 
irritations,  as  pessaries,  repelled  eruptions,  voluptuous  excitement,  and 
nncleanliness. 

Treatment. — Dr.  Good  remarks,  in  relation  to  the  drug-treatment  of 
leurorrhcca,  "The  general  remedies  which  have  been  had  recourse  to 
are  almost  innumerable;"  a  surticiont  acknowledgment  that  they  have* 
genemlly  proved  either  useless  or  injurious.  The  general  hydropathic 
plnn  of  medication  is  the  same  as  for  mismenstruation.  The  local 
trentmont  rrrjuircs  more  especial  attention.  Hip-baths  and  vaginal  in- 
jections are  always  among  the  leading  measures,  and  the  temperature 
of  tho  water  for  oither  purpose  must  be  regulated  hv  the  condition  of 


DISEASES    OJ?    THE    SEXUAL    FUNCTION  291 


the  patient.  In  some  cases  the  diseased  surface  is  so  irritable  that 
quite  warm  water  proves  the  most  available  sedative.  It  is  always  safe 
and  generally  necessary  to  commence  these  baths  with  water  at  80°  or 
90°,  and  gradually  reduce  the  temperature  to  60"  or  50°.  The  vaginal 
syringe  in  severe  cases  should  be  employed  two,  three,  or  four  times  ,i 
day.  Whenever  the  discharge  is  excessive  and  blood-colored,  indica- 
tive of  actual  hemorrhage,  very  cold  water  should  be  thrown  up  the 
vagina,  and  cola  wet  cloths  laid  over  the  abdomen. 

SpERMORRHffiA. — Seminal  misemission,  or  an  involuntaiy  flux  of  the 
seminal  fluid  without  copulation,  is  often  the  result  of  libidinous  ideas, 
especially  if  to  this  cause  is  added  the  irritation  of  a  gross  or  highly 
animal  diet,  or  the  still  more  inflaming  and  exciting  influence  of  wine, 
coffee,  etc.  Not  unfrequently  the  gross  and  debasing  habit  of  self-pol- 
lution, induces  such  a  degi-ee  of  nervous  exhaustion  and  morbid  irrita- 
bility, that  the  emission  takes  place  on  the  slightest  libidinous  excite- 
ment ;  and  sometimes  a  thin,  degenerate,  muco-seminal  secretion  oc- 
curs unconsciously  during  a  dreamy  or  even  a  profound  sleep. 

Treatment. — When  the  general  health  is  fair,  and  the  patient  has 
not  been  guilty  of  a  concupiscent  life,  one  or  two  daily  cold  baths,  ac- 
tive out-door  exercise,  or  what  is  better,  regular  and  laborious  occupa- 
tion, and  a  plain  vegetable  and  fruit  diet,  will  speedily  effect  a  cure.  In 
constitutions  worn  down  by  previous  diseases,  exhausted  by  riotous  liv- 
ing, or  undermined  by  abused  amativeness,  the  cure  requires  a  strict 
and  persevering  observance  of  all  the  laws  of  hygiene,  that  the  patient 
may  out-grow  rather  than  doctor  out  his  ruinous  ways.  Unfortunate- 
ly, however,  there  is  no  class  of  patients  more  fickle,  vascillating,  an(? 
unreliable  ;  the  mind  partakes  of  the  bodily  degeneracy,  and  it  re- 
quires a  combination  of  rare  and  favorable  circumstances  to  keep 
them  from  running  after  every  fooush  and  whimsical  impostor  who  ad 
vertizes  to  cure  them  with  a  single  bottle  of  bitters,  which,  moreover 
is  "  pleasant  to  the  taste." 

These  patients  seldom  aeed  very  active  or  very  cold  water-treat- 
ment. A  daily  towel-bath,  one  or  two  tepid  or  moderately  cool  hip- 
baths, and  a  rigidly  simple  and  abstemious  diet,  afford  the  best  chance  of 
recovery.  Salt,  sugar,  and  even  milk  can  be  dispensed  with  to  advan- 
tage. The  evening  meal  should  always  be  light  and  as  dry  as  possible, 
and  the  patient  should  avoid  sleeping  on  the  back,  the  preferable  posi- 
tion in  bed  being  a  gentle  inclination  to  one  side. 

Venereal  Diseases. — The  affections  if  the  genital  organs  which 
result  from  impure  sexual  intercourse  art-  among  the  most  loathsomo 


SM  PAT.TOLOGr    AXD    THERAPEUTICS. 


in  ap|>eai"nnce  and  the  most  deplorable  in  their  consequences  that  af- 
flict degraded  and  erring  mortals. 

Symptoms. Venereal  affections  appear  in  two  distinct  forms,  syphi- 
lis, or  poi,  and  gonorrhaa,  or  clapp.  The  first  is  a  constitutional  dis- 
ease or.  rather,  may  become  so ;  the  second  is  always  a  local  disease, 
never  extending  beyond  the  genital  organs  or  glands  of  the  groin.  Both 
diseases,  however,  may  coexist  in  the  same  individual,  and  be  commu- 
nicHted  at  the  same  time.  Gleet  is  simply  a  urethral  mnning ;  and, 
tliou"h  often  a  sequel  of  gonorrhcea,  may  exist  from  irritation  uncon- 
nected with  venereal  taint,  and  be  excited  by  stone  in  the  bladder,  leu- 
corrhcea,  and  various  other  causes.  These  distinctions  are  important  to 
keep  in  mind,  for  thousands  have  their  constitutions  ruined  by  a  long 
mercurial  course  for  gonorrhoea,  on  the  mistaken  notion  that  the  dis- 
ease was  in  the  blood  or  general  system.  It  should  be  remarked,  too, 
that  syphilis  never  affects  the  constitution  until  after  the  formation  of 
an  ulcer  and  the  absorption  of  its  matter. 

Si/philis  commences  with  one  or  several  small  pimples,  or  chancres^ 
on  same  part  of  the  genitals,  which  gradually  fester,  and  finally  termi- 
nii;<'  in  spreading  or  deepening  ulcei-s,  filled  with  an  exceedingly  acrid 
niil  corroding  matter.  If  this  matter  is  allowed  to  be  absorbed,  the 
glands  of  the  gi'oin  swell  into  hard  tumors,  called  buboes,  and  often  ul- 
cerate. Eventually  the  whole  body  becomes  contaminated  with  the 
virus  absorbed  from  the  chancres,  and  what  are  called  constitutional  or 
secondary  symptoms  appear,  as  foul  ulcers  in  the  throat  and  palate, 
livid  and  copper-colored  spots  on  the  skin,  or  ulcerating  scabs,  inflamed 
eyes,  pains,  swellings,  and  caries  of  the  bones,  etc. 

Gonorrhea — blenorrhcea  luodes — consists  in  a  muculent  and  virulent 
discharge  from  the  urethra  or  vagina,  attended  with  a  burning  pain  in 
passing  the  water,  and  considerable,  sometimes  violent  pain,  heat,  and 
swelling  of  the  part  affected ;  in  some  instances  the  inflammation  ex- 
tends to  the  glands  of  the  groin,  producing  buboes. 

Special  Causes. — Venereal  diseases  may  be  generated  by  promis- 
cuous sexual  intercourse,  and  when  produced,  the  peculiar  virus  thus 
developed  is  capable  of  propagating  the  same  disease  by  contact. 

Trralmcn'. — The  ulcer  or  chancre  should  be  destroyed  by  fire  or 
caustic  as  soon  as  it  makes  its  appearance.  Aqua  fortis  or  lunar  caustic 
may  be  employed  for  this  purpose.  When  the  ulcer  has  already 
spread  over  a  large  surface  or  corroded  deeply  into  the  flesh,  its  virus 
may  be  destroyed  by  repeated  applications  of  a  strong  solution  of  the 
caustic  or  diluted  aqua  fortis— one  part  to  si\  of  water.  In  all  other  re- 
spects both  forms  are  tcf  be  treated  as  ordinary  local  inflammations.  The 
proper  temperature  of  the  water  for  sitz-baths,  which  should  be  fre 


DISEASES    OF    THE    SEXUAL   FUNCTION.        293 


quently  employed,  will  vary  greatly  in  different  cases  ;  but  in  all  cases 
that  temperature  is  to  be  preferred  which  produces  the  most  sedative 
or  soothing  effect.  In  some  cases  the  morbid  irritability  is  so  extreme 
that  cold  water  aggravates,  wliile  warm  or  very  warm  quiets  the  irri- 
tation, and  relieves  the  pain  and  irritation  at  once. 

Inordinate  Lust — We  need  not  dwell  long  on  this  affection. 
Authors  have  applied  tlie  term  satyriasis  to  an  ungovernable  sexual 
passion  in  the  male ;  and  the  term  nympJiomania  to  a  similar  propensi- 
ty  in  the  female.  They  are  both  produced  by  some  local  irritation, 
which  may  have  its  origin  in  the  general  mental  or  physiological  habits 
of  the  individual.  The  most  frequent  combination  of  causes  which  op- 
erate to  produce  a  state  of  lascivious /aror  is,  gross,  high-seasoned  food, 
intoxicating  drinks,  indolence,  and  personal  uncleanliness — in  other 
words,  inattention  to  bathing. 

These  views  of  the  causation  of  the  disease,  are  supported  by  the 
fact  that  it  is  more  common  in  advanced  life,  even  beyond  the  "three 
score  and  ten'*  peiiod,  than  in  youth  or  middle  age.  The  cure  will 
readilybe  found  in  frequent  general  cold  baths,  copious  water-drink- 
ing, active  exercise  or  occupation,  warm  relaxing  hip-baths,  and  a  sim- 
ple vegetable  diet. 

Genital  DisrLACEMENTS. — ^The  true  pathology  or  proximate  con* 
dition  of  these  affections  is  but  little  understood  by  the  medical  {U'ofes- 
sion,  as  is  apparent  from  the  general  ill-success  attending  the  ordinary 
treatment.  The  term  prolapsus  is  used  indiscriminately  for  all  degrees 
of  simple  descent,  ov  falling  of  the  ivomb  ;  but  in  some  books  the  term 
relaxation  is  applied  when  the  descent  is  only  to  the  middle  of  the 
vagina;  procidentia,  when  the  utei'us  descends  to  the  labia;  and  p/o- 
lapsus,  when  it  protrudes  externally.  Retroversion  is  that  form  of  dis- 
placement in  which  tlie  fundus  uteri  descends  toward  the  saci-um,  tlio 
OS  utei-i  or  mouth  of  the  womb  inclining  toward  the  pubes.  Antever- 
sion  is  the  reverse  of  the  preceding,  the  fundus  falling  forward  and  the 
OS  uteri  inclining  backward.  In  inversion  the  organ  is  turned  inside  out 
Vvhile  in  a  state  of  prolapse.  In  some  cases  the  upper  part  of  the 
vagina  protrudes  into  the  lower,  constituting  what  is  called  prolapsus  of 
the  vagina. 

Symptoms. — Prolapsus  of  the  uterus  is  attended  with  a  heavy,  dis- 
agreeable, or  painful  dragging-down  sensation  at  the  lower  part  of  iho 
abdomen,  aching  or  weakness  about  the  small  of  the  back,  and  when 
severe,  great  difficulty  or  inability  in  walking      At  first  there  is  in- 


294  PATHOLCGV    AND    THERAPEUTICS. 


creased  mucous  secretion,  which  increases  by  degrees  until  it  acquires 
the  chunictcr  of  an  obstinate  JeucoiThoea. 

When  the  I'^erus  is  rclroierled  the  bowels  are  irregular  or  consti- 
pated, and  from  the  pressure  of  the  displaced  organ  on  the  rectum  be- 
hind and  the  urethra  in  front,  there  is  more  or  less  difficulty  experi- 
CDced  in  expelling  the  contents  of  the  bowels  and  bladder.  In  this 
situation  the  womb  often  becomes  congested,  inflammatory,  and  en- 
larged, and  every  attempt  at  walking  is  exceedingly  painful  or  ex- 
hausting, lu  bad  cases  the  patient  can  only  endure  a  fixed,  quiet, 
almost  motionless  position  in  her  chair  or  bed.  There  is,  too,  usually, 
considerable  tenderness  and  tension  of  the  whole  abdomen. 

Anteversion  is  a  less  frequent  occurrence;  it  is  denoted  by  difficulty 
in  w»lkit)i£,  sense  of  weight  or  fullness  in  the  pelvis,  with  man}'  of  the 
symptoms  of  prolapsus,  and  is  attended  with  much  less  difficulty  in 
evacuating  the  urine  and  faeces  than  retroversion. 

Inversion  is  known  by  the  organ  hanging  down  externally;  it  is  usu- 
ally tlie  result  of  violt^nce  in  extracting  the  placenta,  but  may  occur 
from  an  adhesion  of  the  placenta,  or  from  polypus  tumors. 

In  some  instances  the  falling  down  of  the  uterus  or  vagina  drags 
along  the  bladder  with  it,  constituting  what  is  called  complicated  irro- 
lapse.  In  this  case  the  bladder,  being  deprived  of  the  expulsory  aid 
of  tlie  abdominal  muscles,  is  incapable  of  evacuating  its  contents  with- 
out artificial  assistance. 

Genital  excrescence  consists  in  polypus  or  other  tumors,  issuing 
from  the  surface  of  the  uterus  or  vagina.  They  are  of  all  sizes  and 
of  various  degrees  of  consistence,  from  the  softness  of  sponge  to  the 
firmness  of  leather. 

Special  Causes. — Although  medical  authors  and  professors  of  mid- 
wifeiy  are  continually  talking  about  "relaxation  of  the  ligaments" 
which  hold  the  uterus  in  position,  as  the  main  cause  of  its  displace- 
ment, it  is  quite  clear  that  this  relaxation  has  nothing  whatever  to  do 
with  it;  tlie  yielding  or  elongation  of  the  ligament  being  itself  an  efecl 
of  the  displacement.  The  natural  supports  of  the  uterus  are  the 
vagina  and  the  abdominal  muscles ;  if  the  former  is  gi'eatly  relaxed  the 
uterus  will  descend,  and  the  ligaments,  being  kept  constantly  on  the 
btretch,  will  finally  elongate  more  or  less  ;  and  if  the  abdominal  mus- 
cles are  greatJy  debilitated,  they  do  not  contract  vigorously,  so  as  to 
keep  uj)  equable  and  uniform  compression  in  all  the  various  positions 
of  the  body,  liencc  the  uterus  is  liable  to  fall  forward  or  backward,  or 
incline  laterally;  and  when  both  are  badly  rehixed  and  debilitated,  we  find 
both  con.litions  of  disjilacement — falling  down  and  tipping  transversely 
across  the  pelvis.     In  corroboratior   of  thi^  view  of  the  subject,  I  mav 


DISEASES    OF    THE    SEXUAL   FUNCTION.         2% 

advert  to  the  fact,  that  ail  the  cases  of  uterine  displacement  we  meet 
vvirli  in  practice,  with  the  single  and  rare  exception  of  such  as  are 
produced  by  violence,  occur  in  females  who  suffer  from  the  very  cir- 
cumstances which  are  most  efficient  in  inducing  muscular  relaxation 
of  these  parts,  as  constipation,  piles,  dyspepsia,  nervous  debility,  mis- 
menstruation,  abortions  or  miscarriages,  preternatural  labors,  etc. 

Treatment. — How  impotent  for  good,  and  how  potent  for  evil,  are 
all  the  common  chirurgical  and  drug-shop  appliances  for  the  manage- 
ment of  these  cases,  may  be  inferred  from  the  preceding  explanation 
of  their  nature  and  proximate  cause.  Pessaries  innumerable  have  been 
invented,  trusses,  braces,  and  supporters  of  all  sorts  and  shapes  have 
been  contrived,  and  blisters,  issues,  and  caustics,  of  every  kind,  have 
been  resorted  to,  while  many  times  the  miserable  sufferer  has  been 
kept  confined  to  a  fixed  position  in  bed  for  six  months  or  a  year,  all 
intended  to  aid,  force,  and  sting  the  "  relaxed  ligaments"  into  contrac- 
tion, but  which  have,  in  nearly  all  cases,  operated  greatly  to  the  disad- 
vantage of  the  relaxed  muscles,  and  thereby  greatly  aggravated  the 
difficulty. 

A  rational  medication  will  abjure  all  these  "  evidences  of  mechanical 
and  chirurgical  skill,"  and  regard,  first  of  all,  the  general  health.  All 
the  resciirces  of  hygiene  must  be  discriminatingly  adapted  to  each  in- 
dividual case.  No  class  of  patients  require  a  more  rigidly  simple  and 
abstemious  diet.  I  have  had  many  patients  confine  themselves  for 
weeks  to  brown  bread,  boiled  potatoes,  and  baked  apples,  or  some  plan 
as  simple,  and  always  with  the  best  results.  Nothing  will  conduce 
more  to  bring  about  a  firm,  energetic,  contractile  state  of  the  whole 
muscular  system.  If  a  strict  diet  is  adopted,  very  little  water-drinking 
is  necessary.  The  bathing  part  of  the  treatment  must  in  general  be 
moderate,  for  the  reason  that  most  patients  can  take  but  little  exercise. 
A  daily  tepid  dripping-sheet  or  halt-bath,  with  one  or  two  tepid  hip- 
baths, a  foot-bath  in  the  evening,  with  two  or  three  vaginal  injections 
daily,  of  as  cold  water  as  can  be  borne  without  disquiet,  is  the  usual 
combination  of  baths  whicli  are  most  serviceable  in  these  cases.  To 
these  I  would  always  add  occasional  packs  when  the  patient  has  a  good 
degree  of  reactive  power  or  superficial  heat  and  circulation.  As  in  all 
other  cases,  the  patient  should  exercise  according  to  ability  ;  but  in 
bad  displacements  very  little  can  be  done  in  this  way  until  the  uterus 
is  restored  to  its  natural  position.  This  must  be  done  mechanically, 
when  the  ordinary  external  means  fail.  The  os  uteri  must  be  found 
and  elevated,  or  drawn  backward  or  forward,  according  to  the  kind  of 
displacement.  "While  the  uterus  is  in  position,  the  abdominal  muscles 
must  be  strengthened  by  active  yet  gentle  manipulations,  and  the  re- 


296  PATHOLOGY    AND    THERAPEUTICS. 


b.\e<l  fibres  of  the  vngina  constriDged  by  injections  of  a  small  quantity 
of  very  cold  warcr.  The  patient  should  commence  walking,  or  increase 
her  usual  ajnouot  of  exercise,  as  soon  as  the  org-an  is  replaced,  and 
gradually  extend  the  excursions  or  gymnastics,  as  the  muscular  strength 
improves.  When  the  uterus  is  inflamed  and  enlarged,  and  the  parts 
p.'iinful  and  tender,  the  replacement  should  not  be  attempted  until 
thesn  sympton)9  have  been  partially  subdued  by  the  treatment.  la 
some  cases  an  appropriate  instrument  is  necessary  to  effect  the  i'eplace- 
inent,  and  when  the  vagina  is  extremely  relaxed,  the  uterus  will  have 
to  be  6up{X)rted  with  a  piece  of  soil  sponge  inclosf^d  in  a  delicate  cap- 
sule of  India  nibber,  until  the  requisite  rausculai  conti'actiou  can  be 
induced. 

The  inverted  uterus  should  be  restored  as  soon  as  possible  after  the 
accident  which  induced  it,  or  its  contraction  will  render  the  opei'ation 
impossible.  The  treatment  of  the  excrescent  variety  comes  within 
the  province  of  the  surgeon ;  and  of  the  various  operations  propo>»ed 
for  its  removal  the  ligature  is  the  best. 


CHAPTER  XIX. 

DISEASES  OF  THE  URINARY  ORGANS. 


The  various  foin.s  of  mismicturition,  which  consist  in  morbid  secre* 
tions  or  discharges  of  urine,  are  : 

Destitution  of  Urine — Suppression. 

Retention  of  Urine — Ischuria. 

Painful  Urination — Stranguiy — Dysuria. 

Saccharine  Urine — Diabetis. 

Incontinence  of  Urine — Eneuresis. 

Uuassimilated  Urine — Urinary  Diarrhoea. 

Eiratic  Urination — Vicarious  Urination. 

TT  •  /-111      (  Gravel, 

Unnarv  Calcnlas  ^  ^ 

(  Stone. 

Destitution  of  Urine. — In  this  affection  tho  urine  is  not  secretet. 
oy  the  kidneys ;  there  is  no  sensation  of  fullness  or  uneasiness  in  tho 
bladder,  nor  any  desire  to  urinate.  The  excrcmentitious  elements  of 
the  ronal  secretion  are  more  oi    less  thi~Dwn  off  by  ihe  other  emun^^- 


DISEASES    OF    THE   URINARY   ORGANS.         297 

tories,  but  not  sufficiently  to  prevent  great  constitutional  suffering, 
evinced  by  general  torpitude,  apepleptic  symptoms,  etc.  Most  of  thg 
subjects  of  this  complaint  are  fat,  corpulent  persons,  considerably  ad- 
vanced in  life,  and  the  disease  generally  proves  fatal  in  a  very  few 
days. 

Treatment. — To  relieve  the  blood  as  fast  as  possible  of  its  urinous  accu- 
mulations, the  wet-sheet  pack  and  dripping-sheet  should  be  employed ; 
while  the  action  of  the  kidneys  should  be  excited  by  the  alternate  hot 
and  cold  hip  and  foot-baths,  or  better  still,  perhaps,  the  warm  douche 
followed  by  the  celd  to  the  loins  and  abdomen.  The  bowels  should 
also  be  m.oved  by  copious  injecti  ns. 

Hetkntion  of  Urine. — In  this  disease  the  urine  is  duly  secreted, 
but  its  flow  is  interrupted  by  spasm,  inflammation,  calculi,  tumor, 
stricture,  abscess,  concretions  in  the  rectum,  distention  of  the  vagina,  or 
debility  or  palsy  of  the  bladder  itself.  A  frequent  cause  is  over-disten- 
tion  of  the  bladder  in  consequence  of  holding  the  water  too  long,  when 
it  has  been  inconvenient  to  void  it.  This  condition  is  always  attended 
with  pain,  protuberance,  and  a  frequent  desire  to  urinate. 

Treatment. — In  most  cases  a  hot  hip-bath,  or  hot  fomentations  to  the 
abdomen,  followed  by  a  dash  of  cold  water,  will  relieve  ;  but  if  they 
fail,  the  catheter  must  be  promptly  employed. 

Painful  Urination. — Strangury,  or  a  painful  and  dribbling  dis- 
charge of  urine,  may  result  from  several  of  the  causes  of  the  preceding 
malady ;  but  generally  it  is  excited  by  acrid  food,  drinks,  or  medicines, 
particularly  cantharides,  or  Spanish  flies,  and  is  attended  with  a  scald- 
ing sensation.  It  is  also  occasioned  hy  a  stricture,  or  callous  thickening 
of  the  lining  membrane  of  the  urethra,  in  which  case  the  micturition  is 
extremely  troublesome  and  distressing,  the  straining  often  causing  the 
bowels  to  deject  their  contents  at  the  same  time. 

Treatment. — These  cases  are  generally  relieved  by  copious  water- 
drinking,  and  warm  hip-baths  ;  in  severe  cases  the  full  warm-bath  may 
be  necessary. 

Saccharine  Urine. — Diabetis,  termed  water-Jlux,  or  urinal  dropsy, 
by  the  authors,  consists  in  a  free  or  profuse  discharge  of  urine,  ot  ft 
violet  smell,  and  generally  of  a  sweet  taste,  attended  with  great  thirst 
and  general  debility.  Medical  writings  are  full  of  speculations  as  to  the 
nature  and  proximate  cause  of  the  saccharine  matter  or  sugar  which  is 
sometimes  found  in  very  large  quantities  in  the  urine  of  diabetic  pa- 
tients; but  as  they  shed  no  light  o'..  the  subject,  they  are  hardly  worth 


298  PATHOLOGY    AND    THERAPEUTICS. 


our  attention  and  limited  space.  The  most  important  facL  they  have 
miide  us  acquainted  with  is,  that  the  skin  is  always  in  a  condition  of  ex- 
Iremo  turpitude. 

7V<:rt/mc^^— This  disease  has  terminated  fatally,  with  very  few  ex- 
ceptions, under  allopathic  treatment.  Instead  of  dosing  the  kidneys  or 
«toinncli,  as  has  been  and  yet  is  the  custom  of  the  drug-doctors,  we 
BhoulJ  direct  our  main  efforts  to  restore  the  cutaneous  function,  which 
is,  in  fact,  the  only  way  to  take  off  the  excessive  determination  to,  and 
irritation  of,  the  kidneys.  When  the  skin  is  cola  pale,  and  bloodless, 
tlie  tepid  dripping-sheet,  followed  by  the  dry  pack  so  as  to  produce 
moderate  perspiration,  and  the  half  or  shallow-bath,  followed  by  the  dry 
rubbing-sheet,  with  thorough  friction  to  the  whole  surface,  are  the 
leading  meiisures  of  treatment.  Water  may  always  be  drank  to  the 
extent  of  thirst,  and  the  diet  should  be  mainly  farinaceous,  and  the  arti- 
cles principally  dry  or  solid,  as  wheat-meal  biscuits,  brown  bread,  roast- 
ed potatoes,  Graham  crackers,  etc. 

Incontinence  of  Urine. — Eneuresis,  as  the  present  form  of  mor- 
bid urination  is  generally  called,  is  a  frequent  or  perpetual  discharge, 
with  difficulty  of  retaining  the  urine.  It  is  variously  occasioned  by  an 
acrid  quality  of  the  urme,  local  irritation,  atony  or  debilitj*  of  the 
sphincter  of  the  bladder,  and  a  superabundant  secretion.  The  remote 
causes  are  chiefly  hot  drinks,  diuretic  drinks  or  medicines,  intoxicating 
liquors,  etc.  The  plan  of  cure  is  the  same  as  for  the  preceding  dis- 
ease, especial  care  being  taken  to  avoid,  correct,  or  remove  the  ex- 
citing causes. 

UNAssI^^LATED  Urine. — In  this  affection  the  urine  is  impregnated 
or  colored  with  various  alimentary  or  medicinal  articles  which  have 
been  taken  into  and  have  found  their  way  to  the  kidneys,  and  through 
the  bladder,  unchanged.  Rhubarb,  prussiate  of  potash,  and  other  drugs 
pass  rapidly  to  the  kidneys  without  updergoing  decomposition;  and 
those  articles  which  are  called  diuretics  are  carried  to  the  kidneys  di- 
rectly without  going  the  rounds  of  the  circulation.  In  some  cases  ot 
imi>aired  di-estion,  the  urine  is  impregnated  with  a  matter  resembling 
chyle.  This  affectum  is  but  an  "  effort  of  nature"  to  rid  the  body  of 
extraneous  ingredients ;  and  hence  copious  water-drinking,  a  strict  diet, 
and  a  daily  bath  are  all  the  remedial  measures  which  seem  to  be  indi- 
cated. 

Erratic  Urine.— A  vicarious  discharge  of  urine  at  some  foreign 
outlet  is  not  an  unfroquent  oncurrence.    It  is  an  evidence  of  the  vis  vied- 


DISEASES    OF   THE   URINARY   ORGANS.  299 

icat.rix  natures,  to  deterge  the  blood  of  its  urinous  elements  when  some 
obstacle  prevents  their  expulsion  at  the  natural  emunctory,  or  when 
from  atony  or  disease  of  the  kidneys  it  is  not  secreted  at  all.  In  such 
cases  a  urinous  fluid  has  been  evacuated  by  the  stomach,  bowels,  skin, 
salivary  glands,  ears,  eyes,  nostrils,  breasts,  nave  ,  and  at  ulcerous  sur- 
fiices  and  fistulous  openings.  The  medication  is  the  same  as  in  the 
preceding  diseases. 

Urinary  Calculus. — Accumulations  of  calculous  matter  in  the 
urinary  cavities,  are  eithei  re7ial  or  vesical,  as  they  are  found  in  the 
kidneys  or  bladder.  Renal  calculi  comprehend  the  various  forms  of 
urinary  sand  or  gravel ;  and  vesical  calculi  constitute  the  various  kinds 
of  stone. 

The  chemical  elements  of  these  concretions  are  urea,  uric  acid,  lac- 
tic acid,  sulphates,  hydrochlorates,  and  phosphates  of  potash,  soda, 
and  ammonia,  and  various  other  occasicoal  ingredients.  The  most 
common  form  of  urinary  calculus  is  that  called  the  lithic  or  uric  acid. 
consisting  of  urea  with  some  free  acid  and  ammonia. 

The  oxalate  of  lime,  called  also  mulberry  calculus,  is  the  next  in  fre- 
quency ;  and  the  other  most  frequent  varieties  are  the  phosphate  of 
lime  and  ammonia,  and  phosphate  of  magnesia  calculi.  They  vary  in 
size  from  fine  particles  of  sand  to  lumps  of  several  ounces. 

Symptoms. — Calculous  matter  in  the  kidneys  is  attended  with  a  fixed 
pain  in  the  loins,  shooting  downward  toward  the  thighs,  which  are  af- 
fected with  numbness;  the  pain  is  increased  by  exercise ;  the  urine 
often  deposits  a  sandy  sediment,  which  may  be  either  of  a  white  or 
red  color  ;  the  pain  often  alternates  with  a  sense  of  weight. 

The  passage  of  a  large  gravel  or  sandy  particle  through  the  ureters 
is  often  intensely  agonizing,  and  accompanied  with  nausea,  fainting,  and 
generally  retraction  and  inflammation  of  one  of  the  testes.  The  pulse, 
however,  is  not  affected,  from  which  circumstance  this  affection  may 
be  distinguished  from  inflammation  of  the  kidneys  or  bladder. 

If  the  calculus  is  stopped  in  the  ureter,  heat,  thirst,  and  fever  come 
on,  and  the  retained  urine  being  thrown  back  into  the  blood,  soon  oc  • 
casions  intermitting  pulse,  coma,  convulsions,  and  death. 

Stone  in  the  bladder  produces  a  frequent  desire  of  inaking  water, 
with  a  difficulty  of  discharging  it ;  there  is  acute  pain  at  the  extremity 
of  tlie  urethra,  and  on  sounding  the  bladder  the  instrument  meets  with 
a  sonorous  resistance.  After  horseback-riding,  or  any  hard,  jolting  ex- 
ercise, the  urine  is  bloody;  in  some  cases  it  is  voided  by  drops,  and 
sometimes  the  stream  is  suddenly  stopped  before  urination  is  corn- 
oleted.     Wiien  the  stiine  becomes  large  there  is  a  dull  j^ain  about  tlm 


300  PATHOLOGY    AND   THEK  AP  ED  TIC  S. 


neck  of  tho  bladder,  and  the  rectum  is  affected  with  a  troublesome  te 

Special  Causes. — Hard  water,  the  free  use  of  salt,  alkalies,  especial* 
ly  the  ordinaiy  employment  of  saleratus ;  sti-oog  acids,  as  vinegar,  vi- 
nous and  fermented  liquors,  and  flesh-meats,  are  the  most  common  and 
most  efficient  causes. 

The  general  connection  of  the  calculous  or  lithic  acid  diathesis  with 
the  gouty — both  being  almost  always  manifested  in  the  same  person — 
points  with  unerring  certainty  to  animal  food  and  wine  as  among  tho 
leading  causes. 

Ttiore  is  no  doubt  in  my  mind  that  the  salts  and  magnesia  with  which 
nursing  mothers  and  sucking  infants  are  so  frequently  dosed  "for  me- 
dicinal pnrposes,"  occjision  many  of  the  cases  of  gravel  and  stone  we 
meet  with  in  young  children. 

Treatment. — ^To  alleviate  the  suffering,  the  warm  hip-bath,  aud  in 
extreme  cases  the  full  warm  or  hot-bath  is  necessary;  and  if  the  pain  is 
prolonged,  the  wet-sheet  pack,  of  two  or  three  thicknesses,  will  be  the 
best  sedative. 

The  curative  treatment  consists  in  freeing  the  whole  system  from 
all  extraneous  ingredients  as  rapidly  as  possible,  for  which  purpose  the 
diet  must  be  strictly  vegetable  ;  the  drink  nothing  but  pure  soft  water, 
and  frequent  packing  and  rubbing  wet-sheets,  with  such  additional  ap- 
pliances as  the  general  health  may  demand. 

Our  old-school  friends  have  a  variety  of  chemical  tests  to  determine 
the  acid  or  alkaline  predominance  of  the  calculus;  if  acidity  prevails, 
alkalies  are  administered ;  and  if  alkalies  are  most  abundant,  acids  are 
the  remedies.  This  is  like  putting  out  a  fire  by  throwing  on  green  or 
wet  wood ;  it  dampens  the  flame  for  a  moment,  but  increases  the  com- 
bustion in  the  end.  These  acids  and  alkalies  are  all  the  while  filling 
the  system  with  the  very  ingredients  which  afford  the  material  for  cal- 
culous formations.  The  surgical  operation  for  stone  will  be  considered 
hcrrnfter. 

I\'ote. — Tlie  success  which  has  attended  the  diuretic  treatment  of 
calculous  affections,  in  the  hands  of  some  physicians  who  have  made  this 
branch  of  tho  profession  an  exclusive  business,  is  corroborative  of  the 
pathological  and  therapeutical  views  above  advanced.  The  treatment 
of  tljese  "gi-Hvel  doctors"  consists  mainly  in  the  free  use  of  vegetable 
diuretic  drin44s — decoctions  of  dandelion,  milk-weed,  queen  of  the  mead- 
ow, etc  These  drinks  are  continued  for  several  months,  and  by  in- 
creasing the  amount  of  fluid  which  passes  through  the  kidneys  and 
bladder,  assist  to  wash  away  the  superfluous  earthy  particles. 


DISEASES    OF    THE  SKIN. 


801 


CHAPTER  XX. 


DISEASES  OF  THE  SKIN. 


Some  three  hundred  abnormal  appearances  of  the  skin  have  been  de- 
scribed as  distinct  diseases  by  authors;  and  I  know  not  why  a  sufficient 
amount  of  ingenious  but  useless  analytical  skill,  by  elevating  every  pe- 
culiar mark,  spot,  blotch,  patch,  or  pimple,  to  the  rank  of  a  specific 
malady,  might  not  extend  the  list  to  three  thousand.  The  follow- 
ing tabular  arrangement  comprehends  all  that  are  important  to  distin- 
guish, for  either  theoretical  or  practical  purposes  : 


Cutaneous  Rashes  < 


Rose  Rash, 
Gum  Rash, 
Lichenous  Rash, 
Pruriginous  Rash, 
[  Millet  Rash. 

r  Water-Blebs, 

.     J  Herpes, 
BlamsS  -o,      • 
Rhypia, 

,  Eczema. 

(  Veal  Skin, 
Mole, 
Freckles, 
Sunburn, 
Orange  Skin, 
Piebald  Skin, 
Albino  Skin, 

k.  Cyanosis. 

^  ^  -rr        .    ( Lousiness, 

Cutaneous  Vermi-  I  _  _,.  ' 

J  insect  Bites, 

(^  Worms. 


f  Dandruff, 

Scaly  Eruptions  <  ^^  ^^    : ' 
I  Psoriasis, 


\  Ichthyi 


Morbid  Sweat 


Macular  Skin  < 


lasis. 

r  Impetigo, 

Humid  Scans  •j^"™?"' 
j  Ecthyma, 

\  Scabies. 
'  Profuse, 

Bloody, 
"   Colored, 

Scented, 
^  Sandy. 

'  Bristled, 
Matted, 
Extraneous, 
Forky, 
Morbid  Hair<(  Gray, 

Baldness, 
Areated, 
Discolored, 
Sensitive. 


Cutaneous  Rashes. —i^ose  Rash — ro5eoZ<2  of  authors — is  an  efBor- 
eeuence  which  appears  in  blushing  patches  on  the  cheeks,  neck,  or 
26 


802 


PATHOLOGY  AND  THERAPEUTICS. 


oriius  often  fading  and  reviving ;  usually  appearing  in  the  spring  or  au- 
tuiMfi.  Gum  Rash— strophulous— IS  peculiar  to  early  infancy,  and  con- 
eists  in  an  eruption  of  red  or  whitish  pimples  about  the  face,  neck,  and 
arn)!<,  inlenui)ted  by  irregular  patches  of  inflammatory  blush,  and  man- 
ifesting sev«M-al  sub- varieties,  called  red  gum,  white  gum,  tooth  rash, 
tcilJ-fire  rash,  etc.  The  lichenous  rash  is  characterized  by  a  diffuse 
eruption  of  red  pimples,  with  a  troublesome  and  sometimes  intolerable 
sense  of  itching  or  pricking  it  is  subdivided  into  simple  lichen,  summer 
rash,  or  prickly  heat,  wild  lichen,  nettle  lichen,  hair  lichen,  clustering  lich- 
en, livid  lichen,  according  to  its  varying  and  unimportant  appearances. 
Pruriginous  rash  is  known  by  a  diffuse  eruption,  with  pimples  of  nearly 
the  same  color  as  the  cuticle,  itching  acutely,  and  when  abraded  or 
broken  by  the  nails,  emitting  a  fluid  that  concretes  into  minute  black 
scabs.  The  millet  rash  is  distinguished  by  very  minute,  tubercular, 
distinct,  milk-white,  hard,  and  glabrous  pimples,  which  are  confined  to 
the  face. 

Special  Causes. — Roseola  is  often  symptomatic  of  other  diseases. 
Wlien  idiopathic,  it  is  produced  by  sudden  and  extreme  alternations  of 
temperature,  drinking  very  cold  water  after  violent  exercise,  etc.  Gum 
rash  is  produced  by  coai'se  woolen  clothing,  jncleanliness,  greasy  and 
highly-salted  food,  and  various  other  bad  dietetic  habits  of  either  moth- 
er or  child.  Lichenous  rash  is  more  frequently  attributable  to  morbid 
bile  than  to  any  othersingle  cause;  and  when  a  torpid  liver  is  connected 
with  an  obstructed  skin,  and  both  of  these  conditions  with  a  high  sum- 
mer temj)ei-ature,  we  have  the  causes  of  its  worst  forms.  Dr.  Good 
remarks  :  "So  for  as  I  have  seen,  the  varieties  of  this  disease  depend 
upon  n  peculiar  irrilahility  of  the  skin  as  its  remote,  and  some  acci- 
dental stimulus,  as  its  exciting  cause."  If  there  is  any  thing  but  "su- 
perfluous nonsense"  in  such  a  flourish  of  words,  I  am  no  judge  of  the 
article.  Pruriginous  rash  is  more  especially  attributable  to  retained 
perspirable  matters,  and  these  have  their  cause  in  cutaneous  uncleanli- 
ness.  Some  authors  have  imputed  this  form  of  skin  disease  to  a  fish 
diet.  Millet  rash,  Dr.  Good  imputes  to  "a  torpid  state  of  the  cutane- 
ous oxcretories,  or  rather  of  their  mouths  or  extremities,  which  are  ob 
ptructed  by  hardened  mucus."  This  is  a  roundabout  but  very  delicate 
way  of  representing  the  idea  of  a  dirtj^  skin. 

Treatment. — I  have  many  times  in  the  course  of  this  work  had  oc- 
casion to  characterize  the  popular  practice  in  relation  to  certain  dis- 
eases HS  barbarous,  unphilosophical,  absurd,  pernicious,  etc.  I  have 
used  these  terms  deliberatelj-,  conscientiously,  and,  in  my  own  estima- 
tion at  least,  understandingly.  But  if  I  were  to  express  an  honest  opin- 
hm  of  the  ordinary  drug-medicatior   in  the  whole  range  of  skin  dis- 


DISEASES    OF   THE   SKIN.  803 

eases,  I  should  apply  to  it  all  the  preceding  epithets,  and  add  to  them 
the  little  word  silly.  The  ridiculous  was  never  at  a  remoter  distance 
from  the  sublime,  than  is  the  prevailing  drug-treatment  in  aftections  of 
the  skin,  from  true  science. 

The  common,  every -day  remedies  in  the  majority  of  skin  diseases, 
are  mercury  in  its  most  potent  forms  of  corrosive  sublimate  and  red 
precipitate,  arsenic,  antimony,  iodine,  preparations  of  lead,  copper,  zinc, 
and  other  minerals,  with  a  formidable  list  of  irritating  and  narcotic  oint 
ments,  all  of  which  tend  to  repel  the  disease  tc  the  internal  farts,  besides 
poisoning  the  system  with  the  drug-remedy.  Many  an  adult  has  been 
indebted  for  a  fatal  disease,  and  many  a  child  for  a  ruined  constitution, 
to  the  medication  of  a  skin  disease.  For  a  single  illustration — and 
thousands  like  it  might  be  quoted  from  standarc.  medical  books — Dr. 
Good,  who  ascribes  millet  rash  to  an  obstructed  skin,  instead  of  telling 
us  how  to  clear  out  the  obstruction,  prescribes  "  lotions  of  brandy, 
spirit  of  wine,  tincture  of  myrrh,  a  solution  of  sulphate  of  zinc  with  a 
little  brandy  added  to  it." 

The  hydropathic  management  is  intended  to  answer  two  indications ; 
I.  To  allay  the  local  irritation;  2.  To  purify  the  blood  and  all  the  secre- 
tions. In  almost  all  cases  of  excessive  irritation  of  the.  skin,  unaccom- 
panied with  fever,  tepid  water  is  preferable  to  very  cold  for  bathing  pur- 
poses. The  pack,  followed  by  the  half-bath  at  about  72",  with  moderate 
rubbing  or  friction,  is  one  of  the  best  leading  processes.  Tlie  half-bath 
alone,  if  accompanied  with  a  rigidly  plain  and  abstemious  diet,  will 
generally  very  soon  effect  a  cure;  and  the  same  may  be  said  of  the 
dripping-sheet ;  in  fact  almost  any  kind  of  washing,  if  sufficiently  fre- 
quent, with  a  plain  diet,  will  cure  in  due  time.  There  are  no  diseases 
in  which  stale  meats,  highly-salted  or  highly  seasoned  foods,  greasy 
mixtures,  and  excessive  alimentiveness,  have  a  more  pernicious  influ- 
ence than  in  the  affections  under  consideration.  It  is  also  of  some 
importance  td  preserve  a  uniform  temperature  of  body,  avoiding  all 
extremes  of  heat  or  cold,  and  especially  damp,  chilly  winds.  When 
the  itching  or  pricking  is  unendurable,  the  full  warm-bath  may  be  ad- 
vantageously employed  as  an  occasional  sedative. 

Scaly  Eruptions. — The  first  variety,  dandruff,  consists  in  patches 
of  fine  branny  scales,  easily  separated  from  the  cuticle,  which  is  not 
irritable  or  tender.  It  may  affect  the  head,  trunk,  or  whole  body  ;  in 
the  latter  case  the  scaliness  is  red,  brown,  or  yellow. 

Lcjmjsy — lepra— lefriasis — presents  patches  of  smooth  laminated 
scales,  of  a  circular  form,  and  of  different  sizes,  surrounded  by  a  red- 
dish prominent  circle,  with  a  central  depregsior     scattered  generally 


ao4 


PATHOLOGY   AND   THERAPEUTICS. 


over  the  surface.  Its  principal  sub-varieties  are  the  common  or  whiii 
leprosy,  nud  the  black  leprosy;  so  called  from  the  color  of  the  scales, 
which  varies  from  a  bright  white  to  a  dusky  brown.  In  some  cases 
the  scales  exist  in  scattered  patches  and  in  others  in  confluent  clusters. 
It  has  generally  been  regarded  as  contagious,  although  some  authors 
dispute  its  contagiousness  altogether. 

Psorlaais — dry  scall — rough  scabies — consists  in  bright  patches  of 
continuous  scales,  of  indeterminate  outline,  generally  appearing  in  ser- 
pentine or  tortuous  stripes  and  found  chiefly  on  the  back  and  face, 
out  sometimes  extending  over  the  whole  body.  In  children  it  is  con- 
sidered contagious.  The  surface  is  often  chapped  and  excoriated,  and 
itches  or  burns  whenever  exposed  to  unusual  heat.  A  sub-varietj'  of 
this  alVeclion  has  been  called  grocer's  itch,  baker's  itch,  etc.  It  fre- 
quently affects  the  hands  of  grocers,  bakers,  bricklayers,  washerwomen, 
and  bleachei-s,  especially  in  the  spring  and  fall. 

Ichth-jiasis—fish  skin — is  a  harsh,  papulated,  M-atery  rind,  or  horny 
incrustation,  of  a  dusky,  brown,  or  yellow  color,  sometimes  covering 
the  whole  body,  except  the  head  and  face,  palms  of  the  hand,  and 
soles  of  the  feet;  and  sometimes  the  entire  body,  including  the  face 
and  tongue.  In  some  cases  horn-like  excrescences  sprout  out  of  the 
incmstations,  and  occasionally  grow  to  the  extent  of  several  inches. 
It  is  regarded  by  authors  as  a  morbid  development  of  the  cuticle,  and 
is  generally  congenital. 

Special  Causes. — Gross  food,  personal  uncleanliness,  and  sudden  al- 
ternations of  temperature,  are  the  ordlnaiy  causes.  Dandruff"  in  the 
head  is  often  produced  by  too  much  head  apparel,  greasing  or  oiling 
the  hair,  confining  it  too  closely  on  the  head,  and  excessive  brain  labor. 
That  leprosy  was  regarded  as  emphatically  a  disease  of  bodily  impu- 
rity, when  it  prevailed  among  the  ancient  Hebrews,  is  evident  from 
the  whole  tenor  of  the  code  of  the  Jewish  law-giver  on  the  subject 
of  personal  cleanliness,  especially  as  related  to  the  food  of  his  people, 
and  the  rigid  measures  of  purification  deemed  necessary  in  the  treat- 
ment of  lepoi-9  under  the  Mosaic  dispensation. 

Treatment. — The  principal  point  of  difference  in  the  management  of 
cutaneo'.in  rashes  and  scaly  eruptions  is  this  :  in  the  latter,  on  account  of 
the  less  degree  of  irritability  or  tenderness  of  the  skin,  water  of  a  colder 
tempei-ature  may  be  employed,  and  considerable  friction  can  generally 
follow  the  bath  with  advantage.  Probably  the  most  efficacious  treat- 
ment in  a  majority  of  cases,  would  be  the  long  pack,  from  one  to  tno 
hours — usin^  two  or  three  thicknesses  of  the  wet-sheet,  followed  by  a 
thorough  nibbing  with  the  dripping-sheet.  Of  course,  when  there  is 
no  protoruatural  or  feverish  heat,  due  precautions  must  be  taken  to 


DISEASES   OF    THE    SKIN.  306 

secure  proper  reliction  or  a  comfortable  glow  after  each  pack.  Dan- 
druff of  the  body  can  always  be  cured  by  a  perseverhig  employment 
of  the  wet  towel;  and  when  the  head  is  badly  affected,  so  that  the 
hair  is  loose  and  easily  falls  out  when  the  comb  is  used,  the  hair  should 
be  worn  rather  short,  and  the  head  batlied  once  or  twice  a  day  in  very 
cold  water. 

BiiAiNS. — These  affections  consist  in  roundish  elevations  of  the 
cuticle,  containing  a  watery  fluid. 

In  water-blebs — qiompholyx — the  eruptions,  which  are  mostly  dis- 
tinct, and  break  and  heal  without  scale  or  crust,  contain  a  reddish 
transparent  fluid.  They  appear  successively  in  various  parts  of  the 
body,  of  the  sizes  of  peas,  filberts,  or  walnuts,  somotimes  bursting  and 
healing  in  three  or  four  days,  but  occasionally  fornJng  an  ulcerated 
surface. 

Tetter — herpes — is  an  eruption  of  vesicles  in  small  distinct  clusters, 
with  a  red  margin;  transparent  at  first,  but  soon  becoming  opaque;  it 
is  attended  with  tingling  or  itching,  and  the  vesicles  concrete  into  scabs, 
and  desquamate  in  the  course  of  two  or  three  weeks.  It  presents 
several  sub-varieties,  as  miliary,  when  the  vesicles  are  millet-sized ; 
corrosive,  when  the  vesicles  are  hard  and  discharge  an  acrid,  corroding 
fluid,  which  spreads  in  serpentine  trails;  shingles,  when  the  vesicles 
are  pearl-sized,  and  spread  in  clusters  around  the  body  like  a  girdle : 
ringioorm,  when  the  vesicles  have  a  reddish  base,  and  are  united  in 
rings;  rainbow -worm,  when  the  vesicles,  which  unite  in  small  rings,  are 
suiTounded  by  larger  concentric  rings  of  different  hues,  and  local,  when 
they  are  limited  to  a  particular  part. 

In  rhypia — rhupia — sordid  blain — the  eruption  consists  in  broad, 
distinct  vesicles,  having  a  slightly  inflamed  base,  and  filled  with  a  sa- 
nious  fluid,  which  often  produces  gangrenous  and  offensive  eschars. 
The  scabs  are  thin  and  superficial,  and  easily  rubbed  oft*  and  repro- 
duced. 

Eczema — heat  eruption — consists  in  minute,  distinct,  but  closely 
crowding  vesicles,  containing  a  transparent  or  milky  fluid,  attended  with 
ti'oublesome  itching  or  tingling,  and  terminating  in  thin  scales  or  scabs. 

Special  Causes. — Rayer,  who  has  written  an  elaborate  treatise  on 
diseases  of  the  skin,  assigns  "  chronic  vascular  inflammation  or  irri- 
tation," as  the  nature,  cause,  sum  and  substance  of  nearly  the  whole 
catalogue,  while  Drs.  Good,  Cooper,  and  Thompson,  equally  eminent 
authors,  dispose  of  this  branch  of  the  subject  quite  as  conveniently  by 
the  phrase,  "  a  peculiar  irritability  with  debility,  either  general  or 
local" — phrases  which    I  an:  sorry  to  saj  I  cannot  divine  the  meaning 


800  PATHOLOGY    AND    THERAPEUTICS 

of.  Ijidigestible  food  nnd  intoxicating  liquors  are  the  ordinary  causes 
of  w.'itcr-blebs.  Tetter  is  generally  owing  to  acrid  bile,  thrown  upon 
the  surface.  Rhypia  almost  always  aHects  children  who  have  been 
reduced  by  bad  nui-sing  and  bad  drugging.  Heat  eruption  i?  usually 
produced  by  violent  exercise,  exposure  to  hot  air,  or  the  direct  rays  of 
the  sun,  and  not  unfrequently  by  the  use  or  abuse  of  mercurj. 

Treatment. — In  addition  to  the  general  plan  of  treatment  recom- 
mended thus  far  for  skin  diseases,  the  digestive  fLinction,  being  more 
particularly  implicated  in  the  diseases  before  us,  requires  some  special 
HiMitional  attention.  In  all  the  varieties  of  tetter  or  herpes,  free  water- 
drinking,  frequent  liip-baths,  and  the  abdominal  girdle  are  appropriate. 
In  the  soixiid  blain  of  children,  the  parts  affected  should  be  frequently 
washed  in  very  cold  water,  except  when  the  abraded  surface  is  itchy 
and  tender,  when  warm  or  tepid  washing  is  the  most  soothing. 

Humid  Scalls. — The  present  genus  of  scall  or  scale-skin  diseases 
is  characterized  by  an  eiuption  of  small  pustules,  either  distinct  or 
confluent,  which  harden  into  crustular  plates. 

Impetigo — running  scall — appears  in  yellow,  itching,  clustering  pus- 
tules, terminating  in  a  yellow  scaly  crust,  intersected  with  cracks.  It 
is  generally  confined  to  the  hands  and  fingers,  but  sometimes  extends 
over  the  lower  extremities,  and  occasionally  affects  the  neck  and  face. 
A  thin  ichor  or  purulent  matter  often  issues  from  the  numerous  cracks, 
which  corrode  the  skin  and  cellular  membrane;  and  in  some  cases  tho 
aggregated  scabs  form  a  thick,  rigid  casing  around  the  affected  limb  so 
as  to  impede  its  motion.  Sometimes  the  disease  commences  with  a 
pulTy  swelling  of  the  face,  with  oedema  of  the  eyelids,  very  nmch  re- 
sembling erysipelas,  but  without  its  smooth  polish. 

Porngo — scabby  scall — ti7}ca — consists  of  straw-colored  pustules, 
which  concrete  into  yellow  scales.  Its  principal  sub-varieties  are,  the 
milkif  srtill,  ()!•  crusta  lactea,  which  chiefly  affects  infants  at  the  breast, 
the  pustules  commencing  on  the  cheeks  and  foi'chead,  and  often  cover- 
ing the  whole  face  with  a  continuous  incrustation;  and  the  scalled 
head— tinea  capitis— hxindi  mostly  in  young  children,  marked  by  pus- 
tules which  commence  in  the  scalp  in  distinct  patches,  and  gradually 
spread  until  the  whole  head  is  covered,  and  the  roots  of  the  hair  de- 
stroyed. It  is  generally  regarded  as  contagious.  Other  less  important 
lorm.s  have  been  c.dled  lupine,  honeijcomb,  furfuraceous,  ringworm,  etc. 

Ectlnftiui—p<ipulous  scall — is  characterized  by  large,  distinct  pus- 
tules, raised  on  n  hard  red  base,  and  terminating  in  hard,  greenish, 
or  dark-colored  scabs.  It  occurs  at  all  periods  of  life,  from  the  earhest 
iufancy  to  advanced  age,  and  is  very  often  symptomatic  of  other  diseases- 


DISEASES    OF    THE    SKIN.  30T 

Scabies — itch — is  an  eruption  of  minute  pimples  of  a  papular,  pustu- 
lar, vesicular,  or  mixed  character,  accompanied  with  intolerable  itching; 
it  is  found  chiefly  in  the  flexures  of  the  jomts  or  between  the  fingers, 
and  is  highly  contagious.  It  is  one  of  the  most  complicated  of  the  cu- 
taneous diseases,  presenting  many  sub-varieties,  the  principal  of  which 
are  the  papular  or  rank  itch,  the  vesicular  or  watery  itch,  the  purulent 
or  pocky  itch,,  the  complicated,  in  which  the  disease  extends  over  the 
body,  often  affecting  the  fiice,  and  the  mangy  itch,  which  is  produced 
by  handling  mangy  animals. 

Special  Causes. — Most  ®f  the  forms  of  humid  scalls  are  owing  to 
the  combined  operation  of  two  sets  of  causes,  one  of  which  is  nega- 
tive and  the  other  positive.  The  negative  causes  are  the  absence  of 
water,  soap,  flesh-brushes,  and  coarse  towels ,  the  positive,  are  gross 
and  irritating  food,  as  fried  pork,  salt  ham,  sausages,  old  cheese,  fried 
cakes,  and  cookea  and  burnt  fats  of  all  kinds,  and  acrid  or  stimulating 
drinks,  as  hard  cider,  acid  wines,  and  ardent  spirits.  Some  forms  of 
humid  scall,  which  are  confined  to  the  hands  and  feet,  are  occasionally 
produced  by  severe  exposures  to  cold  or  wet ;  a  remark  which  holds 
true  also  of  some  forms  of  dry  scall  which  are  confined  to  the  ex- 
tremities. Mothers  ought  to  know  that  ^Aeir  dietetic  habits  may  induce 
these  and  m.ariy  other  cutaneous  diseases  in  their  offspring  while  nurs- 
ing, and  even  before  birth. 

Treatment. — Thorough  and  frequent  ablutions,  with  a  plain  vegeta- 
ble diet,  and  the  constant  use  of  wet  compresses  when  the  skin  is 
abraded  or  ulcerated,  comprise  the  general  remedial  course.  The 
patient  should  be  kept  in  a  moderate  uniform  temperature,  and  when 
the  hands  or  feet  are  deeply  cracked,  sore,  and  exposure  is  inevital)le, 
the  sores  should  be  anointed  occasionally  with  olive  oil  or  sweet  cream, 
taking  the  precaution  to  wash  or  soak  the  part  in  warm  water  before 
applying  it.  Parents,  as  they  value  the  future  health  of  a  child, 
should  avoid  all  repellant  lotions,  ointments,  or  all-healing  specifics,  in 
all  forms  of  skin  diseases.  They  may  indeed  smooth  the  skin,  but  the 
disease  will  be  only  transferred  to  an  internal  and  more  vital  part. 

The  \v4io1e  system  of  allopathic  medication  is  calculated  to  drive  the 
disease  in  ;  but  all  rational  practice  will  contemplate  the  exact  contrary. 
On  so  simple  a  disease  as  the  common  itch,  which  is  always  cured  as 
soon  as  the  skin  can  be  made  clean,  nearly  the  wlioio  force  of  the 
apothecary  shop  has  been  spent  in  vain  ;  and  the  disease  has  been 
cured  by  two  or  three  thorough  soap-sudsings,  after  sulphur,  lead, 
mercury,  arsenic,  tar,  turpentine,  human  and  animal  urine,  chalybeate 
waters,  gunpowder  and  whiskey,  gin  and  salts,  and  white  and  red  j)i'e- 
cipitate  ointments  lad  been  used  without  success. 


308  PATHOLOGY    AND    THERAPEUTICS. 

CuTANKOUs  Vkrmination. — The  cuticle  may  be  infested  with  the  j 
common  louse,  which  mostly  inhabits  the  heads  of  uncleanly  children ;  I 
the  crab  louse,  which  is  found  chiefly  about  the  gi-oins,  pubes,  and  eye-  i 
brows  of  unhealthy  persons,  producing  extreme  itching;  the  common  I 
Jlea,  whose  eggs  are  deposited  on  the  roots  of  the  hair  and  on  flan-  : 
nel :  tlie  chiggre,  a  West  Indian  flea,  not  more  than  one  fourth  tlie  • 
size  of  tho  common  flea,  which  deposits  a  bunch  of  minute  eggs  in  , 
the  feet  of  dirty  persons,  sometimes  occasioning  ulceration  and  mortifi-  : 
cation ;  the  tick,  of  which  there  are  several  varieties — the  domestic  '. 
tic,  itch  tick,  and  harvest  bug — whose  bite  occasions  an  itching  and  j 
smarting  pain;  the  Guinea-worm  of  th?,  Indies,  the  gad  Jiy,  which,  i 
is  common  to  quadrupeds,  but  sometimes  burrows  in  the  mucous  mem- 
brane of  huJ7ian  noses;  and  the  hair  icorm,  which,  by  the  way,  in-  I 
volves  a  disputed  point,  whether  the  iufestment  is  a  live  animal,  or  | 
merely  a  morbid  growth  of  real  hair.  \ 

Personal  cleanliness  is  the  best  preventive  of  these  intrusive  crea-  | 

turcs,  and  cold  compresses  are  the  best  remedies  when  bitten  by  any  of  | 

them.    The  second  varietj',  crab  louse,  is  often  excessively  troublesome.  : 

iNIedical  books  tell  us  that  strong  mercurial  ointment  is  sure  death  to  i 

thom ;  and  the  same  maj'-  be  said  of  strong  soap-suds,  or  a  sufficient  | 

amount  of  cold  bathing  and  friction  without  the  soap.  \ 

i 

Macular  Si-.iN. — Simple  discolorations  of  the  surface  are  generally  j 

the  result  of  depraved  secretions,  retained  excretions,  the  introduction  i 

of  drugs  or  foreign  substances  in  the  body,  blows  or  bruises,  or  of  ex-  : 

posure  to  strong  cold  winds  or  hot  sunlight.     Sometimes,  however,  a  j 

change  in  the  color  of  a  part  or  oF  the  whole  skin  takes  place,  which  i 
we  are  unable  to  trace  to  either  of  these  causes  ;   and  one  example — 

cyanosis — is  frequently  owing  to  organic  malformation  of  the  heart.  j 

In  the  veal  skin  variety  the  skin  is  marked  by  white,  shining,  per-  ' 

manent  spots,  the  superincumbent  hairs  foiling  off  and  never  reapi)ear-  ' 

ing.      The    mole  is  a  permanent,   circular,   brown   patch,   sometimes  j 

slightly  elevated,  and  crested  with  a  tuft  of  hair.     Freckles  are  yellow-  j 

ish-brown  dots  on  the  cuticle,  resembling  minute  lentil  seeds,  and  often  \ 
tr.insitory.     Sunburn  is  a  tawny  discoloration  from  exposure  to  the  sun, 

which  disappears  in  tho  winter  ;  orange  skiii  is  mostly  confined   to  ' 

young  infants  whose  mothei-s  weio  aff*ected  with  torpidity  of  the  liver  ' 

during  gestation,  but  it  sometimes  appears  in  adult  life  from  biliary  oh-  | 

struction.     Piebald  skin  is  a  general  marbled  appearance  of  the  cuti-  | 

cle,  with  alternate  patches  of  black  and  white.     Albino  skin  is  a  dull-  | 

white  state  of  the  cuticle,  with  rosy  pupils,  weak  si^rht,  and  white  or  I 
flaxen  hair :  it  is  usually  found  among  negroes,  bu  l^  sometimes  knowq 


DISEASES    ')F    THE   SKIN.  309 

nmong  the  white  races ;  it  is  sometimes  congenital,  and  in  some  instan- 
ces the  adult  black  and  also  white,  have  changed  to  Albinoes. 

Cyanosis — blue  disease — cyania — is  known  b}'  the  whole  skin  being 
more  or  less  blue,  the  lips  purple,  with  general  dullness  of  mind  and 
debility  of  body ;  it  is  always  congenital. 

Special  Causes. — Severe  fevers  have  been  followed  by  various  per- 
manent discolorations ;  even  a  black  man  has  been  transformed  into  a 
white  man  by  this  cause.  In  some  cases,  spotted  and  motley-colored 
skins  are  hereditary.  Mineral  medicines  often  produce  livid  spots  or  a 
universal  dingy,  bluish,  or  dark  appearance  of  the  skin.  Nitrate  of  sil- 
ver is  a  very  common  cause.  When  administered  for  several  weeks, 
it  frequently  produces  a  deep  tawny  and  uniform  discoloration,  ap- 
proaching to  a  black,  being  deepest  in  the  parts  most  exposed  to  the 
light.  Sometimes,  however,  discoloration  from  this  drug  appears  in 
patches,  and  sometimes  one  half  of  the  body  is  affected. 

The  blue  disease  is  generally  owing  to  some  malconformation  of  the 
heart,  the  most  common  of  which  is  a  communication  between  the  two 
ventricles,  thus  rendering  the  decarbonization  of  the  blood  imperfect, 
and  giving  rise  to  the  venous  or  carbonaceous  discoloration.  Nitrate 
of  silver  has  also  produced  a  bluish  tinge  of  the  whole  skin,  closely  re- 
sembling cyanosis. 

Treatment. — Most  of  these  affections  are  unimportant  trifles,  and 
many  of  them  are  unalterable  for  the  better.  Yellow  skins,  blotches, 
motley  appearances,  etc.,  when  induced  by  a  diseased  liver,  can  be 
often  cured  by  restoring  the  functional  action  of  this  organ.  When 
the  skin  is  discolored  by  drugs,  a  persevering  employment  of  the  wet- 
sheet,  with  a  course  of  free  water-drinking  and  plain  vegetable  diet, 
will  do  all  that  can  be  done  in  the  way  of  medication,  although  it  will 
seldom  wholly  remove  the  difficulty.  The  blue  disease  is  incurable  ; 
(ts  subjects  are  feeble  and  short-lived  ;  and  all  that  can  be  done  to  pro- 
long existence  is  found  in  plain,  quiet,  simple  habits  of  life. 

Morbid  Sw^at. — Profuse  perspiration,  when  not  a  symptom  of 
6ome  acute  disease,  is  an  evidence  of  debility,  and  requires  no  atten- 
tion, save  a  course  of  tonic  bathing  and  regimen.  Bloody  sweat,  though 
regarded  as  an  idiopathic  disease  by  some  authors,  is  usually  a  vica- 
rious afi'ection,  as  in  mis-menstruation,  or  the  result  of  vehement  emo- 
tion, violent  exertion,  or  intense  agon3^  Partial  sweats  are,  I  believe, 
always  symptomatic.  Colored  siveafs,  which  may  be  green,  blue,  black, 
or  yellow,  result  from  obstruction  of  the  liver  or  kidnej^s,  or  from  some 
metallic  or  mephitic  impregnation.  Scented  sweat  may  be  rank  or  fe- 
tid, sour  or  acrid,  sulphurous  or  musky,  saline,  aromatic,  ere.      .Most 


810 


PATHOLOGY  .AND  THERAPEUTICS. 


of  these  varieties  depend  on  the  dietetic  habits  of  the  individual,  in  con 
nection  with  the  amount  of  bathing  practiced.  Some  persons,  who 
never  or  but  seldoii  bathe,  and  eat  strong  food,  are  exceedingly  disa 
greeable  to  the  olfactory  nerves  of  others.  Many  persons  who  exer- 
cise much  on  foot,  wear  flannel  stockings,  and  bathe  rarely,  have  a 
horribly  ofTensive  scent,  which  becomes  intolerable  on  exposing  the  feet 
to  the  fire.  I  once  had  a  patient  who  exhaled  from  the  axillae  a  strong 
musky,  or  rather  blue-dye  odor,  for  which  he  could  assign  no  probable 
cause.  Sandy  sweat,  known  by  a  reddish  sandy  material  concreting  on 
the  surface,  indicates  great  deficiency  in  the  functional  action  of  the 
kidneys,  or  great  excess  in  the  saline  and  earthy  matter  taken  into  the 
system  with  the  ingesta.  The  proper  treatment,  I  trust,  is  sufficiently 
obvious  in  all  these  cases  without  further  remark. 

Morbid  Hair — Trichiasis. — Even  the  hairs  of  our  heads  may  be- 
come deranged  by  our  physiological  transgressions,  although,  next  to 
the  bones,  they  are  the  most  indestructible  of  our  bodily  constituents. 
The  bristly  or  porcupine  hair,  is  usually  regarded  as  an  effect  of  gross 
nutriment  connected  with  general  habits  more  congenial  with  perfect 
animal  than  jrrogressive  human  nature.  Matted  hair — plica  p)olonica 
— the  hairs  becoming  vascularly  thickened,  inexti'icably  entangled,  and 
matted  together  by  a  glutinous  secretion — is  supposed  to  result  from 
covering  the  head  too  closely,  as  with  a  thick  woolen  bonnet  or  leather 
cap,  with  little  or  no  attention  to  combing,  washing,  or  in  any  way 
cleansing  the  head.  Extraneous  hair — trichosis — is  most  commonly 
noticed  in  bearded  women,  and  has  been  imputed  to  excessive  men- 
struation, the  excessive  use  of  pork,  shell-fish,  and  other  gross  foods. 
Forky  hair — the  hairs  of  the  scalp  weak,  slender,  and  splitting  at  their 
rxtremities — is  a  common  complaint,  depending  for  its  immediate 
cause  on  defective  nutrition  in  the  bulb  or  root.  Gray  hair,  when  not 
"frosted  by  age,"  may  be  produced  by  fright,  terror,  gi'ief,  excessive 
brain  labor,  violent  fevers,  etc.  Baldness  may  result  from  the  same 
causes  as  gray  hairs,  and  is  often  the  consequence  of  skin  diseases.  It 
is  far  more  common  in  males  than  in  females — wliicn  ftict  seems  to 
corroborate  the  physiological  notion  which  some  have  advanced,  that 
the  common  practice  of  catting  the  hair  and  shaving  the  beard  is  a 
source  of  bodily  infirmity.  Aerated  hair — patches  of  bald  spots  in  the 
Bcalp  or  beard — is  probably  owing  to  some  obscure  skin  disease  or  pre- 
ternatural excitement  of  some  portion  of  the  brain.  Miscolored  hair 
— the  liair  changing  to  blue,  black,  green,  or  spotted — occasionally  re- 
sults from  fevers,  terror,  heating  the  head,  mineral  and  metallic  va- 
pors, etc.     Sensitive  hair  is  usually  owing  to  cerebral  excitement:  and 


?OISONS.  811 

this  IS  usually  owing  to  wounds  or  injuries  of  the  head,  and  febrile  oi 
ujflammatory  affections.  The  hair,  in  some  instances,  is  so  acutely 
Sensitive  that  the  slightest  touch,  or  the  cutting  of  a  single  hair,  gives 
•exquisite  pain. 

Treatment. — Cutting  the  hair  short,  and  frequently  bathing  the 
viiole  head  in  cold  water,  is  the  general  restorative  process  in  these 
deviations  from  health — some  of  which,  however,  are  not  curable.  Tn 
cases  of  excessive  sensibility  or  tenderness,  tepid  or  moderately  warm 
water  should  be  employed.  In  the  })]ica  polonica.  the  hair  should  be 
rut  very  close,  the  scalp  frequently  washed  with  tepid  water,  and  de- 
)'ivative  hip  and  foot-baths  directed.  And  in  all  cases  the  general  reg- 
imen must  be  physiologically  regulated,  and  such  bathing  appliances 
?)rought  in  requisition  as  the  general  health  and  particular  circum- 
stances indicate. 


CHAPTER  XXI. 

POISONS. 

So  general  is  the  employment  of  substances  for  chemical,  niechan- 
'cal,  and  medicinal  purposes,  which  are  poisonous  to  the  living  organ- 
ism, whether  taken  into  the  stomach  or  applied  to  the  skin  ;  and  so  nu- 
merous are  the  emergencies  wherein  relief  must  be  either  immediate 
or  impossible,  that  a  work  of  this  kind  would  be  sadly  defective  with- 
out a  brief  consideration  of  this  branch  of  pathology  and  therapeutics. 

Toxicologists  have  usually  classified  poisons  according  to  the  king- 
doms from  whence  they  are  derived,  as  mineral,  vegetable,  and  ani- 
mal. Some  have  arranged  them  according  to  their  action  on  the  ani- 
mal economy,  and  others  have  merely  distinguished  them  into  general 
and  local.  Christison,  who  has  written  the  most  elaborate  work  on 
this  subject,  divides  them  into  irritants,  narcotics,  and  narcotic- acrids. 
The  first  embraces  all  poisons  whose  principtiJ  symptoms  are  those  of 
h'ritation  or  inflammation;  the  second  produce  stupor,  delirium, spasms, 
paralysis,  etc.;  and  the  third,  as  the  term  implies,  pi-oduce  either  or 
both  sets  of  symptoms,  according  to  the  dose  and  other  circumstances. 

But  what  are  poisons  ?  This  is  a  problem  not  yet  settled  among 
medical  men.  In  its  broadest  sense,  the  term  must  comprehend  every 
thing  foreign  to  the  natural  constituents  of  the  human  body,  and  even 
these  constituents  themselves,  when  their  constituent  elements  are  in 


PATHOLOGY  AND  THERAPEUTICS. 


unnatural  relations  or  proportions;  every  thing,  in  a  word,  which  is 
not  properly  food,  drink,  or  atmosphere.  This  latitude  of  definition 
will  include  the  whole  materia  medica  of  our  allopathic  friends;  and  in 
truth,  almost  every  poison  kuown  is  an  iutegi-al  part  of  that  materia  medi- 
ca. Established  usage  has,  however,  restricted  the  idea  of  puison  to 
the  sudden,  prominent,  aud  immediately-dangerous  effects  of  these 
articles,  wliile  their  equally  morbid  yet  more  slow,  gradual,  and  remote 
consequences  are  called  diseases. 

Were  I  to  attempt — what  no  toxicologisi  has  yet  accomplished — a 
saLisfadonj  and  philosophical  arrangement  of  poisons,  I  should  base  it 
on  the  allopathic  materia  medica,  as  ionic  poisons,  stimulant  poisons, 
emetic,  cathartic,  diaphoretic,  expectorant,  vermifuge,  and  eschar otictpo'i- 
sons,  etc. ;  but  whether  such  a  classification  would  be  pathological  or 
therapeudcal,  is  a  question  I  am  willing  to  submit  to  "  future  genera- 
tions.'' In  the  present  chapter,  the  eflfects  of  large  or  poisonous  doses 
will  be  chiefly  considered,  and  small  or  medicinal  doses  only  incident  • 
oily  alluded  to. 

« 

Acids. — ^The  nitric,  sulphuric,  muriatic,  or  hydrochloric,  phophoric, 
oxalic,  and  acetic  acids,  are  corrosive  poisons  ;  and  whether  taken  inter- 
nally or  applied  externally,  produce  redness,  inflammation,  vesication, 
and  ulceration. 

Syinptouis. — When  swallowed,  a  burning  sensation  in  the  throat,  ex- 
cruciating pain  in  the  stomach,  and  gaseous  eructations  are  usually  tiie 
immediate  eflects.  When  taken  in  exti'emely  large  doses,  the  sensi- 
bility may  be  so  suddenly  destroyed  that  the  pain  will  be  deceitfully 
slight.  All  the  symptoms  are  most  severe  wlien  the  poison  acts  upon 
an  empty  stomach. 

Treatment. — All  alkalescent  matters  are  chemically  antidotes;  there 
is,  however,  a  choice,  for  the  reason  that  some  alkalies  are  themselves 
extremely  corrosive.  Chalk  and  magnesia  are  the  best.  A  solution 
of  nard  soap  answers  veiy  well.  Slaked  lime,  or  carbonate  or  supercar- 
bonnte  of  soda  maybe  given  :  and  in  the  absence  of  all  these,  a  remedy 
may  be  found  in  the  common  plaster  of- an  ordinary  room,  which  may 
be  be«t  down  in  a  moment  and  made  into  a  thin  paste  with  water.  The 
])aticnt  should  drink  as  much  water  as  he  can  swaHow  conveniently. 
The  stomach-pump  is  not  necessary. 

Alkalies. — Caustic  j^otash,  saleratus,  quick -lime,  salt  of  tartar, 
pcarlash,  soda,  sal  ammoniac,  carbonate  of  ammonia,  or  synclling  salts, 
and  spirits  of  ammonia,  or  hartshorn,  are  the  usual  alkalies  from  which 
accidental  poisoning  results. 


POISONS.  m'd 


Symptoms. — These  do  not  differ  essentially  from  those  produced  by 
the  strong  acids. 

Treatment. — Of  course,  ail  acids  are  antidotal.  Vinegar,  lemon- 
juice,  or  any  of  the  stronger  acids,  largely  diluted,  may  be  g^en.  la 
the  absence  of  acids,  any  of  the  fixed  oils,  as  olive  or  almond,  by  con- 
verting the  alkali  into  a  soap,  will  neutralize  its  corrosive  effects.  In 
other  respects,  the  ti'eatment  is  the  same  as  for  acid  poisons.  The 
resulting  inflammation,  in  all  cases  of  poisoning,  is  to  be  treated  pre- 
cisely like  inflammation  ^rom  other  causes. 

Neutral  Salts. — The  most  virulent  of  the  preparations  commonly 
known  as  neutral  salts  is  nitrate  of  potash — saltpetre,  nitre,  sal-prunelle. 
In  the  apothecary-shops  mistakes  are  often  made,  by  which  this  article 
is  put  up  for  sulphate  of  soda,  sulphate  of  potash,  and  other  saline  lax- 
atives, so  that  the  patient  gets  poisoned.  It  produces  stinging  pains  in 
the  stomach,  and  the  usual  symptoms  of  a  violent  cholera,  with  cold- 
ness, debility,  and  great  exhaustion  of  the  nervous  system.  Other  neu- 
tral salts  in  common  use,  as  Glauber  and  Epsom,  are  not  dangerous  ex- 
cept in  excessive  doses ;  the  symptoms  then  are  drastic  purging  and 
great  debility. 

Treatment. — We  have  no  direct  antidotes  in  the  cases  before  us, 
and  our  duty  is  chiefly  to  combat  inflammation.  When  nitre  has  been 
swallowed,  warm  water  must  be  freely  taken,  and  the  stomach-pump 
employed  if  practicable.  Wet  bandages  to  the  whole  abdomen  are 
called  for,  and  the  warm-})ack  is  often  serviceable.  The  effects  of  the 
other  neutral  salts  are  to  be  counteiacted  by  cool  or  cold  injections, 
and  warm  hip-baths. 

Mercury — Hydrargyrum. — The  most  actively-poisonous  of  the 
salts  and  oxides  of  mercury  in  common  use,  ai'e  calomel,  turpeth  min- 
eral, corrosive  sublimate,  red  prec?^;i7aie,  cinnabar,  vermillion,  and  cy- 
anuret.  Of  these,  red  preci/>itate  and  vermillion  are  most  frequently 
the  agents  of  accidental  poisoning;  while  calomel  and  corrosive  subli- 
mate are  the  common  agents  in  medicinal  and  suicidal  poisonings.  It 
is  a  serious  fiict,  among  the  "curiosities  of  medical  literature,"  that 
the  standard  books  recognize  Jifty-one  distinct  diseases  resulting  from 
the  medicinal  administration  of  the  various  preparations  of  mer- 
cury ! 

Symptoms. — When  very  large   doses  are  taken,  especially  of  the 

more  powerful  of  the  mercurials,  there  is  violent  pain  in  the  stomach, 

intense  thirst,  vomiting,  heat  and  fever.     When  corrosive  sublimate  has 

been  given  in  large  doses,  or  when  small  doses  }i#\e  been  a  long  time 

11-27 


814  PATHOLOGY    AND    TH  Ell  APEUTICS. 


continued,  there  is  a  griping  pain  in  the  bowels,  with  a  ten/lency  to  di- 
arrhcra.  Whon  the  system  is  slowly  and  gi-adually  saturated  with  the 
poison,  the  effects  are  distinguished  by  the  general  term  salivation,  the 
symptoms  of  which  are  general  fever,  tremors,  f(Bted  breath,  brassy  taste, 
Bore  gums,  loosened  teeth,  driveling  at  the  mouth,  swelled  tongue,  and 
often  ulcerated  bones.  In  some  cases  the  tongue  is  enormously  swollen, 
and  protrudes  hideously  from  the  mouth,  the  poor  poisoned  patient 
being  unable  to  articulate  or  swallow. 

Treatment. — When  a  large  dose  of  corrosive  sublimate  has  been 
swallowed,  albumen  or  gluten  will  decompose  the  salt  and  prove  an 
effectual  antidote.  The  albumen  may  be  found  in  the  white  of  eggs, 
and  the  gluten  in  wheaten  flour.  Either  may  be  given  freely ;  the 
white  of  eggs  being  previously  beaten  up  with  water  or  milk,  and  the 
flour  may  be  administered  in  either  water  or  milk.  In  the  absence  of 
either  eggs  or  flour,  milk  is  the  next  best  antidote. 

To  cure  salivation,  and  remove  mercury  and  its  effects  from  the 
system,  require  a  persevering  employment  of  the  packing-sheet, 
which  may  be  warm,  tepid,  or  cold,  according  to  the  susceptibility  of 
the  patient,  and  so  managed  as  to  produce  moderate  but  frequent  per- 
spiration. 

When  paints,  ointments,  etc.,  which  contain  some  form  of  mercury, 
are  accidentally  swallowed,  the  patient  should  drink  copiously  of  warm 
milk  made  into  a  very  thin  batter  with  wheaten  flour,  and,  if  the  acci- 
dent is  soon  discovered,  the  stomach-pump  should  be  employed. 

Arsenic — Arskmcum. — The  arsenical  preparations  from  which 
poisoning  occasionally  results  are,  the  protoxide,  or  Jiy-poivder ;  arse- 
nious  acid  or  white  arsenic,  commonly  called  ratsbane  ;  ar senile  of  cop- 
per or  mineral  green ;  arsenite  of  ijotass,  as  in  Fowler''s  solution ; 
arseniusetted-hydrogen  gas,  which  is  evolved  in  various  chemical  opera- 
tions ;  and  several  sulphurets  of  arsenic,  as  realgar,  orpiment,  and 
king's  yellow. 

Symptt/ms. — In  a  great  majority  of  cases  there  is  violent  irritation 
and  inflammation  of  the  whole  alimentary  canal ;  a  burning  pain  in  the 
throat  an(i  stomach,  which  soon  extends  over  the  whole  abdomen,  with 
nausea,  faintness,  and  extreme  prostration  of  strength.  In  some  cases, 
however,  the  pain  is  slight,  the  nausea  and  vomiting  moderate,  but  the 
vital  depression  excessive  and  alarming,  and  often  attended  with  con- 
Tulsions,  paralysis,  in?cnsibility  or  delirium.  When  arsenic  has  been 
given  medicinally  in  small  doses  for  some  time,  the  first  prominent 
symptom  of  its  specific  action  on  the  system  is  a  peculiar  puffmess  of 
tiie   whole    face,    called   in   medical    parlance   c&dema   arsenicalis,   and 


POISONS.  816 

attended  with  redness  of  the  eyes,  and  followed  by  gripings,  nausea, 
purgings,  and  a  gradual  sinking  of  the  vital  powers. 

Tieatment. — The  stomach-pump  should  always  be  resorted  to  at 
once,  if  possible.  If  this  is  not  at  hand,  the  patient  should  drink  co- 
piously of  warm  water,  and  have  the  throat  tickled  with  the  finger  or 
a  feather  to  excite  vomiting.  We  have  no  antidote,  in  the  chemical 
sense,  and  medical  books  recommend  a  variety  of  diluent  and  demul- 
cent liquids,  to  involve  the  poisonous  matter  and  thus  indirectly  defend 
the  coats  of  the  stomach.  Flour  and  water,  and  olive  oil,  are  com- 
plete substitutes  for  the  whole  list.  Some  authors  advise  large  quanti- 
ties of  the  hydraled  sesquioxide  of  iron ;  but  its  value  is  uncertain  and 
far  from  being  reliable. 

To  remove  the  subsequent  inflammation  and  counteract  the  effects 
of  the  poison.  Dr.  Pereira  tells  us;  "Our  principal  reliance  must  be 
on  the  usual  antiphlogistic  measures,  particularly  blood-letting,  both 
general  and  local,  and  blisters  to  the  abdomen.  One  drawback  to  the 
success  of  this  treatment  is  the  great  depression  of  the  vascular  sys- 
tem, so  that  the  patient  cannot  svjyporf,  large  evacuations  of  blood" — the 
same  as  to  say,  the  patient  niust  be  bled  on  theory,  although  it  will  kill 
him  in  practice. 

A-NTiMONY — Antimonium. — Accidental  poisonings  with  antimonial 
preparations  are  uncommon  ;  but  medicinal  poisonings  are  extremely 
frequent.  Death  very  often  results  from  an  over-dose  of  tartar 
emetic ;  and  this  deadly  drug  iss  extensively  diffused  amonj'  us,  being  a 
common  ingredient  in  candies,  lozenges,  cough  mixtures,  drops,  and 
eyrups,  etc.  The  popular  ]ireparations  of  the  regular  pi  larmacopjeias, 
James''  poicder,  and  Plummers''  p?7/,  are  strongly  charged  with  this 
dangerous  drug.  Besides  tartar  emetic,  the  oxide  or  sesquioxide  of 
the  metal,  called  jlowers  of  antimony,  and  the  chloride,  are  sometimes 
the  agents  of  accidental  poisoning. 

Symj>toms. — Small  doses  produce  scarcely  any  obvious  effect  save 
general  debility.  Large  doses  produce  epigastric  pain,  voiniting,  and 
often  purging.  In  very  large  doses  it  occasions  extreme  muscular  re- 
laxation, nausea,  depression,  vital  exhaustion,  sometimes  convulsions 
and  death.  Applied  to  the  skin,  tartar  emetic  produces  an  eruption  of 
painful  pustules  resembling  small-pox.  Death  has  resulted  from  the 
absorption  of  the  drug,  when  it  has  been  applied  to  an  abraded  surface. 

T reatmcnt. — Our  main  reliance  must  be  on  the  warm  water  emetic, 
in  the  early  stage,  and  the  usual  "  antiphlogistic"  water-treatment  in 
the  later  stages.  Persons  who  are  severely  poisoned  with  any  form 
of  antimony  are  always  cold,  torpid,  sensitive,  and  debilitated,  so  that 


U6  PATUOLOGY   AND  THERAPEUTICS. 


oui  bathing  nppliances  must  be  gentle  and  of  moderate  temperature. 
Tlio  warm-bath  is  excellent  to  check  excessive  evacuations  when  a 
large  dose  of  the  drug  h;is  been  taken.  Medical  books  recommend 
astiiagent.s,  as  tea,  nutgall,  cinchona,  etc.,  on  the  supposition  that  tannic 
acid  is  antidotal  to  tiirtar  emetic.  Bui  the  numerous  experiments  which 
have  been  tried  do  not  establish  its  claim  to  this  title. 

Lead — Plumbum. — All  the  preparations  of  this  metal,  except  the 
Bulphurets,  are  energetic  poisons.  The  acetate — sugar  of  lead — sac- 
charuin  satunii,  is  the  form  in  which  it  is  usually  given  internally  as  a 
remedy.  The  preparations  from  which  accidental  poisonings  chiefly 
result  are,  litharge — the  protoxide  of  lead  ;  red  lead — the  red  oxide,  or 
dcutoxide  :  ichile  lead — carbonate  of  lead;  and  Goulard's  extract — the 
diacetate.  Milk,  molasses,  and  even  pure  water,  may  acquire  a  poi- 
Bonous  property  by  standing  in  leaden  vessels.  Red  earthen-ware 
ought  never  to  be  used  for  cooking  fruit  or  pastry,  on  account  of  its 
lead  glazing;  indeed  all  colored  crockery  ought  to  be  '"ruled  out"  on 
account  of  its  metallic  coloring  matter. 

Symptoms. — Small  doses  check  the  secretions  generally,  and  consti- 
pate the  bowels.  Large  doses  coustringe  the  circulating  vessels,  re- 
duce the  pulse,  diminish  the  temperature  of  the  body,  produce  dry- 
ne^-s  of  the  mouth  and  throat,  and  a  general  wasting  of  the  body.  In 
most  cases  of  lead  poisoning  there  is  a  narrow  leaden-blue  line  border- 
ing the  edges  of  the  gums,  attached  to  the  necks  of  two  or  more  teeth 
of  either  j  iW;  the  saliva  is  often  bluish.  The  exti'eme  effects  are 
lead-colic.     Excessive  doses  produce  more  or  less  gastro-enteritis. 

Treatinenl  — The  warm  water  emetic  must  be  given  in  the  first 
instance,  and  the  stomach-pump  employed  if  practicable.  The  soluble 
alkaline  or  earthy  sulphates,  or  the  alkaline  carbonates,  will  lessen  the 
injurious  effects  of  the  preparations  of  lead,  by  changing  them  to  sul- 
phates. For  this  purpose  phosphate  of  soda,  alum,  Glauber  or  Epsom 
Baits  are  appropriate.  These  chemicals  are  unnecessary  when  the 
vomiting  has  been  thorough  or  the  stomach-pump  introduced.  The 
treatment  for  lead-colic  has  already  been  given. 

Coi'PKR— Cuprum.— The  salts  of  copper  have  been  much  em- 
ployed in  the  manufacture  of  culinary  vessels,  and  to  color  candies, 
sweetmeat.'',  and  preserves,  from  which  frequent  poisonings  have  re- 
sulted. The  preparations  in  common  use  are  mineral  green—the 
•ixjdrated  oxide ;  blue  vitriol— the  sulphate  ;  natural  verdigris— the 
fC'bonate;  and  artificial  verdigris— the  mixed  acetates. 

Symptoms.— These   are   quite   various.      In   small    doses  they    are 


POISONS.  sn 


manifested  by  cramps,  paralysis,  discolorations  of  the  skin,  slow  fever, 
wasting  of  the  body,  chronic  inflammation  of  the  stomach  and  lungs, 
etc.  In  large  doses,  nausea,  vomiting,  coppery  taste,  eructations, 
gi'iping  pains,  and  giddiness  result.  Very  large  doses  produce  convul- 
sions and  insensibility,  with  the  usual  symptoms  of  gastro-onteric  in- 
flammation. 

Treatment. — Wheaten  flour,  milk,  and  the  white  af  eggs,  are  here 
our  antidotes  again.  Vinegar  has  been  a  popular  prescription,  but  it  is 
actually  injurious. 

Bismuth — Bismuthum. — There  are  two  preparations  of  this  metal 
m  common  use ;  the  first  is  the  trisnitrate,  which  is  extensively  used 
m  medicine,  and  known  by  the  various  names  of  oxide  of  bismuth^ 
suhnitrate  of  bismuth,  and  magi^^ery  of  bismuth ;  the  second  is  the 
tartrate  of  the  metal,  and  is  extensively  used  in  the  cosmetic  art  under 
the  name  of  pearl  icliite.     They  are  both  caustic  poisons. 

Symptoms. — Small  doses  diminish  the  sensibility,  but  large  ones 
cause  pain,  vomiting,  giddiness,  gastric  disorder,  cramps  in  the  extremi- 
ties, etc.  The  cosmetic  preparation  has  produced  spasmodic  trembling 
of  the  muscles  of  the  face,  terminating  in  paralysis. 

Treatment. — We  have  no  chemical  antidote,  and  must  rely  on  warm 
water,  the  stomach-pump,  etc. 

Tin — Stannum. — The  chlorides  of  tin,  used  in  color-making  and  * 
dyeing,  and  the  oxide,  which  forms  a  part  of  the  putty-powder  for 
glass  staining  and  silver  plating,  are  the  preparations  of  this  metal 
which  sometimes,  though  rarely,  occasion  poisoning.  Powdered  tin 
has  been  given  in  ounce  doses  to  expel  the  tape-worm.  The  symp- 
toms of  tin  poisoning  are  similar,  and  the  treatment  the  same  as  in  the 
case  of  the  preparations  of  bismuth. 

It  ought  to  be  known  to  housekeepers  that  acid,  fatty,  saline,  and 
even  albuminous  substances,  ma}^  occasion  colic,  vomiting,  etc.,  after 
having  remained  for  some  time  in  tin  vessels. 

Silver — Argentum. — Nitrate  of  silver — lunar  caustic — though  a 
powerfully  corrosive  poison,  is  extensively  prescribed  internally  as  a 
nervine,  tonic,  and  astringent  medicine.  The  chloride,  oxide,  and 
cyanide,  are  other  preparations  of  the  metal  occasiondly  misapplied  to 
the  human  stomach. 

Symptoms. — Applied  to  the  skin,  hair,  or  nails,  nitmte  of  silver  stains 
them  black ;  to  an  ulcerous  surface  it  produces  a  white  film ;  and  to 
a  raucous  membrane,  smarting    pain,  and  inflammatior.  which  lasts 


816  PATHOLOGY   AND   THERAPEUTICS. 

several  hours.  Taken  into  the  stomach  in  small  quantities,  it  produces 
no  sensible  inconvenience  for  some  time ;  but  if  large  doses  are  given, 
or  the  small  ones  long  continued,  heartburn,  nausea,  and  vomiting  re- 
sult, and  sometimes  inflammation  and  mortification,  especially  when  it 
has  been  taken  medicinally  for  six  months  or  longer.  Its  absorption 
into  the  system  produces  a  blueness,  slate  color,  or  bronze  hue  of  the 
ekiu,  which  is  very  difficult  to  remove.  In  some  cases  the  whole 
body,  internally  and  externally,  has  beet:  blue-dyed  by  the  medicinal 
operation  of  this  drug.  The  discoloration  results  fi-om  a  chemica^ 
combination  of  the  salt  with  the  organic  tissues. 

Treatment. — When  the  drug  has  been  recently  taken  into  the  stom- 
ach, common  table  salt  will  decompose  it  and  render  it  comparatively 
inert.  When  the  body  has  been  pretty  well  saturated  with  it,  a  long 
course  of  hydropathic  bathing  and  dieting  will  be  necessary,  even  to  get 
rid  of  its  effects  partially. 

Gold — AuRUM. — The  morbific  and  medicinal  effects  of  the  prepa- 
rations of  the  rex  metallorum,  as  the  alchemists  termed  gold,  are  similar 
to  those  of  the  mercurials,  though  they  are  generally  more  sudden  and 
violent.  Gold  has  been  administered  in  the  state  of  minute  division — pul- 
vis  auri — and  in  the  forms  of  iodide,  cyanide,  and  various  chlorides.  A 
preparation,  called  fulminating  gold — aurate  of  ammonia — has  been 
experimented  with  considerably;  and  writere  on  materia  medica  tell 
us  with  sufficient  coolness,  that  "  it  has  produced  very  serious  and  even 
fatal  results." 

Treatment. — The  antidotes  are  albumen,  flour  and  milk,  as  in  the 
ases  of  corrosive  sublimate  and  the  preparations  of  copper. 

Iron — Ferrum. — A  very  strange  and  general  delusion  pervades  the 
•nedicnl  profession  respecting  the  medicinal  virtues  of  this  metal.  Some 
chemists  have  detected,  or  imagined  they  have  detected,  a  little  of  it 
in  human  blood;  and,  making  a  spring-board  of  this  fact,  haxe  jumped 
to  the  conclusion  that  iron  was  a  great  remedy  for  a  great  many  dis- 
eases. Even  our  "  botanic,"  "  eclectic,"  and  "  physopathic"  co-reform- 
ers, who  are  so  justly  horrified  at  the  idea  of  mercurial  and  antimonial 
poisoning,  vejy  freely  mingle  chalybeate  waters  and  ferruginous  salts 
and  oxides  in  the  preparation  of  their  purifying  syrups,  alterative  mix- 
tures, and  tonic  powders.  If  it  be  true  that  iron  is  in  some  form  a  nat- 
ural constituent  of  the  human  body,  it  does  not  by  any  means  follow 
that  the  preparations  of  the  metal  which  are  found  in"  the  pharmaco- 
poeifis  are  natural  remedies,  or  remedies  in  any  sense ;  nor  does  it  fol- 
low that  because  phosphate  and  carbonate?  of  lime  are  found  in  the 


POISONS  81^ 

bones,  that  common  chalk,  mason's  mortar,  or  plaster  of  Paris  are  nat- 
ural foods ! 

As  h'on  was  the  first  mineral  introdaced  into  medicine,  the  his- 
tory— all  we  have  on  the  subject — of  its  introduction  may  not  be  un- 
interesting :  "  Melampus,  a  shepherd,  supposed  to  possess  supernat- 
ural powers,  being  applied  to  by  Iphicles,  son  of  Philacus,  for  a  rem- 
edy against  impotence,  slaughtered  two  bulls,  the  intestines  of  which 
he  cut  to  pieces,  in  order  to  attract  birds  to  an  augury.  Among 
the  animals  which  came  to  the  feast  was  a  vulture,  from  whom  Me- 
lampus pretended  to  learn  that  his  patient,  when  a  boy,  had  stuck  a 
knife,  wet  with  the  blood  of  some  rams,  into  a  consecrated  chestnut- 
tree,  and  the  bark  had  subsequent]}''  enveloped  it.  The  vulture  also 
indicated  the  remedy,  namely,  to  procure  the  knife,  scrape  off  the 
rust,  and  drink  it  in  wine  for  the  space  of  ten  days,  by  which  time 
Iphicles  would  be  lusty,  and  capable  of  begetting  children.  The  ad- 
vice thus  given  by  Melampus  is  said  to  have  been  followed  by  the  young 
prince  with  the  most  perfect  success  !" 

Iron  is  employed  medicinal!}^  in  the  forms  of  Jilings ;  black  oxide, 
or  ethiops  martial ;  sesquioxide — the  red  oxide,  peroxide,  or  crocus 
raarlis,  various  preparations  of  which  are  known  as  carbonate  of  iron. 
vitrioli,  brown-red,  rouge,  etc. ;  hydrated  sesquioxide ;  animonio-chlo- 
ride;  iodide;  sulphuret,  or  common  iron  pyrites  ;  ferro-sesquicyanide, 
or  Prussian  or  Berlin  blue  ;  ferro-cyanide  of  jjotassium,  or  Prussiate 
of  potash  ;  sulphate — green  vitriol — sal  niartis — copperas  ;  ferro-tar- 
trate  of  potash  ;  acetate  ;  persulphate  ;  j^er  nitrate  ;  ferro-tar  Irate  of  am- 
monia ;  lactate,  and  citrate. 

Symptoms. — The  effects  of  the  different  preparations  are  exceeding- 
ly various,  both  in  quality  and  degree.  A  few  of  them  are  violently 
irritating;  but  the  majority  are  among  the  slow  and  insidious  poisons. 
Small  doses  generally  constringe  and  harden  the  fibres,  constipate  the 
bowels,  arid  blacken  the  stools,  and  even  reduce  the  size  and  harden  the 
structures  of  various  glandular  viscera,  as  the  liver  and  spleen.  Like 
nitrate  of  silver,  they  form  compounds  with  the  organic  tissues.  They 
increase  for  awhile  the  frequency  and  force  of  the  pulse,  augment  the 
temperature  of  the  body,  and  heighten  the  color  of  the  cheeks :  ef- 
fects indicative  of  fever  and  irritation,  but  which  are  usually  regarded 
as  remedial.  Unfortunately  the  general  and  preternatural  excitement 
is,  ere  long,  followed  by  corrresponding  sinking  and  depression.  The 
suljihate  and  chlorate  of  iron,  in  large  quantu^s,  produce  great  heat, 
weight,  pain  and  uneasiness  in  the  stomach,  with  nausea,  vomiting,  and 
sometimes  purging  and  hemorrhages. 

Treatment. — We  have  no  chemica.  antidote?  except  fhe   alkalies, 


S20 


PATHOLCGY     VND    THERAPEUTICS. 


chalk,  magnesia,  etc.,  when  the  sesquichloride  has  been  swallowed. 
This  is  usually  obtained  at  the  apothecary  shop,  in  the  form  and  under 
the  name  of  muriated  tincture  of  iron.  Against  all  the  other  prepai-a- 
tions  we  must  trust  to  warm-water  vomiting,  the  stomach-pump,  and 
the  usual  means  for  counteracting  inflammation. 

Zi.NC — Zi.NCUii. — The  compounds  of  zinc  ai'e  analogous  to  those  of 
jopper  in  their  action  on  the  system,  though  somewhat  less  violent. 
The  preparations  in  common  use  are  the  oxide — jiowers  of  zinc ;  im- 
pure oxide,  or  tutty  ;  chloride — muriate,  or  huttcr  of  zinc  :  sulphate,  or 
ichite  vitrix>l ;  acetate ;  carbonate,  or  calamine ;  and  cyanide.  The  ti*eat- 
ment  is  the  same  as  in  cases  of  copper  poisoning 

Ma>ga>£sk — Manganesium. — The  hinoxide  of  this  metal  has  been 
sometimes  used  in  medicine.  It  is  employed  by  potters  to  color  earth- 
en-ware ;  by  glass-makers  to  destroy  the  brown  color  produced  by  iron, 
and  to  give  an  amethystine  tint  to  plate  glass ;  and  by  bleachers  to  pro- 
duce chlorine.  It  has  also  been  used  as  a  depilatory.  Its  effects  on 
the  human  system  are  more  severe  than  those  of  iron,  bat  less  injuri- 
ous than  lead,  and  they  are  to  be  counteracted  like  those  of  the  pre- 
ceding poisons. 

Iodine — Iodi.num. — This  is  an  intense  and  acrid  irritant.  In  large 
doses  or  small  doses  long  continued,  it  causes  a  burning  pain  in  the 
stomach,  a  colliquative  and  exhausting  diarrhea,  with  a  rapid  emacia- 
tion of  the  whole  body,  and  extreme  prosti'ation  of  the  whole  system. 
Its  destructive  action  seems  to  be  particularly  determined  to  the 
glandular  structures.  In  some  cases  the  male  testes,  and  in  others  the 
female  breasts,  have  been  nearly  absorbed  and  entirely  destroyed  by 
its  medicinal  employment.  Its  principal  preparations  are  the  hydrio- 
date  of  potassa,  which  is  extensively  used  m  preparations  called  "  sar- 
saparilla,"  and  is  a  frequent  cause  of  paralytic  limbs  and  weak  joints ; 
and  various  combinations  with  sulphur  and  mercury,  which  are  vio- 
lently coiTOsive.  Unfortunately  we  are  without  antidotes  once  more, 
and  must  trust  to  the  principles  of  treatment  ah-eady  explained. 

Phosphorous. — This  article  is  in  less  repute  for  medicinal  purposes 
at  the  present  day  than  it  was  some  fifty  years  ago.  It  is  a  powerful 
initant,  and  its  acid  is  corrosive.  The  antid  )tes  are  demulcents  and  al- 
kalies— albumen,  gluten,  milk,  magnesia,  etc. 

Si  LPnuR. — Various  foims  of  this  artic  ?  nre   familiarly  known  afl 


POISONS.  a21 


brimstone,  flower  of  sulphur,  roll  or  cane  sulphur^  balsam  of  sulphur, 
milk  of  sulphur,  etc.  Their  action  on  the  animal  economy  is  weak  in 
small  doses,  producing  chiefly  those  effects  which  are  called  laxative 
and  diaphoretic.  Its  principal  celebrity  in  medicine  has  been  obtained 
from  its  success  in  curing  the  itch. 

Very  large  doses  of  sulphur  sometimes  produce  severe  griping  and 
purging,  with  great  debility,  the  treatment  for  which  is  the  same  as  for 
an  ordinary  diarrhea. 

Chrome — Chromium. — The  chromate  of  potass,  and  some  other 
salts  of  this  metal,  are  extensively  employed  in  dyeing.  When  taken 
into  the  stomach,  they  produce  the  usual  vomiting,  griping,  and  purging 
effects  of  other  mineral  poisons  ;  but  they  are  peculiarly  liable  to  be  fol- 
lowed by  a  degree  of  debility  and  paralysis  wholly  disproportioned  to  the 
irritant  effects.     The  treatment  should  be  the  same  as  for  lead  poisoning. 

Bromine — Brominum. — This  substance  has  been  employed  medic- 
inally as  a  substitute  for  iodine,  to  which  its  operation  is  similar ;  and 
when  poisoning  results  from  it,  the  treatment  is  the  same. 

Alum — Alumen. — Taken  internally,  alum  corrugates  the  fibres, 
diminishes  the  secretions,  creates  diyness  and  thirst;  and  when  large 
quantities  are  swallowed,  nausea,  vomiting,  gi'iping,  and  purging  suc- 
ceed.    The  remedies  are,  warm  water  and  the  stomach-pump. 

Platina — Platinum. — Some  preparations  of  this  metal,  as  the 
bichloride  and  chloroplatinate  of  sodium,  have  been  used  in  medicine 
and  the  arts.  Their  action  on  the  human  system  resembles  that  of  the 
preparations  of  gold ;  and  their  antidotes  are  the  same. 

Barytes — Barium. — The  carbonate,  chloride,  and  nitrate  of  this 
metal  produce  effects  on  the  human  system  hardly  distinguishable  from 
those  of  arsenic.  The  clfloride  has  been  administered  in  scrofulous 
cases.  The  antidotes  are  alum,  and  the  sulphates  of  magnesia,  lime, 
and  soda,  which  form  an  insoluble  salt  or  sulphate  of  baryta. 

Metallic  Salts  and  Oxides. — Tliere  are  many  preparations  of 
metals  which  it  would  be  tedious  to  enumerate,  which  are  irritant  and 
corrosive  poisons  of  greater  or  less  intensity ;  their  effects  are  analo- 
gous to  those  of  arsenic,  copper,  and  lead,  and  in  all  cases  of  poisoning 
from  them,  our  main  reliance  must  be  on  vomiting  and  the  stcLViach- 
pnmp;  the  al'^'imen  of  pggf  and  gluten  of  wheat  are  always  harmless. 


822  PATHOLOGY    AND    THERAPEUTICS. 


niul  in  some  cases  might  be  serviceable;  hence  it  would  be  at  least  pru- 
dent to  employ  them  in  all  cases  as  auxiliaries.  Among  the  mosi  dan- 
gerous may  be  named  the  oxide  of  osmium  and  hydrochlorate  of  ^)alla- 
dium,  which  are  nearly  as  active  as  arsenic;  the  hydrochlorates  of 
rhodium  and  iridiuju  are  rather  less  violent;  the  salts  of  molybdenum 
are  comparatively  feeble ;  uranium  and  cobalt  are  more  active ;  tung- 
stein,  cadmium,  nickel,  cerium,  and  titanium,  in  their  various  prepara- 
tions, are  among  the  weakest  of  the  metallic  poisons. 

Narcotics. — These  may  be  medicinally  and  toxicologically  divided 
into  the  pure,  stimulant,  and  acrid.  The  jpure  narcotics  prociace  stu- 
por, insensibility,  nervous  prostration,  paralysis,  convulsions,  etc.,  di- 
rectly, and  without  previous  excitement,  as  Prussic  acid,  henbane,  bel- 
ladona,  strammonium,  conium,  cicuta,  ergot,  narcotine,  letMce,  pink, 
cherry  laurel.  The  stimulant  narcotics  produce  at  first  more  or  less 
nervine  excitement  or  exhilaration,  with  an  increased  action  of  the  cir- 
culating system,  followed  by  torpor,  depression,  debility,  stupor,  and  all 
the  symptoms  of  ultimate  narcosis.  To  this  division  belong  opium  and 
and  its  various  preparations  of  morphine,  meconic  acid,  codeia,  lauda- 
num, paregoric,  black  drop,  Godfrey's  cordial,  and  wine  of  opium  ;  al- 
cohol in  all  its  forms  of  intoxicating  malted,  fermented,  or  distilled 
liquors ;  tobacco,  camp>hor,  cocculus  indicus,  nux  vomica,  St.  Ignati- 
us' bean,  etc.  The  acrid  narcotics  produce  violent  irritiition  and  in- 
flammation in  the  stomach  and  bowels,  followed  by  stupor,  delirium 
prostration,  etc.  Among  them  may  be  named  as  prominent,  mezereon, 
squills,  serpentaria,  cantharides,  elaterium.,  colchicum,  gamboge,  jalap, 
scammony,  colocynth,  celandine,  croton  oil,  bryony,  savin,  spurge  lau- 
rel, aconite,  bitter  almonds,  arnica,  arum,  rhus,  cowhage,  anemone, 
marsh-marigold,,  daffodil,  fools'  parsley,  seeds  of  the  castor-oil  tree, 
bitter-sweet,  five-finger  root,  black,  white,  and  green  hellebore,  meadow 
saffron,  rue,  ipecacuanha,  yew,  darnel-grass,  creasote,  etc. 

Treatment. — All  cases  of  narcotic  poisoning  demand  the  stomach- 
pump  or  warm  water  emetic,  or  both,  in  the  first  instance  ;  the  ulterior 
symptoms  will  be  those  of  inflammation,  partial  apoplexy,  or  complete 
asphyxia,  denoted  by  tremors,  stupor,  or  insensibility,  coma,  delirium, 
convulsions,  partial  paralysis,  etc.  In  this  stage  the  treatment  is  nearly 
the  same  jis  for  apoplexy.  The  extremities  must  be  kept  warm  with 
ho'  bottles,  gentle  but  persevering  friction  applied  to  the  surfiice,  and 
the  cold  poming-barh  applied  to  the  head  ;  this  last  is  indeed  the  most 
important  part  of  the  treatment.  Inflammatory  symptoms  are  to  be 
treated  on  general  principles.  When  an  exhausting  diarrhea  attends 
M  from  r.olchicrm  or  elaterium,  the    :.oK'     andage  and  hot  foment*- 


POISONS.  328 

tions  may  be  necessary,  and  may  alternate  with  advantage,  and  small 
quantities  of  very  cold  water  are  to  be  frequently  thrown  up  the 
rectum. 

AcRiDS. — There  are  many  aromatic  and  pungent  vegetable  sub- 
stances not  usually  regarded  as  poisonous,  but  which,  when  taken  in 
large  quantities,  produce  severe  irritation,  and  even  fatal  inflammation 
of  the  stomach  and  bowels.  Of  this  class  are  the  essential  oils,  as  pej)~ 
jpermint,  spearmint,  cloves,  cinnamon,  and  cajysicum ;  various  balsams, 
as  Tola,  copavia,  Canada,  and  Peru ;  many  condiments,  as  pepper, 
mustard,  horse-radish,  cloves,  und  nutmegs;  to  which  may  be  added 
turpentine,  oil  of  tar,  cubebs,  and  two  or  three  hundred  medicines  be- 
longing to  the  classes  of  cathartics,  diuretics,  diaphoretics,  vermifuges, 
emmenagogues,  etc.  The  action  of  these  articles  on  the  system,  or 
rather,  the  resistance  of  the  vital  powers  to  their  action,  is  not  accom- 
panied with  the  indications  of  nervous  prostration  or  exhaustion  pecu- 
liar to  the  narcotics  proper ;  hence  our  ti'eatment  is  limited  to  soothing 
irritation  and  combating  inflammation,  premising,  however,  that  the 
offending  material  is  in  all  cases  to  be  got  rid  of  by  emesis,  catharsis, 
etc.,  as  speedily  as  possible. 

Mushrooms. — The  fly  agaric,  pepper  agaric,  deadly  agaric,  bul- 
lous agaric,  and  champignon,  are  the  kinds  of  mushrooms  from  which 
poisoning  most  frequently  results.  They  produce  nausea,  heat,  and 
pain  in  the  stomach  and  bowels,  thirst,  vomiting,  griping,  and  purging ; 
in  severe  cases,  convulsions  and  faintings  are  frequent,  with  small  and 
frequent  pulse,  delirium,  dilated  pupil,  and  stupor,  followed  by  cold 
sweats  and  death. 

Treatment. — Here  again  the  5cie?i^z^c  treatment  of  the  books  is  emi- 
nently calculated  to  make  a  veiy  bad  matter  very  much  worse  :  "  emet- 
ics of  tartar  emetic,  followed  by  large  doses  of  Glauber  or  Epsom  salts." 
As  these  drugs  have  no  antidotal  property  in  the  chemical  sense,  and  as 
their  employment  is  powerfully  debilitating,  they  are  as  injudicious  a 
selection  for  puking  or  purging  purposes  as  it  is  possible  to  make. 
Warm  water  and  the  stomach-pump,  with  copious  tepid  injections,  are 
our  more  rational  practice. 

Poisonous  Fish. — The  kinds  of  "sea-food"  from  which  poisoning 
most  frequently  happens,  are,  tJie  crawfish,  mussel,  old-wife,  yelloiv- 
hilled  sprat,  land-crab,  gray-snapper,  dolphin,  hyne,  conger-eel,  blue- 
parrot  fish,  smooth-bottle  fish,  grooper,  rock-fish,  barracuda,  king-fish, 
Spanish  mackerel,  porgee.    ioiietta,  blonder,  i).nny,  etc.      The  symp- 


324  PATHOLOGY    AND    THERAPEUTICS 


toms  of  poisoning  usually  appear  in  an  hour  or  two  after  eating  theur, 
but  sometimes  in  a  few  minutes  after  the  ineal  is  finished  ;  a  weight  at 
the  stomach  is  at  first  felt,  with  slight  vertigo  or  headache ;  these  are 
fuUowed  by  a  sense  of  heat  about  the  head  and  eyes,  great  thirst,  and 
an  eruption  of  the  skin  resembling  urticaria,  or  nettle-rash. 

Treatment. — This  has  already  been  given  under  the  head  of  eryth- 
ema. 

Serpents  and  Insects. — Those  serpents  and  insects  whose  bites 
or  stings  fire  poisonous,  are,  the  copper-head,  moccasin,  viper^  black 
viper,  water  viper,  rattlesnake,  Spanish  or  blistering  Jly,  potato  fiy, 
tarantula,  scorpion,  hornet,  wasp,  bee,  gnct,  and  gad-Jly.  All  the 
6ymj)toms  are  those  of  violent  internal  and  external  ery thematic  in- 
flammation, and  the  treatment  may  be  found  also  under  that  head. 


PART    VII. 


SIRGERT. 

Davinitions. — Surgery  is  either  medical,  mechanical,  or  operative. 
Aocording  to  the  old  school  system,  medical  sUi-gery  comprehends  the 
internal  administration  of  drug-remedies,  and  the  external  application 
of  lotions,  liniments,  poultices,  plasters,  etc.  In  the  hydropathic  sys- 
tem medical  surgery  is  limited  to  the  internal  and  external  employment 
of  water  of  every  temperature,  from  steam  to  ice,  as  the  indication  is  to 
induce  relaxation  or  excite  contraction ;  the  internal  administration  of 
chemical  antidotes  or  correctives  in  cases  of  poisoning,  and  the  local  ap- 
plication of  astringents,  caustics,  and  emollients,  for  the  purposes  of 
constringing  bleeding  vessels,  removing  preternatural  formations,  or  de- 
stroying infectious  matter,  and  protecting  abraded  or  ulcerated  surfa- 
ces from  atmospheric  and  thermal  influences.  Mechanical  sugery  is 
applied  to  the  replacement  of  displaced  parts.  Operative  surgery  con- 
templates the  removal  of  mechanical  or  chemical  obstnictions,  and  mor- 
bid structures. 


CHAPTER  I. 

SURGICAL  APPLIANCES. 


It  has  been  said  that  a  good  workman  requires  but  few  tools ;  a  good 
doctor  needs  but  few  medicines,  and  a  good  surgeon  requires  but  a  very 
small  part  of  the  multitudinous  insti'umental  machinery  which  the  in- 
ventive genius  and  manufticturing  interest  of  the  age  has  brought  into 
use. 

The  common  pocJcet-case  of  instruments,  with  tooth-forceps,  liga- 
tures, lint,  adhesive  plaster,  sponge,  bandages,  male  and  female  cathe- 
28 


326  SURGERY. 

tcrs.  the  stomach-pump,  and  the  pump-syringe,  are  all  that  emergen- 
cies deinnnd  to  be  kept  always  in  readiness. 

The  necessary  mechanical,  medical,  and  chemical  appliances — re- 
jecting all  internal  drug-medicines— are,  the  compress,  ligature,  sponge, 
adhesive  plaster,  lints  and  pledgets,  dry-cupping,  bandages,  splints, 
caustics  sutures,  torsion,  the  tourniquet,  refrigeration,  fomentations, 
rniftics,  anaesthesia,  haemastasis,  and  transfusion. 

Tuf  Compress. — This  is  employed  to  equalize  pressure  under  a 
roller  or  bandage,  or  increase  the  pressure  at  a  particular  point.  It  is 
made  of  several  folds  of  linen,  formed  into  a  kind  of  pad  ;  various  shapes 
and  thicknesses  of  compresses  are  employed,  to  suit  the  particular  local- 
ity and  circumstances.  For  applying  around  a  sore,  the  iierforaitd 
compress  is  constructed  with  a  hole  in  the  centre  to  permit  the  escape 
of  matter.  In  Water-Cure  parlance  a  wet  cloth  is  often  called  a  com- 
press :  but  in  the  strictly  surgical  sense,  a  compress  is  connected  with 
the  idea  of  compression. 

Tin:  Ligature. — Various  kinds  of  strings  or  ligatures  are  em- 
ployed to  aiTest  the  bleeding  from  wounded  or  divided  blood-vessels, 
check  the  venous  circulation  so  as  to  retard  or  prevent  the  absorption 
of  poison,  as  in  the  case  of  bites  of  venomous  animals,  remove  tu- 
mors, etc.  Silk,  linen,  and  animal  membrane — cat-gut — are  the  ma- 
terials in  use.  The  latter  is  preferable,  especially  for  tying  bleeding 
arteries  or  veins,  as  both  ends  may  be  cut  off  close  to  the  wound,  and 
the  rest  left  to  decomposition  and  absorption.  In  applying  the  ligature 
to  wounded  vessels^  the  surgeorCs  knot — the  first  knot  having  two  turns 
— must  be  tied,  as  this  prevents  the  firet  knot  from  slipping  while  the 
second  is  being  tied.  The  bleeding  vessel  should  be  genth*  raised  with 
the  forceps  or  tenaculum,  and  the  ligature  drawn  as  tightly  as  may  be 
without  cutting  through  the  coats  of  the  vessel.  Silver  wire  is  some- 
times used  in  ligating  polypus  and  other  tumors. 

The  Sponge. — For  surgical  purposes  the  finest  and  softest  article 
is  the  best.  It  is  used  to  absorb  the  blood  and  other  fluids  from  wounds 
and  ulcers,  and  to  support  temporai-ily  prolapsed  parts,  as  the  uterus. 

Adhesive  Plaster. — This  is  employed  to  retain  divided  parts  in 
proximity ;  to  atTord  meclianical  support  to  relaxed  and  distended  ves- 
sels, as  varicose  veins;  to  excite  absorftion  by  compression,  as  in  indo- 
lent ulcers,  and  protect  abraded  surfaces.  In  dressing  wounds,  it  is  ap- 
plied in  narrow  strips,  with  interspace?*  for  the  discliarge  of  matter.    Fo^ 


SURGICAL    APPLIANCES.  327 

small  cuts  nr  abrasions,  the  collodion  is  the  most  convenient  article,  and 
for  very  small  wounds  or  sores  the  gummed-silk  or  court-j^lasler  is  suf- 
ficient. Where  adhesive  plaster  is  to  be  applied,  the  hair  should  be 
shaved  off. 

Tents  and  Pledgets. — These  are  conical  or  cylindrical  masses  of 
charj)ie,  or  prepared  lint — best  made  by  scraping  the  fine  nap  from  old 
linen — or  sponge,  some  sizes  and  forms  of  which  are  called  meshes, 
rolls,  and  j)ledgets.  They  are  employed  to  keep  up  a  discharge  from 
a  fistulous  or  sinuous  ulcer,  so  as  to  secure  granulation  from  the  bottom 
of  the  sore;  to  introduce  caustics  and  irritants;  to  absorb  matter,  etc 
Tampons  are  large  tents,  for  making  pressure  or  applying  distention  to 
arrest  hemorrhage.  The  sponge-tent  is  the  most  convenient  when  ab- 
sorption is  desired  ;  the  common  puff-ball,  or  silk  pocket  handkerchief, 
are  frequently  employed  in  uterine  hemorrhages. 

Dry-Cupping. — The  application  of  any  convenient  vessel,  as  a  com- 
mon tumbler,  to  the  surface,  in  which  a  piece  of  cotton  is  burned  to  pro- 
duce a  vacuum,  is  employed  to  diminish  the  circulation  in  the  adjacent 
vessels,  and  to  abstract  the  irritation  of  an  inflamed  part,  on  the  princi- 
ple of  counter-irritation.  This  process  is  preferable  to  local  bleeding — 
wet-cupping — and  generally  produces  momentary  relief  of  pain.  But 
I  regard  it  as  hardly  worth  retaining  for  such  purposes,  for  the  reason 
that  cold  applications  to  the  part,  with  warm,  if  need  be,  at  a  remote 
part,  is  a  better  resource  in  nearly  if  not  quite  all  local  inflammations. 
Dry-cupping  is  a  valuable  resource  in  reducing  inguinal  and  femoral 
hernia. 

Bandages. — The  most  common  use  of  bandages  is  to  maintain  the 
fragments  or  parts  of  broken  bones  in  juxtaposition  during  the  healing 
or  knitting  process  ;  to  give  support  to  parts  after  recent  dislocations  ; 
to  promote  circulation,  and  prevent  accumulation  in  chronic  swellings  of 
the  lower  extremities,  as  in  oedema,  varices,  old,  deep,  indolent  ulcers, 
etc.  The  best  are  made  of  firm,  smooth,  unbleached  linen  cloth,  torn 
into  narrow  strips,  and  sewed  together  by  overlapping  the  ends  so  as  to 
avoid  a  seam.  The  bandage  must  always  be  sraootlily  and  evenly  ap- 
plied, and  great  care  must  be  exercised  to  avoid  drawing  it  tighter 
above,  or  toward  the  heart,  than  below,  as  congestion  and  swelling  wili 
result  from  obstructing  the  circulation. 

Figure  190  shows  the  manner  of  applying  the  roller  to  the  lower 
extremity.  It  is  about  tw^o  and  a  half  inches  wide  ;  and,  commencing 
at  the  extremity  of  the  great  toe,  takes  in  the  second  toe  at  the  second 


828  S  'J  R  G  E  R  Y. 

turn,  the  third  toe  at  tl^e  third  turn,  and  so  an  ;  compresses  are  placed 
in  the  depressions  around  the  ankle  so  as  to  preserve  equal  pressure , 

Fig.  190. 


APPLICATIOX    OF    THE    ROLLER. 

each  layer  overlaps  the  preceding  t^^o  thirds  or  more  of  its  width,  and 
the  whole  is  applied  smoothly  from  the  toes  to  the  knee.  Just  above 
the  ankle,  where  the  Umb  is  tapering,  it  has  to  be  folded  over  itself, 
and  its  direction  frequently  changed  to  preserve  its  evenness  of  appli- 
cation. 

Splints. — Tliese  are  employed  in  cases  of  fractures,  and  sometimes 
to  correct  deformities.  They  are  made  of  thin  pine  or  poplar,  cedar 
or  basswood  boards ;  or  better  still,  by  saturating  woolen  cloth  with 
gum  shellac.  They  must,  of  couree,  be  shaped  to  the  part  to  which 
they  are  intended  to  be  applied,  and  padded  with  hut,  cotton,  or  lined 
with  soft  sheepskin  or  buckskin. 

Caustics. — The  red-hot  iron,  called  the  actual  cautery,  is  some- 
times resorted  to  for  the  destruction  of  morbid  parts ;  but  more  com- 
monly some  chemical  substance,  called  the  potential  cautery,  is  em- 
ployed. Caustic  jjotash — potassa  fusa — is  in  general  use  as  a  strong, 
and  the  sesqui-carhonate  of  potash  as  a  mild  caustic.  Nitrate  rf  silver — 
lunar  caustic — nitric  acid,  and  sulphate  of  zinc,  are  frequently  em- 
ployed. Pr*^parations  of  antimony,  arsenic,  and  merc-ury,  are  favorite 
eschoratics  and  caustics  with  allopathic  practitioners,  but  they  have 
already  done  mischief  enough  to  entitle  them  to  future  oblivion.  Mild 
caustics  will  generally  remove  callous  or  fungous  growths  without  de- 
stroying the  healthy  structure;  and  the  strong  is  necessary  when  the 
healthy  parts  are  so  involved  with  the  disease  that  some  portion  of 
sound  structure  must  be  sacrificed  to  get  rid  of  the  morbid.  Fortu* 
nately  this  necessity  is  of  rare  occuirence. 


SURGICAL    APPLIANCES. 


829 


Sutures. — Stitchmg  divided  parts  together  is  much  less  practiced 
fiow  than  formerly — superior  skill  in  the  management  of  bandages  and 
adhesive  straps  having  superseded,  in  a  great  measure,  its  necessity. 
Sutures  are  mostly  employed  to  restrain  the  mobility  of  parts,  and 
prevent  permanent  contraction  of  the  muscles,  in  situations  where 
straps  and  bandages  cannot  bo  well  applied.  The  curved  needle  should 
always  be  passed  from  within  the  wound  outward,  and  take  up  but 
little  more  than  the  skin.  The  ticisted  suture  is  employed  for  the 
double  purpose  of  adaptation  and  compression.  After 
the  needle  or  pin  has  transfixed  the  lips  of  the 
wound,  the  thread  is  applied  in  successive  coils  round 
under  the  point  and  head,  as  in  fig.  191.  The  inter- 
rupted suture  is  made  by  passing  the  threaded  needle 
through  the  edges  of  the  wound,  at  short  distances, 
and  then  removing  the  needle  and  tying  the  thread. 
In  the  dry  suture  the  needle  is  passed  through 
strong  bands  of  adhesive  plaster,  which  are  placed 
above  and  below  the  wound. 


Fig.  191. 


TWISTED     SUTURE. 


Torsion. — This  process 
merely  consists  in  getting 
hold  of  the  extremity  of  the 
bleeding  vessels  with  a  pair 
of  forceps,  and  twisting  them. 
It  stops  the  bleeding  of  small 
arteries,  and  is  so  far  a  sub- 
stitute for  tying. 

The  Tourniquet. — This 
instrument  is  a  form  of  liga- 
ture, and  is  calculated  to 
compress  large  and  deep- 
seated  arteries  in  amputations 
and  other  exigencies.  The 
pad  or  compress  is  applied 
directly  upon  the  artery 
above  the  injury  or  operation, 
and  pressed  upon  the  vesse 
until  the  pulsation  of  the 
artery  beyond  is  suppressed^ 
by  turning  the   screw.     A 


Fig:.  192. 


TISr.    TOURNIQUET. 


880 


SURGERY 


rood  substitute  foi'  the  common  tourniquet  may  be  made  in  a  moment 

in  various  ways.    A 

handkerchief,      tied 

twice    around     the 

hmb,  may  be  twisted 

with    a   stick    until 

^ [y  the    pressure    stops 

the  cuiTent  of  blood 

HANDKERCHIEF  LIGATURE-  in  tlio  artery  against 

which  the  knot  is  applied,  as  in  fig.  193. 

Congelation. — In  deep-seated  chronic  inflammations,  especially 
around  the  joints,  absolutely  freezing  the  part,  by  means  of  pounded 
ice  04-  refrigerating  mixtures,  has  been  attended  with  the  happiest  con- 
sequences; the  application  should  never  be  continued  but  for  a  few 
minutes  at  a  time.  It  is  also  one  of  the  means  for  restraining  hemor- 
rhage. Severe  cold  has  been  employed  to  remove  the  sensibility",  pre- 
paratory to  surgical  operations ;  and  the  testimony  is  unanimous  that, 
in  every  instance  "  the  wound  has  appeared  to  heal  more  speedily 
than  under  the  usual  circumstances."  Dr.  Arnott  has  used  frigorific 
mixtures  as  anaesthetic  agents  in  nearly  two  hundred  cases  withoi^ 
any  injurious  consequences;  and  he  reports  that  foul  ulcers  are  often 
changed  to  healthy  ones  by  their  action.  A  piece  of  ice  dipped  in 
salt,  and  applied  to  the  part,  produces  congelation  in  about  half  a 
minute.  Pieces  of  ice  mixed  with  common  salt  and  nitrate  of  ammo- 
nia, make  a  still  stronger  frigorific.  It  should  never  be  applied  to  a 
very  large  surface  at  once. 


Fomentations. — These  are  intended  to  abate  morbid  sensibility, 
and  relax  the  whole  or  part  of  the  muscular  sj'stem,  to  overcome 
spasms,  and  facilitate  the  replacement  of  luxated  joints,  fractured 
bones,  ruptures,  etc.  All  the  muscular  relaxation  which  regular  sur- 
geons endeavor  to  produce  by  profuse  bleedings  and  deathly  nauseants, 
Ciin  1)6  readily  and  harmlessly  produced  by  the  internal  and  external 
use  of  wai:n  water. 

Emetics. — In  many  cases  of  rigid  muscular  contraction,  to  facilitate 
the  reduction  of  a  dislocation  or  the  replacement  of  the  fragments  of 
fractured  banes,  powerful  and  injurious  doses  of  tobacco  or  tartar 
emetic  are  administered  to  induce  greater  relaxation;  or  the  patient  is 
kept  fur  a  long  time  in  a  state  of  excessive  nausea,  AVarm  water, 
taken  copiously  into  the  stomach,  assisted  by  tickling  the  throat  occa- 


SURGICAL   APPLIANCES.  831 

sionally,  will  answer  all  the  purposes  for  which  so  manydeathful  drugs 
are  employed,  especially  if  conjoined  with  external  fomentations  or 
the  warm-bath. 

Anesthesia. — Chloroform  and  ether  are  just  now  in  common  use 
to  produce  insensibility,  and  thus  obviate  the  pain  attending  surgical 
operations;  and  many  surgeon  accouchers  administer  chloroform  tn 
lessen  or  obviate  the  pain  in  nearly  all  cases  of  parturition.  They  are 
not  without  danger,  and  the  introduction  of  these  agents  into  ordinary 
obstetric  practice  is  to  be  reprobated.  When  an  operation  is  exceed- 
ingly dangerous,  painful,  or  protracted,  the  employment  of  anaesthetic 
agents  is  certainly  commendable;  and,  although  we  have  accounts  of 
some  thirty  deaths  occurring  from  their  direct  effects  since  their  intro- 
duction into  surgical  practice,  yet  I  suspect  that  some  of  those  deaths 
at  least,  were  attributable  to  a  want  of  the  proper  precautions,  or  rather 
an  ignorance  of  the  proper  precautions  on  the  part  of  the  operator. 
The  same  rules  should  be  observed  in  administering  chloroform  or 
et)  .^r,  as  are  enjoined  by  hydropaths  in  administering  a  full-bath.  The 
Stomach  should  be  empty ;  the  patient  in  his  ordinarily  quiet  or  com- 
posed state ;  that  is,  without  rush  of  blood  to  the  head,  or  determina- 
tion to  the  brain ;  the  extremities  must  be  warm,  and  a  general  glow 
upon  the  surface,  etc.  The  ether  is  the  safer  article,  but  the  chloro- 
form is  the  most  powerful.  In  many  cases  magnetism  will  produce 
the  desired  insensibility,  and  when  the  patient  is  susceptible,  this  pro- 
cess is  always  to  be  preferred. 

HiEMASTASis. — This  process  has  been  employed  in  the  treatment 
of  local  congestion  and  inflammation;  but  we  have,  in  water  of  various 
temperatures,  an  ample  and  a  better  resource.  It  is  a  valuable  expe- 
dient, however,  in  some  cases  of  sudden  and  alarming  hemorrhage,  as 
it  enables  us  to  retain  a  greater  proportion  of  blood  within  the  body, 
and  also  to  lessen  its  impetus  at  the  bleeding  point,  thereby  favoring 
the  formation  of  a  clot  or  coagulum.  Dry-cupping  an  entire  limb,  for 
which  purpose  elongated  cylinders  of  flexible  material  have  been  in- 
vented, is  one  method  of  holding  back  its  blood.  The  common  ligature 
round  the  limb  is  equally  eflicacious. 

Transfusion. — In  some  cases  of  excessive  loss  of  blood,  life  hag 
been  preserved  by  opening  the  vein  of  a  healthy  person,  or  of  a  sheep, 
end  transferring  the  blood  immediately  into  the  vein  of  the  bleeding 
patient,  a  suitable  vessel  or  funnel  being  connected  with  the  latter  for 
the  purpose  of  receiving  it. 


3Sf  SURGERY 


CHAPTER  II. 

WOUNDS. 

Distinctions  of  Worrrp?. — The  usual  division  of  wounds  is  into 
incised,  punctured,  penetrating,  contused,  lacerated,  gunshot,  and 
poisoned.  An  incised  wound  is  a  simple  cut,  made,  of  course,  !)y  a 
eharp-edged  instrument,  as  a  knife,  razor,  axe.  A  punctured  wound 
is  made  by  a  sharp-pointed  instrument,  as  a  needle,  awl.  A  penetrating 
wound  is  a  larger  puncture,  as  by  a  bayonet.  A  contused  wound  is 
occflsioned  by  a  blunt  instmraent,  as  a  stone,  club,  which  injures  the 
parts  below  the  surflice,  the  skin  remaining  entire.  A  lacerated 
wound  is  inflicted  bj'  an  instrument  which  is  both  blunt  and  rough,  and 
which  teal's  the  integument  as  well  as  injures  the  parts  beneath  it. 
Gunshot  wounds  include  all  injuries  accniing  from  substance^%npelled 
by  the  explosive  force  of  gunpowder,  as  leaden  bullets,  cannon  balls, 
stones,  etc.  They  partake  of  the  character  of  both  punctured  and 
Incei-nted  wounds.  Poisoned  wounds  are  the  mjuries  inflicted  by  in- 
sects, reptiles,  rabid  dogs,  etc.,  whose  stings  or  bites  are  accompanied 
witli  the  introduction  of  a  specific  virus. 

Genkkal  Consequences  of  Wounds. — Bleeding  is  the  only 
nlurming  symptom  in  incised  wounds,  which  can  generally  be  healed  by 
the  "first  intention,"  that  is,  without  suppurating.  All  the  other 
varieties  are  attended,  save  when  very  large  arteries  are  torn,  with 
but  little  hemorrhage,  but  always  suppurate  more  or  less.  In  gunshot 
wounds,  the  concussion  of  the  air  impelled  by  the  ball  often  inflicts 
severe  injuiy,  without  making  any  mark  upon  the  skin.  In  most 
wounds  there  is  more  or  less  extravasation,  or  an  infiltration  of  blood 
into  the  cellular  membrane.  The  j^ain  is  generally  in  the  inverse  ratio 
to  the  danger,  for  the  reason  that  the  more  destructive  the  injury,  the 
less  f)ower  has  nature  to  cive  the  alarm.  The  danger  of  wounds,  other 
circumsr.inces  being  equal,  depends  on  the  actual  health,  or  physiolog- 
ical state  of  the  system  at  the  time  th^ound  is  received.  The  most 
triviiil  scratch,  or  the  simplest  cut,  has  been  followed  by  bad  sores,  loss 
of  limb,  and  even  lifr,  in  persons  of  extremely  morbid  blood,  foul  se- 
cretions, and  reduced  vitality ;  while  those  of  sound,  pure  bodies,  re- 
cover from  the  most  complicated  injuries  with  comparatively  little  dlf- 


WOUJSDS. 


338 


ficulty.  Spirit-diinkers  and  beer-bibbers  are  notoriously  liable  to  ex- 
treme innamjnation,  foul  ulcers,  mortification,  etc.,  from  injuries  which 
water-drinkers  might  regard  as  trifles. 

Treatment  of  Wounds. — The  first  point,  in  all  cases,  is  to  control 
the  hemorrhage.  Arterial  bleeding,  which  is  always  far  the  most 
dangerous,  may  be  known  by  the  bright  scarlet  color  of  the  blood,  and 
its  issuing  in  jets.  It  may  be  stated  as  a  general  rule,  probably  an  in- 
variable one,  that  all  hemorrhage  from  blood-vessels  below  the  wrist 
and  ankle,  can  be  arrested  without  ligating  the  arteries.  The  injured 
part  should  be  freely  exposed  to  the  cold  air,  and  washed  in  the  coldest 
water.  In  many  cases  the  bleeding  from  small  vessels  is  kept  up  by  the 
dressings — covering  the  wound  with  compresses,  lint,  etc.,  which  keep 
up  the  heat,  and  prevent  the  formation  of  a  coagulum.  I  have  known  a 
deep  wound  in  the  thigh,  made  by  a  piece  of  glass,  bleed  for  several  days 
in  spite  of  lint,  and  sutures,  and  bandages,  and  cease  entirely  on  being  laid 
open  with  a  scalpel  with  a  view  of  tying  the  wounded  artery,  which,  by 
the  way,  was  not  found.  In  some  cases  the  wounded  artery  can  be  com- 
pressed by  the  finger,  as  the  radial  artery  in  fig.  194.     If  the  pressure 


Fig.  194. 


must  necessarily  be  kept  up  a  long 

time,  a   piece   of  soft  rag  several 

times  folded  may  be    placed   over 

the   aperture,    and   secured    by   a 

piece  of   broad  tape,  bandage,    or 

pocket  handkerchief,  as  in  fig.  195. 

When    internal     bleeding    occurs, 

known  by  paleness,  faintness,  etc 

sips  of  the  coldest  water  or  bits  of 

ice  should  be  frequently  swallowed' 

and  absolute  quiet  enjoined.    Bleed-  compressing  the  radial  artery. 

ing  from  large  arteries  must  be  controlled  by  the  tourniquet,  and  the 

artery  ligated.     Wlien  the  bleeding  is  from  the  upper  extremity,  the 

brachial  artery  must  be  com  pj„  ^95 

pressed  above  the  middle  of 

the  arm ;    and  if   from   the 

lower,    the   femoral    artery  Hi  — .  — ::^Y - 


should   be   compressed   just 
below  Poupart's  ligament. 

The   congestion    and    in-  the  common  compress. 

Jlammation  which  may  attend  all  wounds  merely  require  frequent 
changes  of  the  water-dressings  ;  and  when  the  inflammation  of  a 
wound  has    extended    to   the    neighboring  glands,   producing    painful 


334  SURGERY. 

Bwellin«^s,  these  should  be  kept  well  covered  with  several  thicknesses 
of  wet  cloths. 

The  lo(i<7inpnt  of  foreign  substances  in  wounds  is  to  be  ascertained 
r»y  introducing  the  finger  or  a  probe,  and  extracted  if  possible  ;  not, 
•lowever,  until  a'!  danger  from  hemorrhage  is  past;  and  when  poison- 
ous substances  are  imbedded  in  the  flesh,  warm  water  or  neutralizing 
solutions  should  be  frequently  injected. 

In  suppurating  wounds  the  edges  must  be  kept  apart,  to  allow  free 
egress  to  all  matter  that  may  form  within ;  and  if  the  granulations,  in 
the  healing  process,  arise  above  the  surface,  and  become  loose  and 
flabby,  constituting /a;2o-ou5  or  proud  Jlesh,  straps  of  adhesive  plaster  or 
collodion  should  be  applied  to  act  as  a  compress.  In  bad  cases  caustic 
potash  may  be  necessary. 

Secondary  hemorrhage  is  liable  to  occur  in  lacerated  wounds  from 
the  sloughing  of  large  arteries  ;  and  in  bad  cases,  gangrene.  They 
require  the  coldest  water-dressings.  The  moderate  douche  is  excel- 
lent in  contused  wounds  ;  and  when  they  become  irritai^.*^  and  painful 
the  part  may  be  bathed  in  warm  water,  followed  by  the  cold  compress. 
The  absorption  of  extravasated  blood  may  be  promoted  by  the  cold 
streams  and  cold  wet  compress. 

The  general  treatment  of  poisoned  wounds  has  been  detailed  in  the 
preceding  part  of  this  work. 


CHAPTER  III. 

INJURIES. 

Concussion. — A  stunning,  or  concussion  of  the  brain,  is  the  result 
of  blows  upon  the  head,  or  of  falls,  which  so  shock  the  whole  system  as 
to  occasion  u  temporary  suspension  of  consciousness.  The  extent  of 
the  injury  cannot  bo  known,  nor  is  it  material  that  it  should  be  until 
the  psitic-nt  "  comes  to."  It  may  be  so  severe  as  to  produce  instan- 
taneous death ;  or  so  slight  as  to  leave  no  apparent  ill  consequences. 

Treatment. — Perfect  quiet,  and  a  careful  attention  to  keep  up  the 
general  circulation  and  normal  temperature,  are  the  principal  remedial 
resources.  The  extremities  must  be  kept  warm,  cold  cloths  should  be 
laid  over  the  head,  and  if  the  concussion  is  prolonged,  the  bowels  may 
need  evacuating  by  means  of  injections,  and  the  urine  require  to  b** 
drawn  otT  by  the  catheter. 


NJURIES.  B3L 


The  old  })ractice  of  bleeding,  which  I  am  sorry  to  know  is  also  a 
common  practice  with  modern  allopaths,  has  no  better  effect  than  to 
lessen  the  patient's  chance  of  recovery.  Indeed,  this  has  been  the 
opinion  of  some  of  the  best  Em'opean  surgeons  for  the  last  fifty  years, 
and  a  majority  of  all  modern  authorities  is  against  the  practice  ;  be 
sides,  it  is  in  itself  at  variance  with  common  sense ;  yet  our  doctors  con- 
tinue the  killing  practice  of  l«tting  blood  as  though  there  was  some  sci- 
entific reason  for  it ! 

Compression. — This  is  usually  the  result  of  concussion,  and  its  im 
mediate  cause  is  an  extravasation  of  blood  within  the  cranium ;  or  some 
collection  of  other  matter;  or  mechanical  pressure  from  a  depressed  or 
broken  part,  of  the  skull  bones.  It  is  denoted  by  continued  pain  in  the 
injured  part  of  the  brain,  with  cerebral  disturbance  ;  or,  in  the  absence 
of  these,  frequent  faintings,  spasms,  disordered  vision  or  hearing,  with 
nausea  and  vomiting.     The  patient  is  often  also  comatose. 

Treatment. — When  a  portion  of  the  cranium  i«  depressed  it  must  be 
raised  by  a  lever ;  or  if  this  is  impracticable,  the  operation  of  trepliii 
uing  will  become  necessary.  The  head  should  in  all  cases  be  kept 
thoroughly  cooled  with  wet  cloths  or  the  j)ouring-bath,  and  derivative 
treatment,  especially  tepid,  hip,  and  foot-baths  should  be  frequently 
employed,  caution  being  taken  to  secure  prompt  reaction.  In  ex- 
treme cases,  hot  foot  and  leg-baths  are  useful,  especially  when  the  pa- 
tient is  affected  with  delirium  or  coma.  In  young  persons  very  bad 
fractures  of  the  cranial  bones  will  often  replace  themselves  if  the  gen- 
eral health  is  well  attended  to. 

Bruises. — These  are  only  worth  naming  for  the  purpose  of  men- 
tioning that  the  cold  douche,  and  the  wet  compress,  are  worth  more 
than  all  the  stimulating  liniments  and  embrocations  in  the  world,  in 
their  treatment. 

Strains. — These  accidents  usually  happen  to  the  smaller  joints,  as 
the  wrist,  fingers,  ankle,  and  toes  ;  they  are  generally  exquisitely  pain- 
ful, and  are  very  liable  to  be  followed  by  painful  and  protracted  inflam- 
mation. The  part  should  be  held  in  cold  water,  or  the  cold  stream 
applied  to  it  until  the  violence  of  the  pain  abates,  and  then  ^vl'apped 
in  wet  compresses  until  all  inflammatory  excitement  is  passed. 

Burns  and  Scalds. — Burns  are  produced  by  the  action  of  concen- 
trated heat  upon  the  living  tissue.  Scalds  are  produced  by  the  appli- 
cation of  a  boiling  or  hot  fluid.     The  danger  of  these  injuries  is  usually 


830 


SURGERY. 


measured  by  the  extent  of  surface  destroyed.  Authoi"s  make  three, 
fuur,  five,  an('  sometimes  six  degrees  of  burns;  but  the  smallest  num- 
ber is  sutTicieijt  for  all  practical  purposes.  The  first  is  rube/action,  or 
redness  ;  the  second,  vesication,  or  blistering;  and  the  third,  disorgan- 
ization, in  which  the  skiu  is  destroyed,  and  perhaps  some  structures 
beneath  the  skin.  The  pain  is  usually  the  severest  in  the  second  va- 
riety. Superficial  burns  or  scalds  are  easily  healed  when  not  mal- 
treated ;  but  deep  burns,  as  by  a  hot  iron,  usually  leave  an  ugly  scar. 
Many  terrible  burns  are  frequently  taking  plaeo  by  the  clothes  of 
women,  children,  and  servants  taking  fire  from  Ccii-elessness  in  hand- 
liug  camphene,  burning  fluid,  tea-kettles,  cofifee-pots,  etc. 

Treatment. — When  one's  clothing  is  on  fire,  the  first  thing  to  be 
done  is  to  extinguish  the  flame  :  and  as  the  sufferer  might  burn  to  death 
before  a  supply  of  water  could  be  obtained,  the  ^me  should  be  suflb- 
cat«d  by  covering  the  patient  with  a  blanket,  cai-pet,  or  some  similar 

Fig.  196. 


y^y 


\ 


article,  as  represented  in  fig.  196.  The  next  point  of  treatment  is  to 
immerse  the  injured  part  in  water,  or  cover  it  with  wet  cloths  of  the 
temperature  which  feels  most  agreeable  to  the  patient.  The  coldest 
water  will  prove  the  most  soothing  at  first;  and  in  a  longer  or  shorter 
time,  according  to  the  severity  of  the  inflammation,  tepid  water  will  be 
found  most  sedative ;  and  finally  w*arm  water  w^ill  often  feel  the  best. 
But  the  rule  is  invariable  :  follow  the  sensations  of  the  patient.  When 
the  skin  i?  vesicated,  it  should  be  kept  covered  with  soft  linen.  The 
blisters  which  form  should  not  be  punctured  or  torn  until  suppuration 
has  taken  place  on  the  surface,  as  they  form  the  best  protection  to  the 
injured 'surface. 

As  the  contact  of  the  atmosphere,  or  rather  of  a  colder  medium,  is 
excessively  painful  to  the  raw  surface  after  the  skin  or  cuticle  comes 
oC*.  the  roon^  a'lould  be  kept  quite  warm,  and  oil  applications  should 


INJURIES,  837 


then  be  moderately  warm.  The  best  covering  hi  this  condition  is 
simple  flour,  dredged  over  the  surface,  allowed  to  remain  until  it 
becomes  loose  by  the  purulent  matter  beneath,  then  removed,  the 
surface  gently  washed  with  warm  water,  and  more  flour  applied.  A 
soft  cloth  may  be  placed  over  the  flour  and  kept  continually  wet  with 
water ;  and  the  flour-dressing  may  be  continued  until  cicatrization  is 
completed.  I  have  seen  very  bad  burns  heal  rapidly  and  admirably 
under  this  management  :  starch,  and  finely-pulverized  slippery  elm 
bark — elm  flour — are  favorite  applications  with  some  practitioners,  but 
I  know  not  that  they  have  any  advantage  over  the  common  flour. 

There  is  always  a  considerable  degree  of  constitutional  disturbance 
after  a  severe  burn,  as  rigors,  oppressed  respiration,  small,  weak  pulse, 
followed  by  more  or  less  febrile  reaction.  This  requires  warm  hip  and 
foot-baths,  when  practicable,  during  the  period  of  chilliness,  and  tepid 
ablutions  during  the  febrile  stage  ;  the  room  should  always  be  kept  con- 
siderably warmer  than  in  cases  of  the  same  violence  of  fever  from  any 
other  cause. 

The  allopathic  treatment  of  burns  and  scalds  is  a  singular  jumble  of 
the  "  good,  bad,  and  indifi'erent."  Professor  Parker,  of  this  city,  after 
telling  us  that  "the  treatment  of  scalds  and  burns  seems  to  us  to  be 
eminently  empirical  in  all  our  systematic  works  on  surgery,"  gives  us  a 
rational  basis  of  treatment.  This  is  "the  use  of  such  agents  as  are 
calculated  to  meet  the  existing  debility."  "The  most  prominent  of  the 
local  and  constitutional  symptoms  is  gi'eat  nervous  prostration^  On  this 
basis  the  professor  recommends  ivarm  brandy  and  tincture  of  ojnum  to 
get  up  rea-ction  ;  and  then  antimony,  Dover s  poivder,  calomel,  and  ipe- 
cacuanha, to  get  the  reaction  down  again;  or,  in  his  language,  " regu- 
late the  reaction,  that  it  may  not  run  too  high."  "  General  bleeding," 
he  continues,  "is  commonly  indicated  by  the  gi-eat  tendency  in  such 
cases  to  a  typhoid  condition  of  the  system."  Bleeding  indicated  be- 
cause the  nervous  system  is  prostrated,  and  the  whole  system  in  a  sink- 
ing condition  !     Is  not  this  pre-eminently  empirical  ? 

Among  the  sequela  of  burns  and  scalds,  are  contractions  of  the  skiu 
and  adhesions  around  the  tendons,  producing  distortions  and  deformi- 
ties. These  must  be  prevented,  as  far  as  possible,  by  maintaining  the 
normal  position  of  the  parts  during  the  healing  process.  Dr.  Parker 
remarks :  "  When  these  scalds  and  burns  are  upon  the  trunk,  and 
there  has  been  a  copious  suppuration,  unless  we  are  guarded  in  our 
treatment,  as  cicatrization  takes  place  and  the  secretion  is  diminishing, 
there  will  occur  suddenly  and  unexpectedly,  effusion  upon  the  brain  or 
lungs,  and  death."  The  way  to  "  guard"  against  such  disastrous  re- 
sults is,  by  avoiding  the  drugging  and  bleeding  part  of  the  treatment. 
'11—29 


338  SURGERY. 

Particular  Wounds  and  Injuries. —  Venesection-Phlebotomy— 
is  a  wound  made  by  puncturing  a  blood-vessel  with  ihe  point  of  a  lan- 
cet, a  ligature  having  been  previously  applied  betvreen  the  contem- 
plated wound  and  the  heart.  Some  one  of  the  veins  or  the  inner 
Bide  of  the  fore-arm,  near  the  elbow,  is  usually  selected  ;  but  occasion- 
allv  the  external  jugular  vein,  the  veins  of  the  foot,  and  the  temporal 
urtorv  are  opened.  The  consequences  of  this  operation  are,  1.  Loss 
of  blood,  which  is  irremediable.  2.  Eccliymosis — a  livid,  hard  tumor, 
occasioned  by  an  extravasation  of  blood  into  the  cellular  membrane,  in 
consequence  of  the  wound  in  the  vein  not  exactly  corresponding  with 
that  in  the  skin  ;  it  requires  the  cold  do^he  and  cold  compresses.  3. 
Aneurism — an  arterial  swelling,  produced  by  pricking  through  the  vein 
into  the  adjacent  artery,  or  missing  the  vein  with  the  point  of  the  lan- 
cet and  hitting  the  artery ;  this  requires  the  operation  of  ligating  the 
artery  above  the  injury.  4.  LocJc-jaiv — produced  by  pricking  or  di- 
viding some  nerve  in  the  vicinity  of  the  venesected  vein  ;  it  requires  the 
treatment  heretofore  mentioned  under  the  head  of  Spasmodic  Diseases. 
5.  Phlebitis — inflammation  of  the  veins  of  the  wounded  part,  of  whicli 
the  operation  is  the  exciting  cause  ;  this  requires  the  wet-sheet  pack, 
with  wet  cloths  to  the  intiamed  part.  6.  Fainting — which  results  from 
the  abstraction  of  a  large  quantity  of  blood,  or  from  a  less  quantity  sud- 
denly withdmwn  by  making  a  large  orifice ;  the  treatment  has  been 
described  under  the  head  of  Syncope. 

Leeching  and  scarifying  are  among  the  common  injuries  w«hich 
modern  surgeons  are  fond  of  inflicting  upon  afflicted  humanity.  The 
usual  morbid  consequences  are,  inflammation  of  the  skin  and  adjacent 
blood-vessels — erythema  and^Wei/i!?.?—  langerous  hemorrhages,  and  un- 
seemly scars.  For  all  these  '  accidents,"  the  coldest  water  is  the  best 
remrdy. 

Wounds  nfthe  throat,  of  which  throat-cutbing  is  the  most  prominent 
example,  present  many  degrees  of  severity  and  danger,  from  a  mere 
incision  through  the  integument,  to  a  division  of  the  jugular  veins,  wind- 
pil)e,  and  carotid  arteries.  The  principal  danger  is  from  hemorrhage  ; 
and  all  the  vessels  which  bleed  freely,  whether  arteries  or  veins,  must 
be  taken  up  and  tied  ;  after  which  the  lips  of  the  wound  are  to  be  re- 
tained together  with  both  sutures  and  adhesive  straps. 

Wounds  of  the  scalp  are  liable  to  be  followed  by  erysipelatous  in- 
flammation ;  the  hair  must  be  shorn,  and  the  divided  parts  brought  in 
proximity  by  adhesive  straps,  and  sutures  when  necessary. 

Wounds  of  the  chest  are  apt  to  penetrate  the  substance  of  the  lungs, 
in  which  case  air  and  blood  together  will  bubble  oat  of  the  wound, 
Rud  tiio  patient  will  manifest  short  breath  and    )looiy  expectoration 


INJURIES.  389 


The  wound  should  be  covered  with  a  plaster,  and  cooling  derivative 
baths — half  and  hip — employed. 

Dr.  Hill,  author  of  an  excellent  surgical  work  {Eclectic  Surgery), 
makes  the  following  pertinent  remarks  in  relation  to  the  bleeding  prac- 
tice in  this  case.  ^'•Venesection  is  recommended  in  the  books  'to  di- 
vert,' as  they  say,  '  the  blood  from  the  lungs.'  But  surely  it  is  as  well 
to  bleed  to  death  through  a  wound  in  the  chest  as  through  one  in  the 
arm  !  We  are  told  that  the  bleeding  '  can  hardly  be  carried  too  far ; 
for  if  the  patient  be  not  relieved  by  this  measure,  no  other  can  jjossihly 
sa'^e  him.''  (Gibson,  vol.  i.,  p.  19.)  The  reason  given  for  bleeding,  in 
such  cases,  is  as  absurd  as  the  process  itself." 

Wounds  of  the  abdomen  are  among  the  most  dangerous.  When  the 
intestines  are  wounded,  the  patient  is  affected  with  nausea  and  vomit- 
ing, and  the  matters  ejected  or  dejected  will  be  bloody.  When  a  por- 
tion of  intestine  protrudes,  it  must  be  replaced  as  soon  as  possible ;  if 
this  is  not  done  within  forty-eight  hours,  adhesions  may  form  and  ren- 
der it  impossible.  When  the  protruded  bowel  is  distended  with  gases 
or  faeces,  by  which  its  return  is  hindered,  these  may  be  pressed  for- 
ward into  a  portion  of  intestine  within  the  abdominal  cavity;  or,  if  this 
measure  fails,  the  wound  must  be  dilated.  These  wounds,  when  large, 
may  require  the  suture  ;  a  fine  needle  and  thread  only  should  be  used. 
For  several  days  after  severe  injuries  of  the  bowels  or  lungs,  the  pa- 
tient should  eat  little  or  nothing,  and  the  bowels  be  moved,  when  neces- 
sary, by  warm  injections. 

Wounds  of  the  joints  are  liable  to  be  followed  by  severe  inflammation, 
terminating  in  adhesions  and  anchylosis,  or  stiff-joint.  The  limb  should 
be  kept  in  the  easiest  possible  position,  perfect  quiet  observed,  and  cold- 
water  dressings  be  assiduously  applied.  The  modern  disease,  called  in 
some  late  books  synovitis,  is  a  chronic  inflammation  of  the  synovial 
membrane,  and  to  some  extent  of  other  structures  of  the  joint,  and  is 
produced  by  some  external  injury.  I  have  seen  several  cases  affecting 
the  knee-joint,  produced,  most  unquestionably,  by  wearing  strapped 
pantaloons.  Synovitis  is  known  by  a  sense  of  weakness  or  lameness  in 
the  affected  joint,  always  increased  by  any  considerable  motion,  and 
frequently  amounting  to  pain  when  the  exercise  is  prolonged.  There 
is  usually  none,  or  but  slight,  external  redness,  swelling,  or  heat.  This 
affection  requires  a  long  time  to  cure  ;  the  remedial  plan  consists  of  a 
very  strict  dietetic  regimen,  one  or  two  general  baths  daily,  with  the 
constant  application  of  local  compresses,  and  occasional  shalloio  foot- 
baths. When  the  knee-joint  is  the  seat  of  the  disease,  the  cold  leg- 
bath  should  be  employed  for  half  an  hour  once  or  twice  a  day 


440  SURGERY. 


CHAPTER  IV 

TUMORS. 

EvKRY  tumor  is  a  morbid  swelling  era  new  formation — ^an  ncreased 
or  p«'rverted  development  of  organic  substance.  The  common  causes 
are  injuries,  as  pressure,  blows,  bruises,  etc,  although  it  is  seldom  that 
we  can  trace  any  particular  tumor  to  the  particular  accident  from  which 
it  originated.  They  ma}-  also  arise  from  capillary  obstruction,  and  this 
is  induced  by  manj-  of  the  unhealthful  eating,  drinking,  and  anti-bath- 
ing habits  of  society.  A  mechanical  injury  of  the  vessels  of  a  part,  or 
a  long-continued  inflammation  or  obstiuction,  may  produce  a  change  in 
its  nutritive  function,  by  which  an  abnormal  structure  is  developed  ; 
and  when  once  this  perverted  action  commences,  it  may  progress  to  an 
indefinite  period  or  extent.  In  their  incipient  stages  they  can  frequently 
be  removed  by  strong  douches,  cold  compresses,  and  continued  com- 
pression. Tumors  are  distinguished  into  adipose,  cellular,  jihrous,  carti- 
laginous, osseous,  encysted,  fungous,  indurated,  scrofulous,  malignant, 
jyutsating,  vascular,  etc.,  according  to  the  stmcture  affected,  and  the 
form,  character,  and  consistence  of  the  swelling. 

The  older  surgeons  divided  tumors  into  sarcomatous  ov  fieshy — com- 
l>i"ehending  those  which  are  composed  of  ftitty,  fibrous,  medullary, 
fungous,  or  other  substances  softer  than  bone :  osseous  or  bony  ;  osteo- 
sarcomatous — when  involving  both  the  bony  and  fleshy  sti'uctures ;  and 
encysted — containing  a  fatty  or  fluid  substance  within  a  globular  cyst,  as 
in  the  case  of  teens  and  hydatids. 

Adipose  tumors  are  collections  of  fattrj  matter  inclosed  in  a  cyst  or 
Bac  of  condensed  cellular  membrane,  which  renders  them  also  encysted 
tumois.  When  filled  with  a  suefc-like  matter,  they  are  called  steato- 
mous  ;  wlien  containing  a  hone^like  substance,  melicerous ;  and  when 
their  contents  are  a  pap-like  fluid,  atheromatous  They  are  not  pain- 
ful, and  only  inconvenience  the  patient  by  their  bulk,  weight,  or  pres- 
sure. They  are  easily  removed  by  making  a  T  incision  through  the 
skin,  and  carefully  dissecting  around  them  to  detach  the  cysts  from  the 
eurniunding  structures.  They  maybe  removed  by  the  "eight-tailed 
ligature,"  fig.  197,  two  needles  being  drawn  through  the  under  side 
of  the  tumor,  touching  each  other  at  right  angles,  and  each  carrying 
a  double  ligature;  the  loops  are  then  cut,  and  the  ends  tied  in  four 
knots,  by  which  the  tumor  is  completely  strangulated.  These  tiimorg 
do  not  rfnpprar  after  having  been  entirely  removed. 


TUMORS. 


341 


Fig.  ^97. 


LIGATURE    FOK    TUMORS 


Fibrous  tumors  are 
composed  of  capsules  of 
gi'eater  or  less  densi- 
ty, inclosing  yellow  or 
whitisli  substances  di- 
vided into  lobes  or  septa 
by  cellular  substance  ; 
their  shape  is  irregular, 
and  they  have  a  doughy 
consistence.  They  are 
not  painful,  and  are  easi- 
ly removed  by  the  liga- 
ture or  knife,  being  al- 
most always  situated  in 
accessible  places.  The 
fibrinous  contents  of  tl-  ese  tumors  adhere  so  loosely  to  their  capsules 
that  they  can  readily  be  removed  by  the  finger  or  forceps  on  making 
an  incision  through  the  skin. 

Cellular  tumors  are  smooth,  firm,  and  composed  of  compacted  layers 
of  areolar  tissue,  containing,  in  thin  cells,  albuminous,  fibrinous,  and  se- 
baceous matter.  They  are  never  painful  except  when  inflamed.  The 
cutaneous  veins  involved  in  the  tumors  may  become  varicose,  and  when 
abrasion  occurs,  sloughing  and  fungous  growths  are  apt  to  follow.  Ex  ■ 
cision  with  the  knife  is  the  best  treatment;  but  when  sloughing  takes 
place  the  mild  caustic  is  necessary;  and  the  strong  caustic  when  fun- 
gous appearances  present. 

Vascular  tumors  are  limited,  in  surgical  technology,  to  those  raorbi(J 
developments  of  erectile  tissue  called  ncevi  tnaterni,  or  aneurism  hy 
anastomosis  ;  and  these  may  be  superficial  or  subcutaneous.  The 
proper  plan  of  treatment  contemplates  the  destruction  of  the  morbid 
congeries  of  blood-vessels  in  such  a  manner  as  to  avoid  hemorrhage. 
Repeatedly  puncturing  the  prirt  with  hot  needles,  and  the  repeated  ap- 
plications of  caustic,  a  small  part  of  the  surface  only  being  touched  at 
once,  with  constant  but  moderate  compression,  have  each  succeeded  in 
removing  them. 

The  character  of  the  other  varieties  is  sufficiently  indicated  by  their 
name,  and  the  treatment  will  be  given  under  the  head  of  particular 
tumors. 


Whelk — Ionthus. — This  affection  is  a  stationary,  tubercular,  un- 
s«ppurative  tumor,  generally  found  upon  the  face.  It  comprises  the 
varieties  called  stone  fotk,  and  carbuncle ^  J'ai  e,  or  rosy  drop — gufta 


842  SURGERY. 


rosea.  Stone  pock  is  a  pimply  eruption  of  hard,  red  tumors,  which  are 
Bore  to  the  touch,  and  ooze  a  little  fluid  at  the  tip,  or  a  grub-like  con- 
cretion of  mucus.  In  the  carbuncular  variety  the  tumors  are  confluent, 
and  mottled  with  purple,  often  disfiguring  the  nose  with  pendulous 
lobes,  and  marring  the  face,  as  Shakspeare  has  it,  with  "  bubukles,  and 
whelks,  and  knobs,  and  flames  of  fire."  In  Ireland,  the  common  name 
for  these  protuberances  is  grog-blossoms;  in  this  country  they  are 
known  as  rum-blossoms,  grog-roses,  cider-buds,  beer-berries,  etc.,  while 
their  possessors  are  honored  with  the  appellation  of  copper-noses,  bot- 
tle-noses, etc. 

Special  Causes. — Grease-eating  and  "haixl  drinking." 
Treatment. — Few  invalids,  distinguished  by  the  carbuncular  variety 
of  the  whelky  tumor,  can  be  expected  to  submit  to  i^-aier-treatment ; 
and,  moreover,  these  patients  have  the  same  reason  to  regard  their 
'•  rose^"  and  "blossoms"  as  badges  of  honorable  distinction,  that  the 
Englishman  has  his  gouty  toes  and  stomach,  or  the  Polynesian  Islander 
his  enormously  misshapen  leg.  All  alike  can  boast  of  "  high  living.'" 
But  if  we  should  be  called  upon  to  indicate  a  remedy,  we  might  with 
all  propriety  suggest  the  details  of  a  "  sober  and  temperate  life." 

Sycosis. — This  term  has  been  applied  to  a  fig-shaped  tumor,  a  fun- 
gous ulcer,  and  a  horny  excrescence  about  the  eyelids ;  but  usually  and 
here  it  is  employed  to  denote  an  enaption  of  inflamed  tubercles  on  the 
scalp,  and  on  the  bearded  portion  of  the  face.  These  tumors  often  ul- 
cerate and  discharge  an  ichorous  or  glutinous  matter.  They  are  con- 
nected with  uncleanliness  in  either  the  positive  or  negative  sense — bad 
diet  or  drirjk,  or  the  absence  of  wate*-,  and  may  be  cured  by  thorough 
local  and  general  bathing. 

Warts — Verdcc^. — These  are  rather  excrescences  than  tumors  ; 
some  are  smooth  and  apparently  filled  with  fattj^  matter;  others,  called 
seed-waits,  are  rough,  hard,  and  insensible.  Some  warts  secrete  a 
fluid  which  is  infectious,  and  will  produce  a  crop  on  other  persons  or 
on  other  parts  of  the  same  person.  They  may  be  eflfectually  removed 
by  caustics— potassa,  nitrate  of  silver,  nitric  acid,  or  niti-o- muriatic  acid. 
The  latter  preparation  is  the  best ;  it  may  be  applied  by  means  of  a 
pointed  piece  of  wood  to  the  centre,  taking  care  not  to  let  the  acid 
come  in  contact  with  the  surrounding  structure.  To  prevent  this,  a 
piece  of  perforated  adhesive  or  court-plaster  may  be  placed  around  the 
wait.  T.ie  acid  may  be  repeated  until  the  troublesome  and  unsightly 
excrescence  b  entirely  destroyed,  which  will  usually  require  but  a 
ft»w  days. 


TUMORS.  842 


Corns — Clam. — These  well-known  toe-tormentors  are  produced 
by  tight  shoes  or  boots.  The  first  principle  of  cure  is  to  give  the  feet 
a  respectable  area  of  freedom  ;  and  the  second  is  to  soak  them  in  warm 
water,  and  shave  off  the  horny  substance,  and  then  touch  them  with 
the  nitric  or  nitro-muriatic  acid.  When  the  corn  is  inflamed  or  highly 
irritable,  the  tepid  foot-bath  should  be  employed  to  remove  this  condi- 
tion before  the  acid  is  applied.  The  aqua  regia — nitro-muriatic  acid 
— is  the  ordinary  secret  remedy  of  the  "  corn-curers."  When  the 
corn  is  fully  formed,  or  ripe,  a  membrane  separates  it  from  the  ti*ue 
skin,  so  that  it  can  be  taken  off  without  injuring  that  surface  ;  and  this 
circumstance  enables  professional  chiropodists  to  elevate  the  "  grain" 
on  the  point  of  a  pen-knife,  after  an  application  of  the  acid. 

Bunion. — This  affection,  though  generally  regarded  as  a  variety  of 
corn,  is  really  an  inflammation  and  swelling  of  the  bursa  mucosa,  at  the 
inside  of  the  ball  of  the  great  toe ;  it  often  produces  a  distortion  of  the 
metatarsal  joint  of  the  great  toe,  and  is  produced  by  the  same  causes  as 
corns.  The  treatment  is,  warm  foot-baths,  when  the  part  is  very  ten- 
der and  irritable  ;  at  other  times,  frequent  cold-baths ;  and  when  a 
horny  substance  resembling  a  corn  appears  externally,  the  application 
of  caustic.  I  have  known  bad  corns  and  bunions  cease  to  be  trouble- 
some after  the  patient  had  been  a  few  months  under  hydropathic  treat- 
ment for  other  complaints. 

Ontxis. — This  distressing  affection,  sometimes  known  by  the  dis- 
tressing synonym  of  onychogryjjhosis,  consists  in  an  incurvation  of  the 
toe  nail  from  a  bruise  or  the  pressure  of  a  tight  shoe,  producing  in- 
flamnirition  and  ulceration,  and  followed  eventually  by  fungous  growths, 
or  proud  flesh,  which  is  exceedingly  tender  and  painful.  The  cure  is 
slow  but  certain.  The  foot  must  be  frequently  soaked  in  warm  water 
until  the  soreness  is  so  far  abated  that  it  can  be  handled  Vv^ithout  pain; 
then  with  a  probe  press  pledgets  of  lint  as  firmly  as  can  be  borne  under 
the  most  detached  point  of  the  toe  nail,  pressing  them  also  between  the 
nail  and  projecting  portions  of  the  flesh  as  far  as  possible.  Cover  these 
with  the  wet  compress,  and  apply  a  moderately -tight  bandage  over  the 
whole,  frequently  wetting  the  whole  with  waj-ni.  tepid,  or  cool  water, 
as  either  temperature  is  most  agreeable.  The  tents  are  to  be  pressed 
further  and  further  under  the  nail  from  time  to  time,  and  the  foot 
should  be  soaked  and  dressed  once  or  twice  daily.  When  portions  of 
the  nail  become  free  they  may  be  cut  off,  and  mild  caustics  may  be 
employed  to  remove  fungous  or  indurated  growths,  which  do  not  yield 
tp  the  other  measures  of  treatment. 


#jl  SURGERY. 

Ga.nglio.ns.— These  are  encysted  rumors,  formed  of  a  viscid,  albu- 
minous fluid,  resembling  the  white  of  an  egg,  and  varying  in  size  from 
II  pea  to  that  of  an  egg.  They  are  hard,  globular,  and  without  discol- 
uralion  of  the  skin.  Sometimes  the  cyst  is  loose,  but  in  most  cases  it 
commuuicatt' s  by  a  narrow  foot-stalk,  with  the  sheath  of  a  tendon,  or 
the  synovial  capsule  of  a  neighboring  articulation.  Ganglions  are  al- 
ways situated  in  thp  course  of  a  tendon,  and  usually  appear  on  the 
wrist,  hand,  and  top  o(  the  foot.  In  their  ti-eatment  surgeons  have  re- 
sorted to  compression,  percussion,  discutient  applications,  extirpation, 
and  caustics.  When  the  tumor  is  prominent  and  round,  a  simple  in- 
cision will  allow  its  contents  to  escape,  and  if  dressed  with  a  moderate- 
ly tight  c(jmpress,  the  wound  will  heal  readily.  I  have  always  re- 
moved them  in  this  way,  and  never  knew  any  injurious  consequences 
to  result  from  the  operation.  Oblong  and  diffused  ganglions  maj'  be 
punctured  with  a  lancet  or  couching  needle,  and  the  tluid  pressed  out. 
When  the  cyst  is  thin  it  may  be  ruptured  by  a  blow  or  by  pressing  it 
firmly  against  the  bone — in  which  event  the  fluid  will  be  absorbed  and 
a  cure  result ;  but  whether  the  sac  can  be  ruptured  with  a  safe  degree 
of  violence,  can  only  be  known  by  trial.  Irritants  or  caustics,  to  ex- 
cite suppui'ation,  is  a  method  recommended  by  some  authors  ;  it  is 
applicable  to  cases  attended  with  ulceration  or  induration. 

Ran u LA. — This  is  a  small  tumor  under  the  tongue,  resulting  from 
obstruction  of  some  one  or  ^nore  of  the  excretoiy  ducts  of  the  sub- 
maxillary or  sublingual  glands.  It  may  be  cured  by  clipping  off  a 
small  portion  with  a  pair  of  sharp  scissoi's  ;  and,  if  it  does  not  disap- 
pear in  a  few  days,  touch  it  with  niti-ate  of  silver  or  sesqui-carbonate 
of  potash. 

Epulis. — A  small  tuueiv.  e  of  the  gums,  which  generally  appears 
above  or  below  the  incisor  teeth,  sometimes  becomes  a  serious  malady. 
It  commences  with  a  small  seed-like  swelling,  which  gi'ows  so  slowly 
and  painlessly  as  to  attract  little  notice  ;  but  at  length  it  enlarges  rapidly, 
becomes  soft,  bleeds  on  the  slightest  touch,  fungous  formations  spread 
out,  involving  the  gums  displacing  the  teeth,  and  affecting  the  glands 
of  the  mouth  and  othe  soft  parts,  until  the  patient  is  destroyed  by 
hemorrhage  or  worn  out  with  irritation.  The  best  surgeons  recom- 
mend the  removnl  of  the  tumor  as  soon  as  its  character  is  ascertained. 
The  adjoining  teeth  must  bo  iirst  extracted.  Sir  Astley  Cooper  pre- 
fers the  kuife  ;  but  the  cauterizing  process  as  recommended  by  Dr. 
Hill  is,  I  think,  far  preferable;  it  consists  in  destroying  the  tumor  to 
t**  )«:«p.  with   every  portion  of  the   diseased   sti-ucture,  bv  means  of 


TUMORS.  346 


caustic  potash,  applied  until  disorganization  and  sloughing  take  place — 
the  surrounding  parts,  lips,  tongue,  etc.,  being  protected  by  cotton  wet 
in  vinegar,  rolled  up  and  pressed  in  around  the  portion  to  be  cauterized- 
In  all  cases  of  malignant  tumors  and  ulcers,  let  me  here  say  once  for 
all,  a  rigidly  abstemious  and  exclusively  vegetable  diet  is  one  of  the 
most  important,  and  frequently  one  of  the  indispensable  measures  of 
the  remedial  course. 

Bronchocele. — This  tumor,  commonly  called  goitre^  or  swelled 
neck,  is  a  preternatural  enlargement  or  hypertrophy  of  the  thyroid 
gland.  In  its  early  stage  it  is  soft  and  elastic  ;  but  as  it  advances  in 
size  it  becomes  firmer,  and  spreads  toward  the  sides  of  the  neck,  at- 
taining sometimes  a  prodigious  magnitude.  In  the  valleys  of  Switzer- 
land, Savoy,  the  Tyrol,  Derbyshire,  and  some  other  places,  it  is  very 
prevalent ;  most  frequently,  however,  affecting  young  females.  It  is 
found  in  all  parts  of  the  United  States,  but  more  commonly  in  low, 
moist,  marshy,  or  malarious  situations.  In  this  country  the  disease 
seldom  increases  to  a  dangerous  extent,  the  deformity  being  the  prin- 
cipal source  of  uneasiness. 

To  treat  this  complaint  successfully  we  must  employ  as  powerful 
douches  to  the  spine  and  to  the  tumor  itself  as  the  patient  can  conve- 
niently bear,  with  occasional  packings  in  the  wet-sheet,  and  a  thorough 
course  of  derivative  half,  hip  and  foot-baths  ;  and  to  this  course  of  bath- 
ing must  be  added  a  plain,  abstemious,  and  rather  dry  diet.  The 
drop-bath  for  half  an  hour  or  longer,  followed  by  the  wet  compress,  is 
among  the  promising  remedial  resources  ;  and  if  there  is  the  least  ten- 
dency to  constipation,  tepid  injections  should  be  fieely  employed. 

It  is  but  a  few  years  since  iodine  was  the  vaunted  specific  for  this 
disease  throughout  the  medical  world;  but  it  was  found  at  length  that 
a  great  many  more  constitutions  were  killed  than  bronchoceles  were 
cured  by  the  remedy;  hence,  like  every  other  specific  which  ever  has 
or  ever  will'  be  got  up  on  drug-medication  principles,  its  destiny  is — 
oblivion. 

Paronychia — Whitlow — Felon. — An  acutely  painful  inflamma- 
tion, seated  about  the  nails  and  ends  of  the  fingers,  has  been  called  by 
these  terms  indiscriminately;  the  term  paronychia  is  applied  to  all 
phlegmonous  tumors  of  the  fingers  and  toes.  In  some  cases  the  in- 
flammation commences  in  the  periosteum,  and  effusion  takes  place  be- 
tween it  and  the  bone,  constituting  tl\e  worst  or  malignant  form — the 
true  felon;  in  the  tendinous  whitloiv  the  inflammation  commences  in 
the  sheath  of  a  tei  'on;  and  in  a  variety  called  cutaneous,  tke  effusion 


546  SUR  JERY. 

occurs  in  the  subcutaueius  areolar  tissue,  or  between  the  skin  and  epi- 
dermis. Similar  inflammations  are  sometimes  found  about  the  palms 
of  the  hands  and  soles  of  the  feet. 

The  severe  and  lancinating  pain  of  paronychial  tumors  arises  from 
tlie  firmness  and  inelasticity  of  the  skin  and  other  sti'uctures  where  it  \9 
seated,  wnich  act  upon  the  inflamed  vessels  like  a  tight  bandage,  pro- 
ducing- a  most  distressing  sense  of  pressure  ;  and  hence  it  is  that  when 
the  skin  opens  the  soft  parts  below  are  pushed  out  like  a  fungus,  and 
become  exquisitely  tender. 

Treatment. — On  its  first  appearance  this  affection  may  generally 
„.    .gg  be  promptly  cured  by  immersing 

the  whole  arm  in  very  cold  water. 
The  arm-bath,  fig.  198,  should  be 
frequent  and  prolonged.  When 
discoloration  of  the  skin  indicates 
approaching  suppuration,  tepid, 
or  even  warm  water  to  the  in- 
flamed part,  with  the  cold  elbow- 
ARM-BATH  IN  WHITLOW.  ^ath,  wiU  prove  the  most  soothing 

treatment.  In  the  felonious  variety  it  will  save  the  patient  much  time 
and  suffering  to  cut  with  a  scalpel  down  upon  the  bone,  making  a  free 
incision  one  or  two  inches  in  length. 

SciRRHUS  AND  Cancer. — I  have  already  treated  of  cancers  medi- 
cally, but  as  many  surgeons  regard  scirrhus  and  cancerous  tumors  as 
distinct  diseases,  while  others  treat  of  scirrhus  as  though  it  were  the 
first  stage  or  beginning  of  a  cancer,  it  may  be  proper  to  consider  both 
subjects  connectedly  in. this  place. 

It  is  unquestionably  true  that  all  cancers  are  in  their  incipient  stage 
hard,  scirrhous,  indurated  tumors — occult  cancers — and  in  their  latter 
stage,  open  ulcers — carcinoma.  But  it  is  equally  true  that  indm'ated  or 
scirrhus  tumors  often  remain  for  an  indefinite  period  in  a  condition  of 
cartilaginous  and  almost  stony  hardness,  without  evincing  any  tendency 
to  cancerous  ulceration;  and  not  unfrequently,  when  irritated  or  in- 
jured, degenerating  into  other  malignant  tumors,  very  diflferent  from 
true  cancer.  A  scirrhus  tumor,  therefore,  is  not  per  se  the  proof  of 
an  approaching  cancer.  Indeed,  some  authors  have  grouped  together 
scirrhus,  medullanj  sarcoma,  fundus  hcsmatodes,  and  carcinoma,  as 
constituting  species  of  the  generic  family  of  cancer.  But  it  is  enough 
for  practical  purposes,  to  know  that  a  scirrhus  tumor  may  become  a 
cancer  or  some  other  malignant  ulcer ;  and  when  the  surface  of  the 
scirrhus  is  uneven  to  the  touch.  tlTe  pkin  leaden  and  wrinkled,  with  ir- 


TUMORS  847 


^ 


regularly  dilated  veins,  and  twinging,  gnawing,  or  lancinating  pains,  tha 
cancerous  character  is  clear. 

Diagnosis. — Non-canceroid  scirrhus,  and  all  hardened  but  non-malig- 
nant tumors,  are  never  preceded  by  nor  attended  with  pain  of  tlie 
gnawing  or  lancinating  kind.  They  present,  also,  a  smooth  and  more 
rounded  surface,  w'ith  a  manifest  swelling  in  instead  of  out  of  the  part 
in  which  they  are  found;  whereas,  in  canceroid  scirrhus,  the  part 
affected  is  condensed  and  really  diminished  in  bulk. 

Treatment. — Scirrhus  or  hardened  tumors  resulting  from  inflamma- 
tion may  be  dispersed  by  the  plan  of  trwitment  reconmiended  for 
bronchocele.  But  the  caHceroid  tumor,  in  its  early  stage,  may,  per- 
haps, be  treated  with  equal  success  by  the  knife  or  caustic;  and  in 
either  case  care  must  be  taken  to  remove  or  destroy  every  vestige  of 
discolored  skin  or  affected  flesh. 

Open  cancers  can  be  and  frequently  are  cured  by  a  free  application 
of  caustic  potash,  although  the  operation  is  a  painful  one.  Dr.  Hill 
advises,  in  the  scirrhus  stage,  the  application  of  a  pencil  of  potassa,  so 
as  to  surround  completely  as  well  as  to  open  the  cancerous  mass,  letting 
it  penetrate  into  the  very  center  from  several  different  points;  and  if 
the  patient  cannot  bear  so  extensive  an  application  at  once,  the  caustic 
may  be  applied  to  different  parts  from  day  to  day.  Between  the  cau- 
terizations the  sore  is  to  be  covered  with  a  poultice  of  slippery  elm 
flour.  In  the  open  cancer  the  caustic  potash  is  to  be  applied  freely  to 
the  whole  of  the  ulcerated  surface ;  burning  to  the  bottom  of  the  tu- 
mor by  striking  the  pencil  in  from  different  directions.  When  the 
eschar  sloughs  ofl',  any  remaining  portion  of  the  morbid  growth  should 
be  touched  with  the  caustic  ;  and  these  applications  are  to  be  continued 
and  repeated  until  all  of  the  morbid  structure  is  destroyed.  During 
the  healing  process  the  sore  is  to  be  washed  daily  with  the  mild  caus- 
tic— sesqui-carbonate  of  potash — to  destroy  the  vitality  of  any  rem- 
nant of  cancerous  virus  that  may  exist,  and  prevent  the  development  of 
new.  The  constant  application  also  of  floiir,  starch,  or  slippery  elm, 
absorbs  the  pus,  and  thus  prevents  its  corrosive  effect.  When  this  or 
any  other  operation  is  resolved  upon,  the  body  must  be  prepared  by  a 
thorough  course  of  hydropathic  bathing  and  dieting. 

Fungus  H^matodks. — This  term  means  bloody  fungus  ;  the  dis- 
ease is  sometimes  called  medullary  sarcoma,  spongoid  inflammation^ 
mcephaloid  tumor,  and  soft  cancer.  It  commences  with  a  small,  elas- 
tic, movable,  and  nearly  insensible  tumor,  under  the  skin,  the  integu- 
ment itself  being  unaffected.  Sooner  or  later  it  becomes  inflammatory, 
swells  rapidly,  the  skin  becomes  discolored  with  purpl'gh  or  red  spoJi? 


348  SURGERY. 

and  adheres  firmly  to  the  distended  and  lobulated  mass.  Ulceration 
soon  comes  on  ;  dark-colored  fungous  growths  sprout  out  irregularly 
Hiid  at  severfil  points  beyond  the  surface  ;  the  whole  mass  becomes 
exceedingly  vascular,  the  top  being  ruuch  larger  than  the  base ;  event- 
ually the  adjacent  glands  are  affected,  when  the  patient's  general 
health  rapidly  declines 

Treatment. When  the  lymphatic  glands  have  become  affected,  the 

disease  may  be  pronounced  incurable.  In  its  early  stage,  while  the 
tumor  is  loose  underneath  the  skin,  and  nearly  free  from  active  inflam- 
mation and  tenderness  on  pressure,  it  may  be  destroyed  by  caustic  or 
removed  with  the  knife.  The  knife  is  preferable  when  the  diseased 
mass  is  so  situated  that  the  whole  can  be  removed  at  once.  The  ex- 
cision should  include  every  particle  of  morbid  structure ;  and  to  make 
sure  of  this  the  dissection  should  extend  some  distance  beyond  all  ap- 
peanmce  of  disease.  When  cauterization  is  resorted  to  it  must  be 
managed,  as  in  the  case  of  common  cancer,  except  that  it  is  more  im- 
portant to  destroy,  if  possible,  every  vestige  of  the  diseased  mass  by 
the  first  application. 

Bone  Cancer — Osteo-Sarcoma. — ^This  disease,  called  spina 
ventosa  by  some  authors,  consists  in  the  deposition  of  a  flesh-like  mat- 
ter in  the  structure  of  the  bone,  producing  a  morbid  enlargement. 
As  the  disease  progresses,  the  inteynal  structure  is  changed  to  a 
brownish,  fleshy  mass.  When  the  swelling  opens  on  the  surface, 
large  quantities  of  pus,  of  a  more  or  less  ichorous  or  sanious  character, 
are  discharged.  The  affection  is  most  frequently  seen  in  the  lower 
jaw  bone.  The  early  symptoms  are,  acute  pain,  followed  by  a  hard 
elastic  swelling,  afler  which  the  pain  becomes  more  dull,  and  eventu- 
tually  lancinating. 

Treatment. — The  first  thing  to  do — except  when  a  part  or  limb  is  so 
far  destroyed  as  to  require  amputation  or  forbid  any  attempt  to  cure — 
is  to  cauterize  an  opening  into  the  center  of  the  diseased  mass,  so  as 
to  allow  the  free  escape  of  purulent  matter  and  loose  pieces  of  bone; 
the  limb  or  part  is  then  to  be  kept  well  covered  with  wet  compresses, 
find,  when  practicable,  the  cold  stream  or  pouring-bath  should  be  fre- 
<liuM)tIy  applied  ;  the  cavity  should  be  washed  out  once  or  twice  a  day 
v.ith  tepid  water;  and,  if  there  are  fungous  growths  appearing,  a  solu- 
tion of  the  mild  caustic  should  be  applied  daily,  filling  the  cavity,  af^er 
each  application,  with  pledgets  of  lint. 

Carbuncle— Anthrax. — This  affection  is  sometimes  sailed  a  ma- 
lignant boil.     It  commences  with  a  livid,  red  swelling,  attended  with  u 


TUMORS.  S49 


burning,  smarting  pain,  followed  by  vesication ;  the  ulceration  appears 
in  the  form  of  several  fistulous  openings,  from  which  a  thin,  acrid  fluid 
exudes,  excoriating  the  adjacent  surface.  The  disease  always  indicates 
a  very  depraved  or  debilitated  state  of  constitution,  and  rarely  occurs 
in  any  but  aged  persons.  It  is  generally  located  in  some  part  of  the 
back  or  on  some  portion  of  the  head. 

Treatment. — The  best  management  in  the  most  malignant  fbrms  is, 
without  doubt,  the  cauterization  plan  recommended  for  the  preceding 
disease.  There  is  much  less  pain  attending  the  application  of  caustic 
in  carbuncular  than  in  cancerous  or  malignant  fungous  tumors.  But 
the  less  virulent  cases,  wherein  the  fetor  is  moderate  and  the  gan- 
grenous tendency  slight,  may  be  cured  by  thorough  packing,  a  rigid 
diet,  and  wet  compresses. 

Lupus — NoLI-ME-TA^■GERE. — Lupus  literally  means  "the  wolf:" 
and  noli-me-tangere,  "don't  touch  me" — terms  expressive  of  the  ra- 
pacity and  abhorrent  nature  of  this  excrescence.  It  is  a  malignant 
disease,  usually  about  the  nose  and  mouth,  commencing  as  a  small  tu- 
mor, and  progressing  to  a  foul  ulcer.  Its  first  appearances  are  various, 
as  a  small  dark  sore,  tubercle  or  vesicle,  or  a  lai'ge,  prominent  wart. 
The  lupus  ulcer  is  known  by  a  purple  margin  and  depressed  center, 
which  exudes  a  tenacious  pus,  or  an  icherous  matter ;  the  exposed 
surface  has  a  fiery  red  appearance,  and  the  pain  is  of  a  pricking  or 
smarting  kind.  When  occurring  near  the  eye,  it  will,  if  not  arrested, 
destroy  that  organ,  and  may  extend  to  the  brain.  The  general  health 
is  not  usually  much  affected. 

Treatment. — In  the  earlj-  stage,  when  the  disease  appears  in  the 
shape  of  warty  excrescences  or  tubercles,  the  knife  or  caustic  may  bo 
employed  indiscriminately.  When  it  commences  as  a  superficial,  red, 
angry  sore,  the  mild  caustic  will  be  sufilicient.  When  it  has  extended 
over  a  large  surface,  or  penetrated  deeply,  the  strong  caustic  must  be 
freely  applied. 

Aneurism. — An  aneurismal  tumor,  in  its  strictest  sense,  is  a  preter- 
natural dilatation  of  the  coats  of  an  artery,  forming  a  pulsating  swelling, 
which  eventually  rujjtures  and  destroys  the  patient  .by  hemorrhage. 
The  term  is  also  applied  to  enlargements  of  the  cavities  of  the  heart. 
In  the  true  aneurism  the  coats  of  the  artery  form  the  pouch  or  sac  of 
the  tumor ;  when  the  sac  or  covering  is  formed  of  effused  lymph,  into 
which  the  blood  has  escaped  from,  the  artery,  it  is  cnWed  false  aneu- 
rism ;  sometimes  the  blood  is  poured  into  the  cellular  membrane,  con- 
Btitw':ing  the  diffused  aneuris?n  ;  and  when  the  effused  blood,  in  c.onse- 
^0 


J5C  SURGERY. 

qaetice  of  a  rupture  of  the  internal  and  middle  coats  of  an  artery, 
makes  itself  a  channel  between  these  and  the  oute-  -^oat,  it  is  called 
dissecting  aneurism.  Ancunsmal  varix — varicose  aneurism — is  o  ^'la- 
tatiou  of  a  vein  in  consequence  of  a  gush  of  blood  from  a  neigiiboriug 
artery,  and  is  generally  produced  by  venesection."  Ncecus  is  a  dila- 
tation of  the  small  arteries,  producing  a  red,  shining  spot  on  the  skin  ; 
when  these  vessels  are  larger,  the  affection  is  called  aneurism  hy  anas- 
'omosis. 

Diagnosis. — Aneurism,  when  erternal.  is  known  by  a  pulsating  tu- 
rgor, which  beats  synchronous  with  the  artery  where  it  occurs  ;  it  may 
be  diminished  or  emptied  of  its  contents  by  pressing  on  the  affected 
artery  above  the  tumor.  Internal  aueurisms,  which  occur  in  the  heart 
or  largo  vessels  of  the  chest  and  abdomen,  are  extremely  difficult  to 
distinguish.  Aneurisms  of  the  heart  are  divided  into  active  and  pas- 
sive ;  the  former  is  really  a  hypertrophy  or  thickening  of  the  parietes 
of  the  organ,  by  which  its  cavities  are  diminished ;  the  latter  is  the  ti'ue 
cardiac  aneurism,  attended  with  an  enlargement  of  its  cavities.  The 
s3-mptoms  in  all  these  cases  are  exceedingly  obscure  and  vai'iable,  and 
are  common  to  nervous  and  dyspeptic  invalids,  as  w^ell  as  the  result  of 
various  tumors  and  visceral  eulargemen'cs  not  connected  with  any  struc- 
tural lesions  of  the  circulating  system.  The  most  prominent,  however, 
are,  a  strong  and  constant  beating  or  pulsatory  motion  above  or  below 
the  sternum,  when  the  bowels  are  not  constipated ;  a  dull,  heaving,  beat- 
ing, or  boring  sensation  about  the  spine  ;  and  a  double  beating,  or  some 
otiier  uniformly  irregular  character  of  the  pulse  at  the  wrist. 

Special  Causes. — Injuries,  blows,  ftills,  violent  exertions,  mental  excite- 
ments, and  above  all,  obstnictiug,  concentrated,  and  greasy  food,  which 
thickens  the  blood  and  increases  the  labor  of  the  heai't  and  arteries  in 
propelling  it. 

Treatment. — In  the  early  stage  of  aneurismal  tumors,  compression, 
when  it  can  be  managed  by  an  experienced  operator,  is  the  best  reme- 
dial resource.  In  other  states  and  cii-curastances,  the  ligature  is  neces- 
sary. The  most  approved  operation  is  that  of  tying  the  artery  with  a 
single  ligature  above  the  tumor.  After  dissecting  dow^n  to  the  vessel 
affected,  the  blunt  end  of  an  aneurism  needle,  fig.  199,  should  be  work- 


ARMED    NEKDLE    FOR    MGATING    AN     ANEURISMAL    ARTERY. 


T  :J  M  0  E,  S.  851 

ed  around  the  vessel  to  separate  it  from  its  accompanying  vein  ornerve  ; 
this  may  be  done  by  pushing  rather  than  cutting,  to  avoid  wounding  the 
the  nerve  or  vein.  The  ligature  is  improper  in  false  aneurisms  of  large 
extent,  after  the  pulsation  has  ceased  in  the  tumor,  and  when  caries  or 
gangrene  exists  in  the  vicinity  of  the  disease.  After  the  obliteration  of 
the  cavity  of  the  diseased  vessel,  the  anastomosing  vessels  in  its  vicinity 
will  enlarge  to  maintain  the  necessary  circulation. 

In  varicose  aneurism  the  vessel  must  be  tied  both  above  and  below 
the  injury ;  this  double  ligation  is  necessary  also  in  localities  where 
there  are  numerous  anastomosing  branches,  as  on  the  dorsal  surface 
of  the  hand  and  foot. 

The  constitutional  treatment  is  of  first  importance  in  all  cases  of  or- 
ganic diseases  of  the  blood-vessels. 

The  diet  must  be  simple,  bland,  and  opening;  all  violent  exercises  of 
body  or  mind  strictly  avoided,  and  all  bathing  appliances  must  be  mild 
and  gentle,  so  as  to  prevent  any  shock  to  the  circulation. 

Varix. —  Varices  or  varicose  veins  are  tortuous,  knotty,  elongated 
thickenings  and  dilatations  of  the  coats  of  these  vessels.  Varicose  en- 
largements are  most  frequently  found  in  the  lower  extremities,  the 
great  saphenal  vein  and  its  branches  being  the  affected  vessels ;  the 
spermatic  and  hemorrhoidal  veins  are  also  very  liable  to  become  vari- 
cose. In  many  cases  the  valves  of  the  veins  are  destroyed ;  the  af- 
fected vessels  are  liable  to  inflammation  ;  and  the  lower  limb  is  partic- 
ularly disi)osed  to  ulceration,  which  bleeds  easity  and  heals  with  great 
difficulty.  Varicose  ulcers  have  existed  twenty  and  thirty  years,  ren- 
dering the  limb  almost  useless. 

Treatment. — Compression  with  the  common  bandage  or  roller,  when 
skillfully  managed,  will  often  cure  varices  of  the  lower  extremities. 
Surgeons  have  experimented  largely  in  several  processes — cirsotomy 
or  incision,  extirpation,  ligation,  and  cauterization — bu-t  with  very  poor 
success  in  all.  A  plan  for  obliterating  the  vessels  by  the  combined  ac- 
tion of  caustic  and  compression  has  been  successful  in  many  cases.  It 
consists  in  the  application  of  caustic  to  one  or  two  very  small  portions 
of  the  distended  veins  at  a  time,  so  as  to  produce  ulceration  and  ulti- 
mate adhesion,  the  part  being,  meanwhile,  dressed  with  adhesive  plas- 
ter or  the  wet  roller.  As  soon  as  one  dilatation  or  knob  is  obliterated, 
the  caustic  may  be  applied  to  another,  and  so  on.  I  regard  this  prac- 
tice as  perfectly  safe  provided  due  attention  is  paid  to  bathing  and 
dieting. 

White  Swelling — Hydrarthrus. — This  formidable  disease  com 


862  SURGERY. 


monly  aliects  the  knee-joint.  Authors  mfike  two  varieties,  scrofulous 
Riid  rheumatic,  as  it  appears  in  persons  predisposed  to,  or  afflicted  with, 
cither  of  those  complaints. 

Symptoms. — Tlie  swelling  comes  on  very  slowly,  and  is  attended 
with  little  pain  at  first.  Gradually  the  pain  increases  till  it  becomes 
intense,  especiall>  at  night.  The  skin  appears  whiter  than  natural, 
becomes  tense,  shining,  and  marked  with  varicose  veins,  and  there  is  a 
constant  sensation  of  heat  in  the  part.  In  tliis  condition  it  may  renmia 
fl)r  years,  but  usually  the  swelling  continues  to  increase  until  the  soft 
parts  become  so  hard  as  to  appear  like  enlarged  bone.  As  it  progress- 
es tlie  tibia  is  thrown  backward,  the  condyles  of  the  femur  project  for- 
ward, the  whole  limb  emaciates,  anchylosis  takes  place  while  the  joint 
is  flexed,  and  mutter  collects,  and  is  discharged  at  various  sinuous  open- 
ings. Extensive  caries  of  the  bone  often  ensues,  with  hectic  fever, 
soon  terminating  in  death. 

Sjyecial  Causes. — Repelled  eruptions,  local  injury  mercurial  and 
antimonial  medicines,  syphilitic  taint. 

Treatment. — This  is  one  of  the  maladies  which  the  popiilar  "heal- 
ing art"  does  not  pretend  to  heal.  When  the  joint  is  \evy  painful,  it 
should  be  bathed  in  w'arm  water  or  fomented  until  this  is  relieved,  and 
then  dressed  with  several  folds  of  wet  cloth,  except  when  the  inflam- 
mation is  acute,  in  which  event  cold  applications  are  most  appropri- 
ate, the  rule  being,  as  in  all  similar  cases,  to  regard  the  sensation  of 
the  affected  part.  The  cold  pouring-bath,  douche,  or  leg-bath,  or  even 
moderate  congelation,  may  be  employed  with  advantage  when  the 
sensibility  of  the  part  is  such  that  they  can  be  administered  without 
pain.  Indeed,  in  most  cases  they  will  each  and  all  have  a  soothing  and 
sedative  influence-  Callous  edges  of  the  ulcerated  sur&ces,  sinuses,  and 
fungous  growths,  will  require  the  application  of  the  mild  or  strong  caus- 
tic. The  limb  should  be  kept  as  extended  as  possible,  and  as  much 
compression  employed  during  the  suppurative  stage  as  can  be  borne 
without  pain.  To  these  local  measures  must  be  added  thorough  con- 
Ptitutional  treatment,  in  which  the  packing-sheet  should  be  the  leading 
process.  The  regimen  must  be  such  as  has  been  heretofore  recom« 
mended  for  scrofula. 

ilvDROPS  Articdli. — This  is  usually  regarded  as  a  result  of  rheu- 
matic disease,  and  hence  called  rheumatic  white  swelling.  It  consists 
in  a  distention  of  the  synovial  membrane  and  capsular  ligament  by 
serous  effusion,  which  renders  the  limb  lame  and  stifl",  though  not  very 
painful  except  from  exercise.  Sonietimes  the  eflHision  extends  along 
the  tendons  of  the  muscles.     The  warm  or  cold  douche,  wet  bandages. 


TUMORS  368 

the  pack-sheet,  copious  water-drinking,  and  frequent  injections  to  keeo 
the  bowels  entirely  free,  are  the  remedial  measures. 

Varicocele — Circouele — Spermatocele. — A  varicose  dilata- 
tion of  the  veins  of  the  scrotum  and  spermatic  cord,  is  called  indiscrim- 
inately by  these  terms.  When  the  spermatic  veins  are  affected,  the 
tumor  is  soft,  knotty,  doughy,  unequal,  and  compressible,  increasing 
from  below  upward.  The  disease  I'equires  no  special  attention,  save  a 
careful  regard  to  hygienic  habits ;  occasional  sitz-baths,  or  the  ascend- 
ing douche,  with  the  use  of  a  suspensory  bandage. 

HiEMATOCELE. — Tliis  is  an  extravasation  of  blood  in  the  tunica  vag- 
inalis, or  an  effusion  into  the  cellular  membrane  of  the  scrotum.  The 
external  parts  are  often  thick  and  dark,  somewhat  resembling  gan- 
grene. The  treatment  is  the  same  as  for  the  preceding  affection. 
Sometimes  the  disease  is  producevl  by  the  wounding  of  some  large 
vessel,  in  which  case  the  scrotum  may  be  laid  open  and  the  vessel  tied. 

Sarcocele. — This  term  is  variously  applied  to  a  scirrhus  or  can- 
cerous, encysted,  or  fibrous  tumor  of  the  testis,  and  to  a  simple  enlarge- 
ment as  a  consequence  of  maltreated  chronic  inflammation.  When 
the  tumor  is  malignant,  castration  is  the  only  sure  remedy ;  other- 
wise it  may  be  reduced  by  the  remedies  recommended  for  the  prece- 
ding maladies. 

Hernia  Humoralis. — This  technic  is  applied  to  a  swelled  testicle 
from  common  inflammation,  or  to  a  hardened  tumor  which  is  at  first 
confined  to  the  epididymis,  the  pain  extending  along  the  cord  to  the 
loins.  The  latter  variety  is  frequently  the  result  of  a  suddenly-sup- 
pressed gonorrhoeal  discharge.  I'he  former  variety  requires  cold,  and 
the  latter  warm  water-treatment  at  first,  to  be  followed  by  cool,  and 
finally  cold  applications. 

Cystic  Sarcoma. — This  is  a  hydatid  disease  of  the  testis.  It  oc- 
curs chiefly  in  middle  life,  and  is  sometimes  mistaken  for  hydi'ocele  • 
but  the  oval  shape  of  the  tumor  will  readily  distinguish  it  from  that  af- 
fection which  is  pyriform.  The  morbid  mass  consists  in  pp.rt  of  a  solid 
structure,  and  partly  of  cysts  of  various  sizes,  containing  a  thin,  trans- 
parent, yellow  serum,  or  a  turbid  fluid.  The  complaint  had  better  be 
managed  on  the  "lee  alone"  system,  unless  its  bulk  or  malignancy  cre- 
ates great  inconvenience  or  suftering,  in  which  case  extirpation  is  the 
on'y  reraeiy. 


II&4  SURGERY. 


Polypi. — The  most  common  situations  for  polypus  tumoi-s  are  the 
nose  and  vagina,  although  they  may  grow  from  any  inti-overted  mu- 
cous surface.  For  all  practical  purposes,  it  is  sufficient  to  distinguish 
them  into  soft  and  hard,  altliough  sui-gicai  writers  have  made  several 
subdivisions  of  each,  as  mucous,  vesicular,  fibrous,  fleshy,  scirrhus,  or 
cancerous,  etc.  The  latter  variety  is  probably  a  true  cancer,  instead  of 
a  cancerous  polypus. 

Treatment. — In  addition  to  what  has  been  heretofore  said  in  relation 
to  the  treatment  of  these  morbid  growths,  it  may  be  remarked,  that  the 
application  of  j)owdered  caustic — either  mild  or  strong,  according  to  the 
firmness  of  the  tumor — will  frequently  be  sufficient  to  destroy  them 
In  many  cases  the  caustic  may  be  advantageously  combined  with  me- 
chanical force,  as  squeezing,  twisting,  crushing,  etc.,  tearing  a\^y 
such  jKirts  as  may  be  conveniently  detached.  The  powder  should  be 
apj)lied  with  a  camel's-hair  pencil.  This  plan  is  particularly  adapted 
to  nasal  polypi.  The  practitioner  should  also  bear  in  mind  that  nasal 
polypi  are  very  liable  to  grow  again,  after  having  been  removed  by  me- 
chanical means,  unless  the  surface  fi-om  which  they  are  detached  is 
thoroughly  cauterized. 

Polypi  in  the  vagina,  whether  originating  from  its  sides  or  from  the 
mucous  surface  of  the  uterus,  usually  present  a  pedunculated  shape, 
which  is  favorable  to  the  operation  of  removal  by  ligature.  I  have 
known  cases  connected  with  such  a  degree  of  prolapsus  as  to  allow  the 
application  of  a  ligature  without  any  instrumental  assistance  ;  but  gen- 
erally the  ligature  will  have  to  be  introduced  by  means  of  the  polypus 
forceps,  or  the  double  canula,  fig.  200,  afte*--  which  it  is  to  be  drawn 


Fig.  200. 


DOUBLE   CANT7L>,    WITH    LIGATURE. 

tight  enough  to  cut  off  the  circulation  and  sti-angulate  the  tumor;  the 
canula  is  to  remain,  and  the  ligature  tightened  from  time  to  time,  until 
the  tumor  comes  away,  which  will  usually  be  in  five  or  six  days. 
When  the  neck  of  the  polypus  cannot  be  reached  by  ligature,  the  tu- 
mor may  be  destroyed  by  a  solution  of  the  caustic  potash,  inti'oduced 
through  a  silver  catheter;  or  the  powdered  caustic  may  be  applied  b} 
means  of  nieces  of  fine  sponge,  with  threads  attached  to  withdraw 
them. 


TUMORS  855 

Nodes. — A  majority  of  bone  tumors  are  included  under  the  terra 
exostosis,  and  the  term  7iode  is  usually  restricted  to  hard  concretions  or 
incrustations  which  form  around  rheumatic  and  gouty  joints.  It  is  em- 
ployed, however,  by  several  writers,  synonymously  with  exostosis ;  and 
many  authors  apply  it  to  tumors  of  the  cylindrical  bones  resulting  from 
the  venereal  taint.  It  is  the  opinion  of  some  surgical  authors  that 
syphilitic  nodes  only  occur  in  persons  who  have  taken  mercury,  which, 
by  the  way,  has  inflicted  vastly  more  mischief  on  the  human  constitu- 
tion than  has  the  disease  it  is  intended  to  cure. 

Samuel  Cooper  says  {Coopers  Surgery),  "I  believe  that  ti'ue  nodes 
are  rarely  produced  in  syphilis,  unless  the  patient  has  been  using  mer- 
cury." Dr.  Hennen,  who  had  an  extensive  experience  in  the  treat- 
ment of  syphilitic  diseases,  affirmed  that  he  had  never  seen  but  two  cases 
of  nodes  in  patients  who  had  not  taken  mercury ;  and  in  relation  to  those 
two  cases  the  question  may  be  fairly  raised,  Whether  the  patients  had 
not  taken  mercury  on  some  previous  occasion. 

Treatment. — This  is  mainly  constitutional.  Thorough  general  bath- 
ing, an  abstemious  diet,  and  local  compresses,  are  the  leading  meas- 
ures. When  the  tumor  becomes  projecting  and  pointed,  the  soft  parts 
may  be  laid  open,  and  the  tumor  removed  with  a  saw,  chisel,  or  tre- 
phine ;  when  ulceration  occurs,  attended  with  callous  edges  or  fungous 
excrescences,  these  require  cauterization. 

Enlargement  of  the  Prostate  Gland. — In  this  affection  the 
gland  often  attains  manj^  times  its  ordinary  size,  and  is  much  harder 
than  natural.  It  produces  but  slight  difficulty  in  urination,  yet  it  pre- 
vents the  bladder  from  being  completely  evacuated,  and  the  urine  is, 
in  consequence,  rendered  constantly  turbid.  Total  retention  of  urine, 
however,  is  liable  to  occur  if  the  swelling  is  aggravated  by  any  ex- 
cesses to  which  the  patient  is  addicted.  There  is  a  sense  of  weight  in 
the  perineum,  and  the  middle  lobe  of  the  gland  usually  projects  into 
the  bladder,  altering  the  shape  and  direction  of  the  urethra,  and  ren- 
dering the  passage  of  a  catheter  or  sound  more  or  less  difficult.  The 
disease  is  usually  caused  by  calculous  concretions  or  venereal  affec- 
tions. 

Treatment. — Frequent  hip-baths,  and  a  thorough  employment  of 
the  ascending  douche  are  the  ordinary  local  appliances ;  to  which  must 
be  added  some  general  daily  bath,  as  the  dripping-sheet,  or  pack  and 
half-bath.  When  it  is  produced  by  repelling  or  suddenly  drying  up  a 
gonorrheal  discharge,  warm  hip  and  foot-baths  must  be  assiduously 
employed  until  the  discharge  reappears  or  the  irritation  subsides ;  after 
which  the  cold  treatment  may  be  employed  as  above. 


85e  SURGERY. 


CHAPTER  ^ 

ULCERS. 

Ulcers  ai-e  purulent  solutions  of  the  continuity  of  the  animal  tex- 
ture. In  a  general  sense,  they  are  distinguished  into  the  benign,  or 
heaWiy,  and  the  malignant,  the  indolent,  and  the  irritable,  etc.  They 
are  also  subdivided  into  many  varieties,  according  to  their  causes,  na- 
ture, tendencies,  consequences,  etc.,  as  simple,  sinuous,  fistulous,  fun- 
gous, gangrenous,  cancerous,  scorbutic,  syphilitic,  sc'^fulous,  inveterate, 
phagedenic,  virulent,  sordid,  cacoethic,  carious,  varicose,  etc.  Many 
tumors,  if  not  arrested  in  their  early  stage,  become  ulcers,  as  cancer 
cnrbuncle,  etc. 

An  ulcer  is  called  healthy  when  its  purulent  matter  is  a  normal  se- 
cretion, unattended  with  the  destruction  of  the  surrounding  parts.  Its 
surface  is  florid;  its  granulations  are  small  and  of  uniform  size;  it  is 
without  offensive  smell ;  and  it  heals  regularly,  leaving  little  or  no  scar. 
A  common  boil  is  an  example. 

An  irriiable  ulcer  is  very  tender  to  the  touch ;  exti'eraely  liable  to 
bleed ;  its  discharge  is  slight,  and  of  a  thin,  ichorous,  or  sanious  ap- 
peiirance ;  its  color  is  dark  or  purplish  ;  its  granulations  are  imperfect 
and  spongy  ;  its  edges  are  ragged  and  everted ;  the  parts  around  are  red, 
pwollen,  and  often  oedematous. 

The  indolent  ulcer  is  the  more  frequent  form  of  "running  sore"  we 
meet  with ;  its  edges  are  inverted,  rounded,  thick,  glossy,  and  regu- 
lar; the  granulations  are  of  a  dull  pale  aspect,  and  insensible  ;  the  pus 
b  thick,  of  a  dark  yellow  color,  and  adheres  to  the  bottom  of  the  ulcer. 
It  is  most  frequently  located  on  the  lower  extremities. 

Varicose  ulcers  may  be  either  irritable  or  indolent ;  they  are  con- 
nected with  enlargements  or  varices  of  the  adjacent  veins.  They  are 
generally  situate  below  the  knee. 

Fistulous  ulcers  are  sinuous  cavities,  having  a  narrow  outlet,  the  dis- 
ease being  kept  up  by  an  altered  texture  of  the  part. 

Specific  ulcers  result  from  the  inflammation  of  specific  diseases,  as 
scrofula,  salivation,  syphilis,  etc.  Other  distinctions,  depending  on  mere 
varying  appearances,  or  on  common  causes  and  terminations,  are  of 
no  practical  importance. 

Gfnkrai.  Trkatment  of  Ul:ers.— The  constitutional  treatment 


ULCERS,  857 

is  n]^yays  of  primary  importance  in  chronic  ulcerations  of  every  kind. 
In  all  matters  of  regimen  the  patient  must  be  held  to  a  strict  accounta- 
biiity  to  physiological  law.  The  whole  skin  must  have,  at  least,  one 
thorough  daily  ablution  or  packing.  The  local  medication  will  vary  ac- 
cording to  the  character  of  the  ulcei*.  The  healthy  u]cer  needs  nolhuig 
more  than  a  cool  wet  cloth.  When  the  irritable  ulcer  is  very  painful,  the 
limb  or  surrounding  part  may  be  fomented  with  warm  cloths  until  it 
becomes  easy,  and  then  "  done  up"  with  the  ordinary  "  water-dress- 
ing." When  exposure  to  the  air  aggravates  the  pain,  the  surface  may 
be  covered  with  flour.  The  indolent  ulcer  often  requires  the  applica- 
tion of  the  mild  caustic  to  remove  fungous  growths  or  callous  edges. 
When  the  surrounding  parts  are  hard,  they  should  be  occasionally  fo- 
mented ;  and  if  the  sore  is  on  the  lower  extremity,  compression  with 
the  roller  or  by  adhesive  straps  is  useful.  Varicose  ulcers  require 
etill  stronger  compression ;  the  roller  bandage  should  be  applied  to  the 
whole  limb,  and  the  sore  treated  in  other  respects  according  to  its 
character.  When  the  veins  are  extremely  distended  and  knotty,  ad- 
hesive straps  may  be  advantageously  applied  over  and  adjacent  to  the 
ulcer  ;  and  these  may  be  covered  by  the  roller.  Cauterization  of  each 
distended  vein  with  potassa  fusa,  one  or  two  inches  distant  from  the 
ulcer,  so  as  to  obliterate  their  cavities  by  adhesive  inflammation,  may 
be  resorted  to  in  bad  cases  with  safety,  and  usually  with  success.  Fis^ 
tulous  ulcers  generally  require  to  be  opened  with  the  ligature,  or  ob- 
literated by  caustic. 

FuRUNCULUS. — A  boil,  or  hile,  as  some  authorities  have  it,  is  a  small 
phlegmon,  seated  in  the  dermoid  texture,  and  tending  to  a  pointed  tumor 
which  sooner  or  later  breaks  and  discharges  a  white  or  yellowish  pus, 
mixed  with  blood.  Sometimes  a  small  fibrous  mass  of  dead  but  undis- 
solved areolar  tissue  appears,  after  it  suppurates,  called  the  core.  The 
only  medication  demanded  is  the  wet  dressing;  and,  should  the  tumor 
not  open  spontaneously  when  matter  has  evidently  formed,  it  should 
be  punctured  with  a  lancet  and  the  matter  pressed  out. 

Parulis. — The  common  gum-boil  is  a  small  abscess  which  frequently 
forms  in  the  gums.  It  is  sometimes  owing  to  carious  teeth,  but  is  gen- 
erally produced  by  bad  dietetic  habits.  Those  who  eat  coarse  vegetable 
food,  and  use  the  tooth-bruslr  daily,  are  seldom  trouHed  with  such 
affections. 

Fever  Sores. — The  most  common  form  of  chronic  ulcers  are 
Known  as  '•'■fever  sores,^^ ''  brandj  sores,^^  ^^ whisky  sores,'^  etc.,  and  some- 


868  SURGERY 

times,  in  view  of  their  usual  locality,  ''old  sore  legs''  They  are  gen- 
erally connected  with  and  the  penalty  of  intemperate  habits.  I  have 
known  several  bad  cases  among  the  children  of  liquor-drinking  parents. 
The  ulcers  are  deep,  the  limb  is  swollen,  in  some  cases  nearly  as  hard 
as  bone,  and  frequently  purple  or  dark.  The  character  of  the  sore 
may  be  irritable,  or  indolent,  or  of  a  mixed  character,  some  portions 
being  irritable  and  others  indolent. 

Treatment. — These  cases  require  a  long  course  of  treatment,  but 
can  generally  be  cured,  provided  the  patient  will  sign  and  then  keep 
the  temperance  pledge.  When  painful,  they  are  to  be  soothed  with 
Wiu-m  water  or  the  warm  fomentation  ;  when  hot  and  inflammatory, 
the  cold  douche  should  be  applied  to  the  whole  limb  daily.  Callous  or 
fiingous  excrescences  are  to  be  destroyed  by  caustic.  The  roller  ban- 
dage is  also  an  indispensable  part  of  the  treatment.  It  must  be  ap- 
plied twice  a  day — every  morning  and  evening  is  a  good  rule — ana 
thoroughly  wetted  with  cold  water  aftcx  it  is  applied:  wet  cloths 
should  always  be  placed  over  the  bandage  when  there  is  the  least  pre- 
ternatural heat  or  active  inflammatory  excitement.  All  these  meas- 
ures, however,  will  fail,  unless  the  whole  surface  is  thoroughly  attended 
to  in  the  way  of  bathing ;  and  the  stomach  and  bowels  are  kept  unbur- 
dened and  well  cleansed  by  the  appropriate  quantity  and  quality  of 
food. 

It  is  a  prevailing  opinion  among  drug-physicians,  and  a  popular  pre- 
judice with  the  people,  that  it  is  dangerous  to  cure  old  sores.  Truth, 
"they  say."  lies  between  two  extremes.  The  truth  in  this  case,  as  in 
all  others,  is  at  one  extremity.  It  is  always  dangerous  to  heal  them 
drug-opathically,  but  nexer  dangerous  to  cure  hydropathically. 

Caries  and  Necrosis. — These  terms  are  often  employed  synony- 
mously ;  but  in  strict  surgical  parlance,  caries  is  an  idceration  of  the 
bony  structure,  analogous  to  gangrene  of  the  soft  parts ;  while  necrosis 
is  the  death  of  the  bone,  analogous  to  'fortification.  Caries  usually 
attacks  the  spongy  bones,  as  the  vertebrae  ;  and  necrosis  as  generally 
aifects  the  long  or  flat  bones,  as  the  tibia,  humerus,  and  bones  of  the 
cranium.  Necrosis  in  the  leg  or  arm  is  generally  called  ''fever  sore." 
The  process  by  which  dead  portions  of  bone  separate  from  the  living — ■ 
:.vilogous  to  sloughing  of  the  soft  parts — is  called  exfoliation. 

Symptoms, — The  bones,  though  insensible  in  their  healthy  state,  be- 
come exceedingly  painful  when  diseased.  The  swelling  has  no  regnlar 
a|)ex  or  point,  but  is  more  distressing  than  ordinary  inflammatory' 
9%veirmgs,  especially  at  night.  The  pait  is  hot,  somewhat  hvid,  and 
•ometimes  come*  on  suddenly  and  progresses  rapidly  to  suppuration. 


ULCERS.  359 

The  pus  is  dark,  sanious,  and  fcetid,  and  generally  discharged  through 
several  fistulous  openings  or  pipes  ;  and  through  these  the  rough,  un- 
even surface  of  the  bone  can  be  felt  by  means  of  the  finger  or  common 
probe.  Sometimes  the  bones  of  the  cranium  are  perforated  at  numer- 
ous points,  constituting  the  worm-eaten  caries  of  authors.  There  is 
more  or  less  fever,  which  is  of  the  hectic  character.  When  necrosis 
occurs  in  the  center  or  shaft  of  the  long  bones,  it  seldom  or  never  ex- 
tends to  their  articular  extremities ;  but  the  exterior  layers  form  a 
canal  around  the  dead  portion,  which  is  called  sequestrum  ;  and  between 
these  swollen  layers  and  the  sequestrum  suppuration  takes  place. 

Special  Causes. — Professor  Parker  disposes  of  the  causes  of  necro- 
sis in  the  following  summary  manner :  "So  f^u'  as  any  thing  can  be 
known,  it  seems  to  bo  the  result  of  sudden  changes  of  temperature." 
But  the  fact  that  both  caries  and  necrosis  frequently  follow  local  inju- 
ries, as  blows  and  falls,  and  are  also  frequently  connected  with  consti- 
tutional taints,  as  scrofula,  scurvy,  syphilis,  mercurialization,  etc.,  seems 
to  indicate  that  something  should  be  known  beyond  mere  temperature. 
The  greatest  number,  as  well  as  the  most  malignant  kinds  of  caries 
and  necrosis  owe  their  existence  to  the  combined  action  of  mercury 
and  syphilis,  or  mercury  and  scrofula ;  or,  in  the  language  of  Samuel 
Cooper,  "  to  the  prejudicial  influence  of  a  badly  conducted  course  of 
mercur3^" 

Treatment. — In  its  forming  stage  the  disease  can  generally  be  "dis- 
cussed" by  douching  the  part  frequently  with  cold  water,  the  constant 
application  of  wet  cloths,  and  one  or  two  packs  daily.  The  late  Pro- 
fessor Ntithan  Smith  recommended  making  a  free  incision  down  upon 
the  bone,  and  even  into  its  substance,  if  relief  from  pain  did  not  follow 
the  first  incision,  on  the  plan  of  treating  a  felon  or  whitlow ;  and  no 
doubt  such  a  practice  in  a  very  early  stage,  would  lessen  tho  extent  of 
the  inflammation:  still  if  the  cold-water  measures  are  vigorously  em- 
ployed it  will  be  unnecessary.  After  ulceration  has  taken  place,  "the 
books"  furnish  us  with  any  number  of  vinegar-and-meal,  carrot-and- 
onion,  bread-and-miik,  soap-and-molasses,  rum-and-sugar,  scraped-po- 
tato,  tobacco,  strammoniutn,  etc.,  poultices,  to  help  "digest"  the  affiiir; 
but  I  know  of  nothing  in  theory  or  in  experience  which  gives  them  any 
advantage  over  a  few  folds  of  old  linen  rags  well  wetted  in  pure  soft 
water,  provided  the  temperature  is  duly  regulated. 

But  when  the  disease  proceeds  to  suppuration  and  exfoliation,  it  is 
important  to  get  rid  of  the  purulent  matter  and  lead  bone  as  fast  as 
possible,  yet  all  rough  handling  of  the  diseased  part  must  be  avoided. 
If  any  portion  of  bone  becomes  loose  or  projecting,  or  can  be  ascer- 
tained to  be  dead — in  which  case  its  color  will  be  zvhiter  or  darker  than 


^tjO  SURGERY.  : 

Dntural — the  cHUstic  should  be  applied  to  it.     "The  mild  caustic,"  saya  j 
Di'.  llill,  "has  ft  peculiur  ^JFect  on  diseased  bone,  ntid  seems  to  exert  \ 
a  stronger   inrtiietice  thuu  the  bi-curbouule,  or  even  the   pure  alkuh —   \ 
caustic   {>olu5h — williout  nny  injury  to  lieulthy  parts."     When   there  \ 
are  several  optMiiu;;s*  they  should  bo  converted  into  a  single  ulcer   'f  | 
p<):««iible ;  for  which  purpose  the  caustic,  knife,  or  ligature  may  be  em-  i 
;'!.tvt\l  according  to  circumstances.     Dead  bone  and  fungous  growths 
may  be  dissolvixl  by  passing  tents,  charged  with  the  sesqui-carl)onate  I 
of  {K>tash,  into  llie  sinuses,  and  pushing  them  against  the  morbid  struc- 
ture.    Sometimes  uew  bono  is  formed  around  the  dead  part,  inclosing 
it  in  n  shell,  and  producing  a  preternatural  eukirgement  of  the  part ; 
i:i   .>(>ening,  however,  is  usually  left   in  the  new  formation,  through 
\s     rii  purulent    matter   issues.     This  opening    must  be   enlarged   by* 
caustic  sufficiently  to  allow  of  armed  tents  or  caustic  solutions  to  be  1 
passed  through  a  tube  or  syringe  to  the  dead  bone,  to  effect  its  disso- 
lution.    After  every  vestige  oi"  disorganized  matter  has  been  removed 
from  the  ulcerated  cavity  the  ulcer  will  heal  kindly  ;  yet  the  bone  will 
geuerully  remain  preteruaturally  enlarged.  j 

Fistula  in  Ano. — Any  abscess  about  the  rectum,  opening  either 
within  or  without  the  anus,  or  both,  is  known  by  tlie  term,  Jisfula  in  j 
ano.  Fistulie  are  so  common  iu  this  situation,  tiiat  some  physicians,  I 
whose  pnictice,  "from  being  general  is  confuied  to  a  particular  bra;«ch  i 
of  their  profession,"  have  selected  "diseases  about  tlie  anus"  as  the  j 
'  '  ir  field  which  is  to  etu  r  "  prof  mud  attentiDn."     Fistulce 

'  e  usually  connected  w       ^      s  and  botii  have  habitual  costive-  ' 
ness  as  their  common  caus**,  although  the  former  is  sometimes  occa- 
'  V  wouu'Ja  and  injuries. 
•        1  tiiere  is  an  opeu  communication  between  the  rectum  and  the 
cutaneous  surface,  the  fistula  is  called  complete  ;  and  incomplete  or  blind  j 
when  it  comuumicates  with  but  one ;  the  latter  is  called  bUnd  internal  \ 
or  blind  external  fistula,  as  it  opens  into  the  bowel,  or  Ufxxi  the  exter-  ' 
iml  »kin.     In  a  majority  of  cases  the  fistulous  pipe,  or  sinus,  is  tortu-  j 
» t:>  and  branching,  sevenil  distinct  openings  being  internally  connected.  ' 

"  '^  lined  with  a  semi-cartilaginous,  or  callous  growth,  having 

^  property  of  mucous  membrane,  from  which  exudes  ai 
Intl.  yetk)wish  pus;  thin  indurated  surface  is  generally  extremely  ten-  j 

•      -nich. 

i 

. — The  "standard  authors"  on  surgery  are  surely  not! 
wi  II  jKMsled  in  the  matter  of  curing  the  disease  under  consideration.  | 
'l"tir  pliiii  ..flaying  the  ulct-r  open  with  the  knife  i^  always  barbarous,  ! 
p.ruTnlly  unsuccessful,  and  sometimes  fatal.      More  than  twenty  yean  ■ 


r  L  C  E  R  8 


over  ft  ittfe  womlHi 

Fif.nB.. 


tfo  a  •eifHCOMUMed  relonn  flrftmol  of  mmiikaam  in  the  city  dT  'Sem 
York.  puUUbgd  to  dio  WKirld  {Dr.  Bfusidh't  Ame/rwam  Pm,i 
%am€)  «  smcto&eiffml  aiethod  df  ttvamieall ;  rel  \v<e»  do  not  fiod.  ..  '^ 
|ftMfaiMMf»  adopbof  or  cnoMDoadittg  il^  prrdkajore  oo  ftcmoal  oif  ic»  ?/r« 
*y^  W/tfr  ciriipa.     Tli«  nun  fiatare*  of  dm  ■mntlKMi  tmmmfb&i  m  mtili 
tmm^  tkm  h^twn  •«!  the  cuMKic  far  die  koife  ftnsi  die  fcoiifiaMar. 

The  inrt  |«yuM»  ii  to  nUMiae  die  wAammatiua  maA  overcome  dM 
iirrii«Me  coodblinB  of  die  ulcer^  for  whacfa  pnrpocie  thnfieal  win  kip- 
biiLbB,  widi  die  w«f  oMnpnnMK,  imut  he  einptojed ;  after  vhieh  dm 
exact  iOtte  of  die  caritf  msy  be  KKefltanied  hf  dbe  probe.  The  vum- 
piece  falBlft  on  J  he  h^ted  bjp  pwahig  die  dannded  probe  from  dw  «&> 
tsraoltodie  iafeeraaJ  ohfioe^  die  i<no|r  beiaf  hnmght  doors  hjp  die  So- 
ger uKrodneed  uto  die  redtmm.  The  Sfptfnre  is  lo  be  iMd  Mi  inofy  M 
die  ptfieMt  con  well  hieor^  and  tightened  o  fatde  dadj.  Dr.  Hirs  medi- 
od — die  beA  exlnnl,-H»f  dghleoiBg  dm  h§tfm  a,  hefiwe  tfin^loiat 
die  eoMJh  oCdie  Mring  pnn  ttoofh  ftlufe  ml  corik,  aepaniinK  damn 
fbmrdn  dTan  incJi  where  dieir  omerfe,  and  p— ii 
rofier,  tKbed  Id  rwliil  yoiwe*  cadt  on  die  ead  of 
dieoart,%SQl.  TheaeaohelMewilhoUldMBMick^ 
after  liimiBg  or  twarting  to  t^faien  die  atrinf  . 

Wbde  die  procem  of  Kgption  arfoiof  on,  die 
caauiic  powder  nnat  he  iaaeifed  hf  mmaa  of 
pfedfela  of  iiat  to  act  npon  and  d'awwigu  dm  cal- 
kM»  mr  caatdapnoaa  (growthB.  ifoeTendaiannni 
euil  diej  nnrt;  al  be  nnnn|i:ed  in  die  saeme  wa;^„ 
and  everj  caAooet  ftaiiniii  moit  he  dmroof^ 
CBBfteraed.  The  part  riionld be  irt^pwallj  Imlheil 
with  warn  water  when  punfalaad 
fiilda  of  arnt  cfatha^  WHwed  with  drr. 
kepil  cnnntnalijf  appnedl  wrap  rvCaiued  n  pAa.'cv 
bgp  a  T  huadairft- 

WhenhrL 
BO  enlar|ge)C . 
araaed  teai.  A 
pvnboor  di^ 
oanveatmili  r, 
nximMlftvr 
fiai,diedir< 
iam  dae  rec . 

it  mm  v 
:  a©: 
he  e> 

!: 


r:Frri.A 


,»Tir».B.. 


.laM 

-Stm 


8^2  SURGERY. 


and  he  should  keep  very  quiet,  resting  much  of  the  time  in  the  hori- 
zonrnl  iwsition. 

Fistula  in  Perineo. — A  sinuous  ulceration  in  the  perineum  is 
generally  the  result  of  a  stricture  in  the  uiethra;  the  urine,  thus  ob* 
Btructed,  acting  upon  the  lax  structures  of  the  part,  often  occasions  ex- 
tensive ulcerations,  attended  witn  very  offensive  discharges  of  purulent 
or  sanious  matter. 

Treatment. — After  the  stricture  has  been  removed,  or  the  urethra 
dilated,  as  the  case  may  be,  a  gutta  percha  catheter  should  be  intro- 
duced into  the  bladder,  and  worn  constantly ;  the  hard,  callous  edges 
of  the  ulcer  are  then  to  be  disorganized  by  the  repeated  application  of 
the  mild  caustic,  or  the  pure  potash,  if  necessary.  Before  applying  the 
caustic,  the  parts  should  be  soothed  with  warm  fomentations ;  and  if 
the  urethra  is  too  irritable  for  the  constant  employment  of  the  cathe- 
ter, the  patient  should  keep  on  his  back  while  it  is  withdrawn,  taking 
care  to  have  the  instrument  inti'oduced  before  he  rises,  so  that  the 
bladder  may  he  emptied  without  allowing  any  urine  to  come  in  contact 
with  the  ulcerated  parts. 

Strictures  and  Fissures. — Strictures  and  fissures  of  the  urethra 
and  rectum,  though  not  in  any  sense  ulcers,  are  so  intimately  con- 
nected with  fistulse  that  they  may  as  well  be  considered  in  this  place. 
The  membranous  portion  of  the  urethra,  between  the  bulb  and  the 
prostate  gland,  is  most  frequently  sti'ictured,  although  a  stricture  may 
occur  at  any  part  of  its  channel.  The  disease  may  be  spasmodic  or 
organic.  In  the  former  case  obstruction  is  temporary,  and  is  produced 
by  a  partial  or  total  obliteration  of  the  canal  in  consequence  of  its  sides 
being  pressed  together  by  the  contraction  of  the  surrounding  muscular 
fibres.  In  the  latter  form  the  obstruction  is  permanent,  and  results 
from  a  morbid  thickening  of  the  mucous  membrane.  A  partial  organ- 
ic stricture  may  become  total  by  spasmodic  action,  superadded  to  the 
structural  difficulty.  The  most  frequent  cause  of  stricture  is  gonor- 
rhea, or  rather,  the  irritating  drugs  which  are  employed  to  cure  it.  In- 
juries from  the  passage  of  stone  or  gravel,  and  by  surgical  instruments, 
Eometimcp  produce  it. 

Sipnptoms. — The  spasmodic  stricture  is  known  by  the  sudden  stop- 
page of  the  sti-eam  after  it  has  reached  the  irritable  spot ;  there  is  alsc> 
H  desire  to  urinate  frequently  and  hurriedly.  In  the  organic  stricture 
the  streain  becomes  crooUed,  gradually  diminishes,  and  at  length  di- 
vides, and  finally  passes  only  in  drops.  The  excretion  eventually  be- 
comes yellow  and  purulent,  evincing  ulceration  in  the  urethra  or  blad- 


ULCERS.  363 

der.  The  constant  habit  of  straining  often  induces  hernia  or  piles ; 
and  when  extensive  ulceration  has  taken  place,  rigors  and  hectic  fever 
are  the  precursors  of  a  fatal  termination. 

Treatment. — The  first  measure  is  to  relieve  the  bladder.  When 
tne  stoppage  occasions  a  tense,  round,  painful  distention  above  the 
pubes,  the  catheter  must  be  employed  ;  the  gonorrheal  inflammntioHi  or 
irritation,  when  it  exists  may  be  subdued  by  frequent  warm  hip-baths, 
followed  by  tepid,  then  cool,  and  finally  cold ;  the  bowels  must  be  kept 
free  by  a  simple  opening  diet,  with  tepid  injections  when  necessary; 
and  cold  water  should  be  drank  as  copiously  as  the  stomach  can  com- 
fortably bear.  With  the  subsidence  of  the  morbid  irritation,  the  spas- 
modic stricture  will  usually  disappear;  but  if  not,  the  additional  meas- 
ures are  necessary,  which  pertain  particularly  to  the  treatment  of  per- 
manent stricture.  These  consist  in  dilating  the  urethra  by  means  of 
gum  elastic  or  gutta  percha  bougies^  or  destroying  the  stricture,  which 
is  usually  confined  to  a  very  small  space,  by  the  application  of  caustic, 
or  both.  The  dilating  process  is  managed  by  introducing  a  very  small 
bougie  at  first,  and  after  it  has  been  worn  as  much  of  the  time  as  pos- 
sible for  a  day  or  two,  a  larger  one,  and  so  on,  until  the  constricted 
calibre  is  enlarged  as  much  as  possible.  If  sufficient  relief  is  not  ob- 
tained by  dilatation,  the  caustic  is  the  dernier  resort.  This  is  applied 
by  means  of  a  bougie  armed  with  caustic  Tiotash,  or  nitrate  of  silver, 
and  passed  to  the  strictured  point,  against  which  the  caustic  is  pressed 
for  about  one  minute  at  a  time.  If  there  are  several  strictures,  each 
must  be  cauterized  successively.  Another  method,  called  malaxation. 
which  consists  in  introducing  a  bougie  through  the  strictured  portion, 
and  retaining  it  as  long  as  possible,  during  which  time  pressure  is  made 
against  the  stricture  by  an  external  compress  and  bandage,  to  excite 
absorption,  has  been  frequently  successful.  During  all  or  any  of  these 
operations,  the  irritation  must  be  kept  down  and  constant  relaxation  of 
the  parts  maintained  by  very  frequent  warm  hip-baths  or  fomentations. 
Indeed,  a  majority  of  cases  will  yield  to  the  medical  part  of  the  hy- 
drotherapeutic  treatment,  without  any  resort  to  mechanical  surgery 
whatever ;  and  the  cases  are  extremely  rare  which  will  require  any 
mechanical  operation  except  the  dilating  process,  provided  all  the  pa- 
tient's habits  and  management  are  thoroughly  hydropathic.  It  should 
be  generally  known  that,  as  a  majority  of  stricture  J,  of  both  the  spas- 
modic and  permanent  kind,  are  produced  by  astringent  and  irritating 
applications  employed  to  check  gonorrhefil  or  gleety  discharges,  so  a 
majority  will  get  well  by  reproducing  the  discharge  ;  and  this  may  gen- 
erally be  done  by  the  persevsring  employment  of  warm  local  baths  and 
fomentations. 


864  SURGERY. 


Stricture  of  the  rectum  is  a  thickening  and  hardening  of  the  intes- 
tine, resulting  from  constipation  ;  it  produces  a  serious  difficulty  in 
passing  the  faeces,  which  are  evacuated  in  small,  contracted,  elongated, 
or  flattened  lumps,  or  in  a  fine  stream.  As  in  the  case  of  fistulse,  all 
callous  formations  must  be  removed  by  caustic;  and  the  consti-icted 
intestine  must  be  mechanically  dilated.  Apiece  of  ordinary  wood,  cov- 
ered with  oiled  silk,  of  a  conical  shape,  about  three  inches  in  length, 
the  smaller  end  just  large  enough  to  pass  the  stricture,  and  the  other, 
about  two  inches  in  diameter,  answers  every  purpose.  It  must  be  held 
by  a  T  bandage,  made  of  gum-elastic,  and  worn  as  long,  and  as  fre- 
quently advanced  as  the  patient  can  well  bear  ;  the  rectum  should  be 
well  cleansed  with  a  tepid  injection  previous  to  each  application  of  the 
dilator. 

Fissures  of  the  anus  are  ulcerous  gtaoves  in  the  rectum,  extending 
upward  from  the  orifice.  The  edges  of  the  crack  or  fissure  be«corae 
thickened  and  hardened,  and  constantly  exude  a  sanious  fluid.  These 
should  be  removed  by  caustic,  as  in  the  case  of  fistulse,  the  patient  kept 
quiet,  the  warm  relaxant  baths  employed,  and  the  general  regimen  strict- 
ly attended  to. 

Salivary  Fistula. — Wounds  of  the  face,  which  sever  some  one  of 
the  excretory  ducts  of  the  salivary  glands,  are  often  followed  by  an  ob- 
literation of  the  cavity  of  the  duct,  and  the  formation  of  a  fistulous 
opening  through  which  the  saliva  escapes  upon  the  outside  of  the  face. 
The  difficulty  may  be  remedied  by  making  an  opening  with  a  small 
trochar,  passed  into  the  open  end  of  the  duct  at  the  fistulous  opening, 
and  then  inserting  a  gold  or  silver  tube  to  guide  the  saliva  into  the  mouth ; 
after  which  the  fistula  may  be  healed  by  adhesive  straps,  or  these  aid- 
ed by  the  mild  caustic.  When  the  injured  parts  ai"e  entirely  healed, 
tlie  canula  or  tube  may  be  removed. 

FisTUL-E  Lachrymalis. — In  the  true  lachrymal  fistula  the  lachry- 
mal sac  is  distended  to  a  tumor  at  the  inner  corner  of  the  eye,  which 
ulcerates  and  forms  an  opening  through  Nvhich  the  tears  are  discharged 
on  the  face,  instead  of  passing  to  the  nose.  There  is  also  a  morbid  se- 
cretion of  the  sac  distinct  from  the  tears,  for  which  the  mild  caustic 
may  be  necessary ;  and  the  nasal  duct  may  be  &D  obstructed  as  to  re- 
quire probing,  and  the  application  of  a  tent. 


ABSCESSES  366 


CHAPTER  VI. 

ABSCESSES. 

An  abscess — aposteme — vnposthume — is  a  collection  of  purulent  mat- 
ter in  a  cavity,  or  in  the  substance  of  an  organ  or  part  of  the  body. 
Sometimes  the  pus  is  contained  in  an  orbicular  cavity  Jmed  by  a  cyst; 
and  sometimes  it  is  infiltrated  into  the  meshes  of  the  areolar  tissue. 
The  formation  of  an  abscess  is  often  preceded  by  chills,  or  shivering 
fits,  called  rigors ;  and  just  before  suppuration  takes  place,  the  pain, 
tension,  swelling,  throbbing,  etc.,  are  increased.  After  matter  is  form- 
ad,  a  sensation  of  weight  and  throbbing  continues  in  the  pait,  and  a 
conical  projection  soon  denotes  the  pointing  of  the  abscess,  preparatory 
to  its  bursting  and  discharging  its  contents.  Some  abscesses  will  point 
in  a  week  ;  others  may  not  do  so  in  several  months.  Generally  aJZwc- 
tualion  may  be  felt  in  the  swelling  previously  to  its  pointing.  In  order 
to  distinguish  the  fluctuation  of  an  abscess  to  the  best  advantage,  two  or 
three  fingers  should  be  placed  on  one  side  of  the  swelling,  and  the  op- 
posite side  briskly  tapped  with  the  fingers  of  the  other  hand. 

Deep-seated  abscesses,  and  those  formed  beneath  fascias  and  dense 
fibrous  tissues,  do  not  readily  point,  but  they  are  attended  with  greater 
constitutional  disturbance  ;  and  severer  hectic  symptoms,  as  shiverings, 
night-sweats,  small,  frequent  pulse,  etc.  A  sense  of  weight  and  cold- 
ness in  the  part  will  also  succeed  the  acutely  throbbing  pain ;  and  not 
unfrequently  the  integument  over  the  abscess  will  become  oedematous. 

The  general  treatment  of  abscesses  is  precisely  the  same  as  that  of 
inflammatory  tumors  and  ulcers,  preceding  the  formation  of  matter ; 
after  which,  as  a  general  rule,  they  are  to  be  opened  by  cutting  or  cau- 
terization— usually  the  former. 

Empyema. — This  is  a  collection  of  matter  in  the  cavity  of  the  pleu- 
ra. Inflammations  of  the  lungs  or  of  their  membranes  occasionally  re- 
sult in  suppuration,  producing  .the  abscess  under  consideration.  It  is 
known  by  a  manifest  enlargement  of  the  side  affected  ;  a  dry,  tickling 
cough  ;  laborious  breathing,  which  is  easiest  in  the  erect  posture ; 
fixed  pain  in  t?he  chest,  with  diflficulty  of  lying  on  the  sound  side. 

Treatment. — In  a  few  instarces  the  matter  has  worked  its  way  into 
the  bronchial  tubes    and  been    expectorated,  followed  by  recovery. 


56C  SURGERY. 

When  any  tiling  is  done  surgically,  it  is  the  operation  of  paracentesis 
thoracis.  An  incision  is  made  with  the  bistoury  an  inch  and  a  half  in 
length,  through  the  integuments,  usually  at  the  upper  edge,  and  a  little 
behind  the  middle  of  the  sixth  rib;  the  intercostal  muscles  are  care- 
fully separated,  and  the  point  of  the  instrument  passed  in  through  the 
pleura  costalis  ;  a  canula  is  then  introduced,  through  which  the  matter 
escapes.  Care  must  be  taken  that  air  does  not  pass  in  through  the 
tn'je ;  to  prevent  which,  the  patient  may  incline,  after  the  introduction 
of  the  canula,  on  the  affected  side ;  or  a  valvular  instrument  may  be 
used.     This  operation  has  not  been  generally  successful. 

Maxillary  Abscess. — This  disease  is  an  ulceration  of,  and  collec- 
tion of  matter  in  the  antrum  of  the  upper  maxillary  bone.  It  is  gen- 
erally produced  by  the  irritation  of  decaying  teeth,  and  may  exist  for 
years,  passing  for  toothache.  It  may  be  known  by  severe  and  obsti- 
nate pain  in  the  face  just  below  the  prominence  of  the  malar  bone;  the 
fetor  is  also  extremely  offensive  to  the  patient,  and  to  others  about 
hira.  Sometimes  there  is  a  considerable  discharge  of  offensive  matter 
from  the  nose,  and  in  some  cases  the  face  is  much  swelled  and  disfig- 
ured. 

Treatment. — The  Inflammation  and  irritation  should  be  allayed  by 
derivative  baths  and  local  fomentations.  The  surgery  proper  in  the 
case  consists  in  extracting  the  second  or  third  molar  tooth,  or  both ;  and 
if  the  pus  does  not  find  a  ready  exit,  a  hole  is  to  be  drilled  through  the 
alveolus  into  the  antrum  about  the  size  of  a  goose-quill ;  the  cavity 
should  then  be  repeatedly  washed  by  injecting  warm  water  ;  and  if 
the  fetor  does  not  soon  subside,  a  few  applications  of  the  mild  caustic, 
in  solution,  should  be  made. 

Mammary  Abscess. — Abscess  in  the  breast  is  sometimes  the  re- 
sult of  injuries,  as  blows,  pressure,  etc. ;  but  generally  it  is  the  conse- 
quence of  bad  management  or  mal-treatment  during  the  periods  of  ges- 
tation, childbirth,  and  lactation.  The  disease  usually  appears  in  four  or 
five  weeks  after  parturition ;  in  about  ten  days  thereafter  suppuration 
takes  place,  beginning  in  several  distinct  parts,  and  forming  many  sep- 
arate sinuses,  all  uf  which,  however,  communicate.  It  opens  at  one 
or  several  points. 

Treatment. — This  distressing  affection  is  a  standing  disgrace  to  the 
doctor,  the  nurse,  the  patient,  and  all  parties  concerned.  It  is  produced 
by  the  mi.st  foolish  stuffing,  and  slopping,  and  stimulating,  and  heat- 
ing, and  drugging;  nor  is  the  usual  method  of  doctoring  the  disease, 
after  it  has  been  artificially  producet:  half  as  well  calculated  to  cure  the 


ABSCESSES.  867 


malady  as  to  kill  the  patient.  If  promptly  and  properly  treated,  it  can 
almost  always  be  speedily  resolved  in  its  early  stages.  The  constitu- 
tional treatment  is  more  important  than  the  local,  and  both  should  be 
managed  on  the  plan  heretofore  recommended  for  visceral  inflamma- 
tion. The  wet-sheet  pack,  or  frequent  tepid  ablutions,  with  hip  and 
foot-baths,  are  the  general  measures  ;  and  the  constant  application  of 
several  folds  of  wet  linen,  very  frequently  renewed  and  well  covered, 
Is  the  local  appliance.  Water  may  be  drank  freely,  but  the  diet  should 
ie  rather  dry. 

Onyx. — A  collection  of  purulent  matter  between  the  laminae  of  the 
cornea,  having  the  shape  of  a  nail,  is  so  called  in  surgical  technology. 
Its  form,  however,  is  nearly  semilunar,  like  the  white  mark  at  the  root 
of  one  of  the  finger  nails.  It  usually  occupies  the  lower  edge  of  the 
cornea,  and  may  be  distinguished  from  hypopyum  by  its  form  and  situa- 
tion remaining  unchanged  in  all  positions  of  the  patient's  head.  This 
affection  can  generally  be  removed  by  the  appropriate  remedies  to  re- 
duce inflammation — on  which  its  existence  depends — and  promote  ab- 
sorption. The  head  and  eye-baths,  a  moderate  douche,  and  deriva- 
tive, hip,  and  foot-baths,  are  all  serviceable. 

Lumbar  Abscess — Psoas  Abscess. — This  is  one  of  the  most 
formidable  and  fatal  of  abscesses.  It  commences  with  a  dull,  heavy 
aching  in  the  lumbar  region  ;  pains  shooting  down  the  spine  and  thighs, 
and  a  lameness  in  one  or  both  lower  limbs,  with  a  difficulty  of  standing 
erect;  there  is  usually  a  drawing  up  of  the  testicle  of  the  side  more 
particularly  affected ;  the  patient  is  easily  fatigued  by  exercise,  and 
when  lying  down  is  disposed  to  flex  the  thighs  or  the  abdomen.  At 
length  the  local  pain  becomes  throbbing,  chills  and  night-sweats  occur, 
a  fluctuating  enlargement  appears  along  the  psoas  muscle,  and  the  apex 
of  the  tuinor  presents  itself  immediately  below  the  groin.  The  dis- 
ease usually  occurs  in  scrofulous  persons,  and  is  often  connected  with 
caries  of  the  spine,  in  which  case  curvature  of  the  spine  and  paralysis 
of  the  lower  extremities  are  apt  to  result. 

Treatment. — If  detected  in  the  early  or  forming  stage,  this  disease 
requires  thorough  constitutional  treatment,  of  which  the  pack-sheet 
daily  is  the  leading  process.  The  diet  must  be  strict,  the  bowels  kept 
open  by  injections,  and  wet  cloths  constantly  applied  to  the  painful 
part.  If  the  treatment  is  not  commenced  early  enough  to  prevent  sup- 
puration, the  abscess,  as  soon  as  fluctuation  is  clearly  detected,  should 
be  punctured  to  let  out  the  matter.  When  the  pus  lies  very  deep,  an 
Dponing  may  bo  made  t/i  it  with  caustic  potash.     After  the  abscess  is 


8G8  SURGERY 


opened,  moderate  compression  should  be  kept  up,  and  the  water-dress 
ing  cotitiiuied. 

jSute. — Sometimes  the  swelling  of  a  lumbar  abscess  in  the  bend  of  the 
pom  so  nearly  resembles  that  of  a  hernial  protrusion,  that  great  diffi- 
culty is  experienced  in  the  diagnosis ;  and  the  difficulty  is  increased  by 
the  fact  that  the  same  impulse  is  communicated  to  the  swelling  when 
the  patient  coughs  in  either  case.  Usually,  however,  the  swelling  ia 
lumbar  abscess  is  larger  and  more  toward  the  ilium.  In  cases  of  ex- 
treme doubt,  a  needle  may  be  introduced  into  the  tumor  to  ascertain  the 
character  of  its  contents. 

Hip  Disease — Coxarum  Morbus. — This  disease,  like  the  prece- 
ding, is  seldom  cured  in  the  regular  way.  It  consists  in  an  abscess 
originating  from  caries  of  the  head  of  the  os  femoris  ;  it  generally  occa- 
sions a  luxation  of  the  hip  joint  and  a  permanent  shortening  of  the  limb. 
The  symptoms  come  on  insidiously.  Generally  a  slight  pain  in  the 
knee  is  the  first  thing  noticed.  On  a  close  examination  the  limb  will 
be  found  elongated,  which  causes  the  knee  to  be  slightly  bent,  and  the 
whole  limb  more  or  less  disfigured.  At  this  period  the  pain  will  atfect 
the  groin,  and  may  be  severe.  Extensive  ulceration  has  generally 
taken  place  when  purulent  matter  makes  its  appearance  ;  this  may  be 
dtschiu*ged  at  several  points,  although  the  abscess  commonly  opens  in 
the  groin.  In  some  cases  the  head  of  the  femur  is  not  destroyed,  and 
anchj'losis  results  ;  but  usually  the  head  is  dislocated  upon  the  dorsum 
of  the  ilium,  where  it  may  form  a  new  joint,  and  produce  a  deformed 
and  shortened  limb ;  when  the  head  is  entirely  destroj^ed,  the  limb 
will  be  shortened  several  inches. 

Treatment. — This  does  not  differ  essentially  from  that  applicable  to 
the  preceding  disease.  When  fistulous  openings  exist,  their  callous 
edges  or  fungous  growths  may  require  the  caustic  ;  and  when  theyare 
connected,  they  should,  if  practicable,  be  converted  into  a  single  one 
by  the  ligature.  In  order  to  enable  the  patient,  during  the  lengthy 
process  of  cure,  to  exercise  in  the  open  air,  he  should  be  supplied 
with  crutches,  and  the  limb  should  be  dressed  with  gum-shellac,  or 
other  light  splints,  to  keep  the  affected  joint  as  motionless  as  possible. 

Prostatic  Abscess.— Abscess  of  the  prostate  gland  k  a  result  of 
acute  inflammation,  and  may  be  known  by  rigors,  with  swelling,  heat, 
and  redness  of  the  perineum  externally.  As  soon  as  matter  has  formed, 
the  abscess  must  be  opened  at  once,  lest  the  matter  work  its  way  into 
the  rectum  o'-  urethra 


HERNIA,   OR    RUPTURES.  8«9 


CHAPTER  VII. 

HERNIiE,  OR  RUPTURES. 

Tme  terms  hernia  and  rupture  are  commonly  employed  as  syijony- 
mous ;  but  writers  who  are  strict  in  the  use  of  language,  apply  the 
former  word  to  all  pi'otrusions  of  the  viscera  of  parts  from  their  nat- 
ural cavities,  while  the  latter  term  is  limitea  to  abdominal  protrusions. 
The  word  rupture,  however,  is  always  a  misnomer,  for  it  implies  that 
something  is  burst  or  torn,  which  is  not  necessarily  the  case. 

Varieties  of  Hernia. — These  are  innumerable.  They  may  in 
volve  the  brain,  lungs,  stomach,  intestines,  bladder,  the  different  por 
tions  of  the  peritoneum,  and  in  rare  cases,  the  liver,  spleen,  uterus,  or 
ovaries.  The  parts  commonly  affected  with  hernia  are  the  abdominal 
viscera;  of  these  the  intestines,  or  omentum,  or  both,  are  the  portions 
usually  protruded  ;  and  the  abdominal  ring,  the  navel,  and  a  point  at 
the  inner  side  of  the  femoral  vein,  just  below  Poupart's  ligament,  are 
ihe  places  where  herniae  most  frequently  appear.  They  are  met  with 
occasionally  at  all  points  of  the  linea  alba,  at  \he  foramen  ovale,  the 
ischiatic  notch,  in  the  perineum,  and  in  the  vagina. 

Technology  of  Hernije. — This  is  derived  from  their  contents  and 
locality.  A  protrusion  of  the  brain  is  called  encephalocele,  or  hernia 
cerebri ;  of  parts  within  the  thorax,  piieumatocele ;  of  the  stomach, 
gastrocele ;  of  the  intestine,  enterocele  ;  of  the  omentum,  epiplocele  ; 
of  both,  entero-epiplocele  ;  of  the  liver,  spleen,  bladder,  uterus,  etc., 
hepatocele,  splenocele,  cystocele,  hysterocele,  etc.  Abdominal  hernias  are 
distinguished  according  to  the  aperture  from  which  they  escape.  A^ 
or  near  the  navel  they  are  called  umbiliccd — exomphalos,  or  empha- 
locele;  through  the  linea  alba  above  the  umbilicus,  epigastric ;  through 
the  linea  alba  below  the  umbilicus,  hypogastric,  infra-wnbilical,  or 
ceeliocele  ;  through  the  abdominal  ring,  inguinal,  or  supra-puhian,  and 
this  variety,  when  small,  is  called  bubonocele,  and  in  man,  oscheocele,  or 
scrotal  hernia,  when  the  intestine  has  descended  into  the  scrotum, 
while  in  woman  its  extension  to  the  libiae  is  called  epiciocele,  or  vulvar^ 
pudendal,  or  labial  hernia;  through  the  crural  cnnR\,fe77ioral,  or  mero- 
cele;  through  the  opening  which  gives  passage  to  the  infra-pubian  ves- 
sel?!, infra-pubian  ;  through  the  saci  5-ischiatic  notch,  ischiatic  hernia, 


870  SLRGERT. 

through  the  levator  ani,  and  appearing  at  the  perineum,  mesosceloceU, 
or  perineocele  ;  through  the  narietes  of  the  vagina,  coleocele,  elytrocele ; 
and  through  the  diaphragm,  diaphragmatocele,  etc. 

*'  Ventral  hernia'"'  includes  all  forms  of  abdominal  proti-usion,  except 
those  occurring  at  the  umbilicus,  abdominal  ring,  or  femoral  sheath. 

In  inguinal  hernia,  the  intestine  may  be  arrested  in  the  canal,  after 
having  passed  through  the  internal  abdominal  ring,  when  it  is  called  in- 
complete inguinal  hernia  ;  when  it  passes  through  the  canal  and  emerg- 
es at  the  external  abdominal  ring,  it  is  called  complete  inguinal  hernia 
Complete  inguinal  hernia  is  called  direct,  or  veniro-inguinal  hernia^ 
when  the  bowel  passes  through  the  space  between  Poupart's  and  Gim- 
bernat's  ligaments,  leaving  the  external  ring  and  spermatic  cord  on  the 
outside  ;  and  in  other  cases  it  is  termed  oblique. 

Congenital  hernia  is  the  protrusion  of  some  portion  of  the  abdominal 
contents  into  the  tunica  vaginalis  testis,  owing  to  a  want  of  adhesion  ^(* 
tween  its  sides  after  the  descent  of  the  testicle. 

Pathological  Distinctions. — In  abdominal  hernia  the  protruding 
part  usually  pushes  along  a  portion  of  peritoneum,  which  forms  a  sort 
of  pouch,  and  is  called  the  hernial  sac ;  the  narrow  part  of  which 
ie  the  neck,  and  the  expanded  portion  the  body.  The  bladder  and 
caecum,  however,  not  being  contained  in  the  peritoneum,  do  not  have  -a 
complete  sac  ;  and  in  cases  of  wounds  and  ulcerations,  the  sac  may  be 
absent;  nor  does  it  exist  in  internal  herniee,  in  which  there  is  really  no 
protrusion  at  all. 

In  complete  or  direct  inguinal  hernia,  there  are  two  necks,  one  at  the 
internal  and  one  at  the  external  rmg. 

Hernia  is  culled  reducible  when  the  displaced  part  is  attended  with 
no  disturbanc-e  of  the  general  health,  and  is  susceptible  of  being  easily 
replaced ;  when  incapable  of  replacement,  from  its  size  or  from  adhe- 
eions,  it  is  called  irreducible  or  incarcerated ;  and  when  the  incarce- 
rated part  is  constricted  and  inflamed,  obstructing  the  passage  of  faeces, 
and  causing  violent  pain  and  sickness,  it  is  called  strangulated. 

Special  Causes  of  He rmje.— Surgeons  tell  us  that  blows,  falls, 
violent  exertions,  us  lifting,  wounds,  dropsy,  abscesses,  pregnancy, 
Btmining  at  stool,  hard  ridnig,  and  severe  coughing,  are  the  common 
exciting  causes,  while  general  debility  is  the  general  predisposing 
cause.  All  of  these  causes  are  favorable  to  these  complaints,  and  some 
of  them  alone  produce  them ;  but  the  general  and  special  cause  is  cos- 
tiveness.  Without  this  predisponent  condition,  most  of  the  other  causes 
named  would  be  powerless.     Many  persons,  perhaps  a  majority  in  re* 


HERNIA,    OR    RUPTURES.  371 

fined  society,  scarcely  ever  go  to  stool  without  being  obliged  to  strain 
dangerously,  to  respond  to  the  "solicitation  of  natui'e."  And  when 
this  straining  has  been  kept  u\:  for  years,  it  is  not  remarkable  that  very 
slight  accidents  should  cause  the  "bowels  to  gush  out"  of  their  natural 
inclosures  in  the  shape  of  hernial  protrusions.  Some  have  estimated 
the  subjects  of  hernia  to  be  one  eighth  of  an  entire  population. 

Diagnosis  of  Hernia. — In  a  reducible  hernia  the  tumor  may  ap- 
pear gi-adually  or  suddenly  at  some  one  of  the  points  above  named;  its 
size  is  changeable,  being  larger  when  the  patient  stands,  and  smaller 
when  he  lies  on  his  back  ;  compression  Avill  generally  diminish  it;  it  is 
usually  more  tense  after  a  full  meal,  or  when  the  patient  is  flatulent ; 
when  the  patient  coughs,  an  impulse  may  be  felt  at  the  tumor,  as  if  air 
were  blown  into  the  swelling.  When  the  sac  contains  intestine  only, 
the  tumor  is  uniformly  smooth  and  elastic,  and  also  painful  to  pres- 
sure ;  when  it  contains  omentum  only,  the  tumor  is  insensible,  and  has 
a  more  flabby,  or  doughy,  and  somewhat  unequal  feel;  and  when  it 
contains  both — enter o-cpiplocele — a  part  of  the  contents  of  the  hernial 
tumor  will  slip  up  with  a  gurgling  noise,  leaving  behind  a  portion  less 
readily  reduced. 

Irreducible  hernias  are  distinguished  by  more  or  less  difficulty  in 
evacuating  the  bowels  ;  colic  pains  are  frequent,  with  a  variety  of  dys- 
peptic symptoms.  They  do  not  usually  occasion  great  inability  or  in- 
convenience, but  are  liable  to  intussusception — a  slipping  of  one  portion 
of  bowel  into  another — and  this  is  a  dangerous  and  often  fatal  ac- 
cident. 

Strangulated  hernia  presents,  first,  an  irritable  condition  of  the  parts 
afl'ected,  with  a  hectic  flush  externally,  and  a  pain  at  the  point  of  con- 
striction; the  pain  generally  extends  to  the  diaphragm,  followed  by 
nausea,  vomiting,  obstinate  constipation,  rapid  pulse,  and  general  fever- 
ishness.  The  peristaltic  action  is  often  inverted,  and  fcecal  matters  are 
ejected  from  the  stomach.  If  reduction  is  not  soon  effected,  the  bow- 
els become  distended  with  air,  the  abdomen  hard  and  tense,  the  ex- 
tremities cold,  while  hiccough,  clammy  sweats,  and  a  sinking  pulse, 
with  a  sudden  cessa^zW  q/'i/iepam,  denote  the  existence  of  mortifica- 
tion, and  the  approach  of  death. 

General  Treatment  of  Herm^. — When  the  hernia  is  reduci- 
.ile,  the  protruded  part  is  to  be  returned  to  its  natural  position,  and 
maintained  there  by  a  truss,  or  other  suitable  contrivance.  In  some 
rare  cases,  however,  the  contents  of  the  hernia  are  so  bulky,  or  the 
paits  so  altered,  that  it  is  advisable  mei'ely  to  support  the  tumor  with  a 


•72  SURGERY. 


suspensory  bandage,  unless  an  attempt  at  a  radical  cure  should  be 
deemed  expedient. 

In  irreducible  cases  the  strictest  attention  must  be  paid  to  the  diet, 
Avhich  should  be  so  managed  as  to  obviate  the  least  tendency  to  con- 
Btifmtion.  With  this  precaution,  the  use  of  a  truss  or  bandage,  and  the 
avoidance  of  all  rough  exercises,  the  patient  may  "  live  through  life" 
very  comfortably. 

But  when  the  reducible  variety  sudden!}^  becomes  incarcerated,  and 
in  all  cases  of  strangulation,  the  first  attempt  at  relief  should  be  by  the 
la.ris,  or  hand  oj^eration.  The  taxis  can  almost  alwaj^s  be  successfully 
performed  by  any  one  who  has  a  clear  idea  of  the  mechanism  of  the 
l)art  and  the  existing  obstacles. 

The  patient  is  to  be  placed  in  a  horizontal  posture  on  tlie  sound 
side — these  directions  apj)Iy  particularly  to  inguinal  and  femoral  her- 
nia, otiier  varieties  not  recjuii-ing  specim  instructions — with  the  hipg 
elevated,  the  chest  inclined  forward,  the  thigli  of  the  affected  side  flexed 
upon  the  abdomen,  and  drawn  toward  tlie  other — all  of  which  is  intend- 
ed to  relax  the  muscles  and  integument  at  and  around  the  protrusion. 
The  sac  is  then  to  be  gently  grasped,  and  moderately  elevated  and  coni- 
pressetl  with  one  hand,  while  the  forefinger  of  the  other  hand  presses 
as  much  of  the  tumor  as  possii)le  uj)  to  and  within  the  point  of  protru- 
sion ;  the  returned  portion  is  to  be  retained  while  the  middle  fingei 
pushes  up  another  portiorj,  when  the  forefinger  may  be  again  em- 
ployed for  still  another  jmrtion;  the  middle  finger  holding  the  part  it 
has  brought  up,  or  the  ring  finger  may  be  used,  while  the  odiers  are 
both  occupied  in  holding  the  advantage  gained.  In  this  way  the  whole 
tumor  is  to  be  lemoved. 

In  tlie  c.rlcrnal  insrulnal  hernia,  the  pressure  must  be  directed  up- 
nard  and  oulicard,  along  tlie  course  of  the  spermatic  cord  ;  but  m  fem- 
oral hernia  it  is  to  be  directed  first  doivmvard  and  then  backivard.  In 
vmhdicai  and  vcnlral  hernia  the  pressure  is  to  be  made  directly  hack- 
icard.  Violence  must  never  be  used,  nor  the  parts  handled  so  roughly 
as  to  occasion  much  pain. 

Several  circumstances,  however,  may  interfere  with  the  operation 
of  taxis,  or  defeat  its  successful  result,  as  extreme  distention  of  the  pro- 
truded intestine,  great  pain  and  tenderness,  active  inflammation,  severe 
«onstrictior.  around  the  neck  of  the  sac,  etc. ;  but  these  things  should  not 
discourage  us.  We  have  in  cold  icater  or  ice  a  suitable  auxiliary  for 
the  first-named  complication  ;  its  assistance  will  often  enatle  us  to  suc- 
ceed at  once.  When  the  part  is  excessively  tender  and  irritable,  hot 
water  must  be  brought  in  requisition.  The  full  warm  bath,  or  local  fo- 
mentations, cr  both,  may  be  employed,  and  these  mav  be  fohowed  hy 


HERNI.E,    OR    BUPTURES.  S73 

a  reapplication  of  the  iold  process.  Our  "old  school"  friends,  on  iheir 
characteristic  principle,  that  when  a  patient  is  suffering  locally,  he  ought 
also  to  be  made  to  suffer  constitutionally,  recommend  tartar  emetic  and 
bleeding  to  produce  sickness  and  faintness,  with  a  view  of  bi'inging 
about  relaxation  and  quietude ;  but  warm  water  externally,  and  inter- 
nally by  injection,  may  be  made  to  produce  any  degi'ee  of  these  effects 
which  can  be  desired.  After  the  employment  of  either  of  these  water 
processes,  the  taxis  is  to  be  tried  again. 

There  is  yet  another  resource  in  bad  cases — dry-cupping — which 
Dr.  Hill  {Eclectic  Surgery)  significantly  calls  traction  from  tvithin,  and 
which  is  not  mentioned  in  any  other  work  with  which  T  am  acquainted. 
A  large  cup,  or  any  convenient  vessel*  may  be  applied  to  the  abdomen, 
covei-ing  the  umbilical  region,  in  which  a  piece  of  burning  cotton  is  placed 
to  exhaust  the  air;  the  "suction"  thus  established  will  pull  upon  the 
protruded  intestine  while  we  may  be  pushing  from  without.  Holding 
the  patient's  heels  up,  and  head  down,  and  jouncing  him  in  that  condi- 
tion, has  succeeded  in  "  domestic  practice,"  in  reducing  a  rupture,  of 
which  Dr.  Hill  gives  a  notable  instance. 

In  extreme  cases,  when  the  strangulation  with  inflammation  has  ex- 
isted, despite  the  efforts  to  reduce  it,  for  twelve  or  fifteen  hours,  the 
only  chance  for  the  patient  is  by  the  operation  with  the  knife ;  yet  this 
does  not  afford  him  quite  an  equal  chance  to  live.  It  consists  in  making 
an  incision  through  the  skin  three  or  four  inches  in  length,  along  the 
course  of  the  tumor,  cutting  through  the  successive  layers — described 
in  the  first  part  of  this  work  under  the  head  of  "  Anatomy  of  Hernia" — 
or  coverings,  by  picking  up  a  small  bit  at  a  time  with  the  forceps  and  cut- 
ting horizontally  through  it  under  their  points,  until  an  opening  into  the 
sac — which  can  be  distinguished  by  its  bluish  appearance — is  made. 
"The  sac" — I  quote  substantially  from  Dr.  Hill — ^"  is  then  opened  in  the 
same  manner,  and  the  small  director,  fig.  202,  inserted,  and  an  opening 

Fig.  202. 


THE    SMALL   DIRECTOR. 


made  large  enough  to  admit  a  finger.     The  forefinger  of  the  left  hand  \e 
32 


874 


SURGEKY. 


F,n  irtftodured,  fig.  203.  and  passed  up  to  the  neck  of  the  sac  to  find 

Fig.  203. 


*^Vv. 


OPERATION  FOR  STRANGULATED  HERNIA. 

ihe  Stricture,  which  may  be  at  the  internal  or  external  ring,  or  at  both 
places:  the  stricture  should  be  sufficiently  dilated  to  permit  the  finger 
to  enter  the  abdomen;  this  may  be  done  by  the  probe-pointed  bistoury, 
or  similar  knife,  made  for  the  purpose,  not  edged  quite  up  to  the  point, 
nor  but  a  short  space  below  it,  fig.  204.     The  blade  is  passed  u])Jiat- 

Fig.  204. 


HERNIAL.    BISTOURY. 


xois€j  along  the  finger,  and  pushed  on  through  the  sti-icture.     Its  edge 


Fig.  205. 


CUTTING  THE  STRICTURE 


is  then  turned  up- 
ward,cutting  no  more 
than  necessary  to  ad- 
mit the  finger,  figure 
205.  The  cut  must 
always  be  made  ^i- 
redly  upward,  paral- 
lel to  the  linea  alba, 
to  avoid  the  epigas- 
tric   artery.       After 


HERNIA,    OR    RUPTURES.  376 


the  sti'icture  is  thus  relieved,  the  parts  must  be  examined,  and  if  firm 
adhesions  have  taken  place,  or  fatty  deposits  accumulated  largely,  no 
attempt  at  reduction  must  be  made,  but  the  wound  allowed  to  heal. 
When  mortification  has  taken  place,  the  only  chance  is  by  an  artificia. 
anus.  In  femoral  or  crural  hernia,  the  sac  is  usually  very  small,  and 
embraces  the  bowel  very  tightly ;  hence  it  must  be  opened  with 
caution. 

Radical  Cure  of  Herma. — Beyond  the  taxis  for  reducing  dis- 
placement, and  the  operation  for  relieving  strangulation,  little  or  nothing 
has  been  done  for  this  class  of  invalids  in  the  way  of  regular  surgery, 
while  mechanical  skill  has  generally  been  content  to  prevent  further 
mischief  by  the  constant  application  of  a  truss.  But  it  has  been  no- 
ticed that  in  recent  cases  the  pressure  of  a  truss  has  sometimes  excited 
adhesive  inflammation  in  the  parieties  of  the  canal  between  the  ab- 
dominal rings,  or  in  the  femoral  sheath,  and  thus  closed  the  passage 
against  all  future  danger.  Acting  on  this  hint,  others  have  succeeded 
in  some  recent  cases,  by  keeping  up  as  strong  pressure  as  the  patient 
could  bear,  by  means  of  a  truss  with  a  large  and  hard  pad,  so  applied 
as  to  compress  the  whole  canal  or  sheath  through  which  the  viscera 
had  passed.  Others  have  succeeded  in  cases  of  long  standing,  by  add- 
ing to  the  mechanical-pressure  treatment,  that  of  vital  irritation,  the 
combined  effect  of  both  being  to  produce  the  requisite  degree  of  ad- 
hesive inflammation  to  obliterate  the  canal,  slieatii,  or  cavity,  where 
the  rupture  presents.  Professors  Morrow  and  Hill,  of  Ohio,  employ 
an  irritating-plaster  —  compounded  of  bloodroot,  mandrake,  wake- 
robbin,  pokeroot,  tar  and  rosin — large  enough  to  cover  the  whole  cenal 
or  sheath — two  to  two  and  a  half  by  three  to  three  and  a  half  inches — 
over  which  the  truss  is  worn,  the  pad  of  which  is  nearly  as  large  as 
the  plaster.  The  part  is  first  shaved,  the  plaster  applied,  and  then  the 
truss  ia  adjusted  as  tightly  as  the  patient  can  bear,  the  compression 
being  diminished  as  the  parts  grow  tender.  The  truss  is  removed 
daily,  and  the  plaster  re-spread,  during  which  the  patient  must  keep 
perfectly  still  in  the  horizontal  posture,  with  the  thighs  flexed  upon 
the  abdomen.  When  the  truss  cannot  be  longer  borne  on  account  of 
the  pain,  it  is  substituted  by  a  compress  and  bandages ;  and  while  these 
are  worn  the  patient  is  recommended  to  keep  on  his  back.  A  point 
of  practice  especially  insisted  on  is,  that  no  pi'otrusion  must  on  any 
account  be  allowed  to  take  place  during  the  treatment.  Should  tlie 
pain  and  irritation  become  intolerable,  the  plaster  is  to  be  omitted  for  a 
few  days,  a  slippery  elm  poultice  taking  its  place ;  and  this  the  hydro- 
path  could  readily  supersede  by  simple  flour  to  the  surface,  over  wliic^" 


TTp  SUE,  C-  E  P.  T- 

wrm  wet  oiorhs  ravrhr;  oe-  i"-  -•:.      ...:  -^  ■-■:  '-".r  —  y'ara:.  bj  ^.ijs  puia  oi 
cre:i*menr.  no  e:Tc.r "  '.  "  ■  ■;-     ■  •-  4    •-.  ■  ^  ■  •  r^  .^.-    -y 

and  a  scnr 

«cor»  ©f  w 

tfa#  irricania  are^  pro'^Tjd^d!  the;  ^   precisety  "  ^ 

of  arriCaEioa,  ami  do  ooiC  p: 

of  a  few  (irefs  Q'f  0%^ '/ 

tBiiOlBiiiirxl  sSne  emEpu".  .3 

maffiBeaC  of  beciamm.  &r  wMeii 

mrnhdical  hemaia :  tke  BroGraaii: 

B  too  LoCS^.      T....^  -.  -i.--;    i    •---... 

protessioniiJ  mea'3  n^ath' i»,  th  •  :t 

its  JT3st  what  prodnGea  nrie  r'  -».     in  is 

tfais  nfaat  tnake>  —  ■  -'  ^  -  ■  ■  -  -    - 

feifcle  ic  will  be  to  iaave  a  rjt)tare-     ic  •• 


npoB '       . 

TwiatmenL — The  pv  ■  -  - 

dr      •        •      ■  - 

WU.-    ._:   - .     ;„,-    ,     ■     -     - 

■bdboBuea.     A  -              ;  de;a3re«'  (irf 

ri'  r  iridted  by                                                          --i  iu* 

tb  -^cieta,     A  m-;,.,                                 .■...._..-.-    .j,;a8aaa 

w  •  xh^  ryrtrrritn^c^  aoii  r                        *  mrwi*.  Ipjr  wiuicli 

ti-  be  SO    i                                  •  ■•iaare'  wfl 


t'^-  -  "  Tane  a  circulitr  r*  "i 

aoirr    -  ■■  -h ^  --.--,-.   -  -.   .. 

ome  an 

the  IleachMv  «>  as  to  oitike  ic  re:§uJairi.y  cocuuBvre. 
preasioQ  bi=  -  :     ■  — 


DEFORMITIES.  377 


close  the  orifice,  by  pressing  frora  the  sides,  while  the  muscles  are  in 
this  relaxed  condition.  The  edges  being  thus  kept  in  contact,  apply, 
directly  over  the  point  of  protrusion,  a  layer  of  raw  cotton  or  soft  lint, 
wet  in  a  strong  decoction  of  white-oak  bark.  This  application  should 
be  just  large  and  thick  enough  to  fill  the  excavated  sui^face  in  the 
leather,  without  causing  any  pressure.  Apply  your  leather  pad  over 
it,  and  secure  it  by  a  bandage  passed  round  the  body,  sufficiently  tight 
to  compress  the  muscles,  and  keep  in  contact  the  parieties  of  the  aper- 
ture. It  is  better  to  fasten  the  pad  to  the  bandage  before  it  is  applied. 
This  should  be  kept  on  six  or  eight  days  without  being  removed,  unlesa 
it  produce  too  much  irritation.  It  should  be  wet  once  or  twice  a  day 
with  the  oak  decoction,  by  applying  it  upon  the  surface  and  allowing  it 
to  soak  thi'ough  the  pad  and  cotton."  One  or  two  weeks  will 
often  sufl5ce  to  produce  adhesion  in  an  infant,  while  an  adult  may 
require  the  treatment  for  one  or  two  months.  '  While  removing  the 
dressings  the  patient  must  be  placed  in  the  position  before  described, 
and  the  walls  of  the  abdomen  firmly  held  by  an  assistant,  so  that  no 
motion  be  allowed  to  inteiTupt  the  adhesive  process. 


CHAPTER  VIII. 

DEFORMITIES. 


The  deformities  which  result  fromaccident,  disease,  or  malcon forma- 
tion, are  innumerable ;  but  an  understanding  of  the  principles  which 
apply  to  the  management  of  those  which  are  common,  will  readily 
suggest  the  modifications  applicable  to  unusual  cases. 

Hare-Lip — Labium  LEPORI^■UM. — This  is  a  fissure  in  the  upper 
lip,  which  lUJiy  be  single  or  double.     In  the  Fig.  206. 

former  case  it  is  usually  on  one  side  of  the 
mesial  line;  in  the  latter  each  fissure  ex- 
tends downward  and  outward  from  one  of 
the  nostrils,  as  in  fig.  206.  In  some  cases 
the  division  extends  backward  through  the 
palate  bone,  and  often  the  front  teeth  pro- 
ject through  the  fissure,  adding  greatly  to 
the  deformity.  docble  hare-lip. 

Treat'ient. — ^The  operation  of  tying  by  the  twisted  surare  is  the 


378  SURGERY. 


only  rtMiiedN .  Tiio  edges  of  the  fissure  are  raised  with  the  fingers  (ir  i 
forceps  ;  a  flat  piece  of  wood  is  placed  between  the  lip  and  gum ;  and  I 
the  edges  are  then  pared  olf  fvoi'.?  hoth  sides  upon  the  wood  with  a  ; 
8cali)el  or  bistoury,  leaving  the  edges  straight  like  the  shape  of  the  let-  J 
ter  V.  Tiio  bleeding  ran  be  stopped  by  sponging  with  cold  water,  ; 
after  which  a  thhi  sewing  needle  is  passed  through  and  across  the  fis-  i 
sure  near  its  lower  extremity  ;  t)ie  needle  must  penetrate  nearly  to  the  \ 
inner  surface  of  the  lip,  which  will  keep  the  inner  edge  together  while  i 
the  ligature  secures  the  outer  edge.  After  this  needle  is  secured  by  j 
the  thread  two  others  are  to  be  introduced  above  at  proper  distances,  j 
and  the  part  dressed  with  wet  lint,  over  which  a  bandage  is  applied,  ' 
and  kept  constantly  wet  with  cold  water.  Adhesion  will  take  place  in 
about  a  week,  during  which  time  the  patient  must  be  kept  very  quiet; 
after  this  time  the  needles  may  be  removed  and  adhesive  straps  ap-  j 
plied.  When  two  fissures  exist  each  is  to  be  treated  in  the  same  way,  | 
and  both  should  be  operated  upon  at  the  same  time.  When  projecting  , 
teeth  are  in  the  way  they  should  be  extracted.  i 

I 

Tied  Tongue. — Notwithstanding  I  have  had  some  fifty  applications  , 
to  cut  babies'  tongues,  I  have  never  yet  seen  a  case  of  this  kind.  It  is  \ 
an  extremely  rare  occurrence  in  reality,  thougli  very  apt  to  exist  in  I 
the  imagination  of  nurses.  W^hen  the  frenum  lingua  is  extended  to  | 
the  tip  of  the  tongue,  firmly  holding  this  "unruly"  member  to  the  j 
floor  of  the  mouth,  and  preventing  the  child  from  sucking,  it  is  a  j 
tongue-tie ;  and  then  the  surgeon  may  elevate  the  member  with  one  ' 
or  two  fingers,  and  snip  the  string  across  as  near  the  floor  of  the  mouth  \ 
as  possible,  with  a  pair  of  scissors.  The  cut  should  rarely  extend  be- 
yond one  eighth  of  an  inch. 

Enlarged  Tonsils  and  Uvula. — These  are  rather  inconveniences  i 
tlian  dof(}nnities ;  yet  it  is  sometimes  advisable  to  excise  them.  The  i 
proper  instrument  for  doing  this,  fig.  207,  has  an  angular  or  rounded  i 

Fijr.  207.  I 


INSTUU-AIKNT    FOR    KXCISING    THE    TONTSILS    AND    UVULA. 

blade,  which  can  be  drawn  back,  leaving  a  ring  to  be  passed  over  the 
part  to  be  removed,  after  which  the  blade,  armed  with  a  needle  to 
prevent  the  excised  portion  falling  into  the  throat,  is  pushed  forward 
against  the  tumor. 


BEFOKMITIES. 


S79 


Squinting — Strabismus. — In  the  majority  of  cases  of  permanent 
e-'pinting,  the  difficulty  is  owing  to  a  disproportionate  contraction  in  the 
recti  muscles,  one  being  too  much  relaxed  and  the  other  preternatu- 
raiiy  contracted.  The  remedy  consists  in  a  division  of  the  contracted 
muscle,  and  this  is  usually  the  internal  rectus.  The  eye  is  secured 
and  held  by  the  wire-spring  speculum,  fig.  208 ;  a  double-hook  is  then 

Fi>  ''OS 


SPECULUM  APPLIED    TO    THE  EYE. 

hitched  to  the  conjunctiva  midway  between  the  margin  of  the  cornea 
anc'  internal  canthus,  by  which  the  ball  is  rolled  outward,  as  represented 
in  fig.  209,  and  the  handle  then  held  by  an  assistant.  The  operator 
next  raises  the   conjunctiva  with  Fig.  209. 

fine  hook-forceps,  cuts  into  it  per- 
pendicularly with  the  curved  scis- 
sors, and  continues  to  raise  and  di- 
vide the  cellular  tissue  until  he 
reaches  the  muscle,  when  he  sev- 
ers it  with  the  scissors. 

If  the  muscle  has  been  com- 
pletely divided,  the  patient,  on  hav- 
ing the  eye  released,  will  be  able 
to  turn  it  in  all  directions,  except 
directly  inward.  Aftei"  the  opera- 
tion, the  eye  requires  to  be  kept         operation  for  strabismus. 

covered  for  a  day  or  two  with  a  wet  cloth. 

Superfluous  Fingers  and  Toes. — Supernumerary  appendages  to 
the  hands  and  feet  are  not  of  much  consequence ;  but  as  they  are  not 
usually  attached  by  a  regular  joint,  they  may  readily  be  got  rid  of  by 
means  of  the  ligature  or  knife. 


"Wkb  Fingers. — These  only  require  division  by  the  scalpel,  and  to 


880 


SURGERY 


be  prevented  from  reuniting  by  a  piece  of  oiled  silk  kept  between  the  i 

fingers  until  cicatrization  takes  place.  i 

Wry  Nkck. — If  this  deformity  is  so  great  as  to  render  an  operation  [ 

desirable,  the  constricting  muscular  tendon  or  fascia  is  to  be  divided  ' 

with  the  knife.    The  incision  should  be  as  superficial  as  possible;  when  j 

the  muscle  luis  been  completely  divided,  it  will  snaj)  back.    The  hemor-  I 

vhnge  can  be  prevented  by  the  ordinary  compress.  i 

Spina  Bifida — Hydro-Raciiitis. — There  is  a  jJossibility  of  curing  ■ 
some  cases  in  which  the  membranous  covering  is  rather  thick  and  firm  ^ 
b}-  means  of  a  linen  compress  and  bandage,  applied  moderately  tight,  and 

so  adjusted  as  to  press  the  tumor  down  to  a  level  v/ith  the  surface.     If  ■ 
inflammation  exists,  the  cold  water-dressings  must  be  added. 

Spinal  Curvatures. — These  deformities,  which  have  been  con-  ! 

sidered  in  the  preceding  part  of  this  work,  are  rather  medical  than  sur-  | 
gical  maladies ;  and  the  subject  is  only  introduced  here  to  add  an  ocular 

demonstration  of  the  theory  advanced  in  relation  to  their  pre  isposing  ,! 
and  proximate  causes.     Fig.  210  is  a  representation  of  a  singlo  cuiTa- 

Fig.  21L 


Fig.  210. 


UISPOSIVION  AT  WORK. 


IVJtTBLE  CURVATURR. 


DEFORMITIES. 


381 


ture  in  its  forming  stage,  occasioned  by  a  habitually-improper  position  at 
a  work-table,  which  is  raised  too  high.  Those  who  have  a  clear  idea 
of  the  manner  in  which  these  ailments  originate,  will  at  once  appreciate 
the  absurdity  of  the  ordinary  treatment  with  mechanical  machinery  and 
surgical  cauterization,  by  which  many  poor  backs  have  been  cruelly 
tortured  and  many  bodies  permanently  crippled.  An  extreme  result 
of  the  same  cause  is  seen  in  the  curvature,  fig.  211. 

Scrofulous  persons,  from  their  greater  frailty  or  laxity  of  organiza- 
tion, are  peculiarly  liable  to  lateral  curvatures,  when  exposed  to  any 
causes  which  debilitate  the  muscular  system,  or  throw  the  different 
Bets  of  muscles  out  of  balance. 

In  double  curvatures  the  mispo&ition  of  body  is  generally  connected 
with  causes  which  tend  especially  to  debilitate  the  abdominal  muscles, 
as  constipation,  hot  drinks,  feather  beds,  etc. 

Mercurialized  Tongue. — This  is  both  a  cruel  disease  and  a  hor- 
rid deformity,  as  the  accompanying  representation  will  bear  witness, 
fig.  212,  and  I  introduce  the  subject  in  this  place  for  the  especia'  pur- 
Fig.  213. 


■ALIVATIOJ* 


882  SURGERY. 

poses  of  protesting  against  its  cause,  and  against  tlie  treatment  whicb 
those  physicians  whose  "healing  art"  creates  the  disease,  recom- 
mended to  cure  it.  This  treatment  consists  in  making  long  and  deep 
incisions  into  the  tongue  with  a  scalpel.  ^  It  is  not  strange  that  those 
practioners,  whose  "  remedies"  produce  such  consequences,  should  be 
the  poorest  doctors  in  the  world  when  those  consequences  themselves 
require  medication.  Nothing  will  reduce  this  violent  mercurial  inflam- 
mation equal  to  the  wet-sheet  pack,  so  managed  as  to  produce  mod- 
erate but  frequent  perspiration.  At  the  same  time  the  bowels  must 
be  kept  very  free  with  tepid  injections,  the  wet  compress  applied  to  the 
neck,  the  mouth  frequently  rinsed  with  cool  but  not  very  cold  water, 
and  sips  of  cool  or  cold  water — as  either  is  most  agreeable  to  the  patient 
— swallowed  whenever  the  patient  has  the  ability  to  swallow.  When 
the  body  is  extremely  sensitive  to  cold,  a  tepid  ablution,  followed  by  the 
dry  pack,  is  the  best  way  to  promote  a  perspirable  condition  of  the  skin, 
and  this  may  be  frequently  repeated. 

Professor  Chapman,  in  a  text-book  for  medical  schools  {Materia 
Medico),  tells  us  that  "  Occasionally  mercury,  from  some  unaccounta- 
ble cause,  instead  of  operating  as  a  remedy,  acts  as  a  poison ;''  and  Dr. 
Thacher,  author  of  two  standard  works  {American  Practice  of  Medi- 
cine, and  American  New  Dispensatory),  informs  us  that  "  no  rules  can 
be  given  or  regarded  to  regulate  its  administi'ation"  or  obviate  the  un- 
certainty always  attending  its  introduction  into  the  human  stomach; 
and  surely  such  authorities  sufficiently  sustain  the  protest  here  entered 
against  destroying  any  more  tongues,  teeth,  gums,  palates,  jaws,  and 
lips — I  have  seen  one  case  in  which  both  lips  were  eaten  off  by  a  mer- 
curial action — and  ruining  any  more  constitutions  by  this  Paracelsian 
quackery. 

PsEUDARTHROsis. — This  is  an  unnatural  or  false  joint,  resulting  from 
a  failure  of  the  portions  of  a  fractured  bone  to  unite  by  ossification  or 
callus  ;  it  may  be  caused  by  morbid  habit  of  body,  or  the  fault  may 
arise  from  the  fractured  bones  not  being  properly  brought  into  contact. 
A  ligamentous  capsule  forms  around  the  extremities  of  the  broken 
bones,  which  finally  become  smooth  and  round ;  and  in  some  cases  a 
regular  ball-and-socket  joint  is  formed.  The  most  hopeful  plan  of 
treatment  is  to  pass  a  seaton-needle,  armed  with  a  skein  of  silk,  through 
the  limb  between  the  ends  of  the  bones,  by  means  of  which  a  running 
sore  may  be  kept  up  for  six  or  twelve  months,  and  possibly  adhesive  in- 
flammation excited  and  a  re-union  produced. 

Club-Foot— Talipes.-  Surgeons  distinguish  four  varieties  of  this 


DEFORMITIES. 


583 


deformity.      In  the  first — talipes  varus — fig.  213,  the  foot  is  turned 

Fig.  213.  Fig.  214. 


TALIPES    VARUS. 


TALIPES    EQUINAS. 


Inward,  the  patient  walking  on  the  outside  of  it,  the  heel  being  el- 
evated. In  the  second  variety  Pi^.  215 
— talipes  equinas — fig.  214,  the 
heel  is  more  or  less  elevated,  the 
patient  walking  on  the  ball  of 
the  foot  oronthe  toes,  and  pres- 
sing equally  on  all  the  toes,  or 
principally  on  the  side  of  the  lit- 
tle, or  that  of  the  great  toe.  In 
the  third — talipes  valgus — the 
foot  is  turned  out  so  that  the 
patient  walks  on  the  inner  sur- 
face, the  external  edge  being 
raised  from  the  ground,  and  the 
sole  standing  outward  ;  and  in 
the  fourth — talipes  calcaneus — 
fig.  215,  the  toes  and  foot  are 
elevated  to  an  acute  angle  with 
the  leg,  the  heel  resting  on  the 
ground. 

Causes. — The  first  variety  is 
produced  by  a  conti'action  of  the 

TALIPE3    CALCANEUS 


g84  SURGERY. 

muscles  of  the  calf  of  the  leg  and  the  adductors  of  the  foot;  the  sec- 
ond variety  is  usually  owing  to  a  contraction  of  the  gastrecnemii  mus- 
cles alone,  but  sometimes  the  flexors  of  the  toes  are  also  contracted  ; 
the  third  variety  is  caused  by  the  contraction  of  the  adductor  muscles, 
and  also  those  of  the  calf  of  the  leg ;  and  the  fourth  vaiiety  is  owing 
to  the  contraction  of  the  tibialis  anticus  and  the  extensor  muscles. 
These  deformities  are  usually  congenital,  but  may  result  from  acci- 
dents. 

Treatment. — The  majority  of  cases  can  be  remedied  b}^  proper  me- 
chanical apparatus,  if  it  is  applied  early — say  before  three  years  of  age. 
A.  variety  of  machines  are  in  use,  and  the  skill  of  the  surgeon  is  re- 
quired to  adapt  one  to  each  particular  case.  They  consist  essentially 
[/fa  stiff  shoe  or  sole,  fixed  to  an  upright  shaft,  to  which  springs  are  so 
attached  as  to  make  gentle  but  constant  extension  against  the  contracted 
muscles.  Where  machinery  fails,  or  is  not  applicable,  the  operation  of 
tenotomy — a  division  of  the  conti*acted  tendon  or  tendons — is  the  only 
chance.  A  division  of  the  tendo  achillis  is  sufficient  in  a  majority  of 
cases  of  the  first  vai'iety.  The  skin  is  drawn  tense  so  that  it  will  cover 
the  wound  when  it  contracts,  and  a  long,  narrow-bladed  knife  is  passed 
through  the  skin  flatwise  between  the  tendon  and  the  bone,  near  the 
anterior  surface  of  the  tendon,  one  or  two  inches  above  the  internal 
malleolus,  and  carried  through  to  the  skin  on  the  opposite  side ;  the 
edge  is  then  turned  upon  the  tendon,  and  while  an  assistant  bends  the 
foot  80  to  put  the  tendon  firmly  on  the  stretch,  this  is  cut  through,  v/hen 
it  will  separate  with  a  crackling  noise.  The  limb  is  kept  in  an  easy  po- 
sition for  three  or  four  days,  and  then  placed  in  a  suitable  machine  to 
keep  up  extension  and  fix  it  in  its  proper  situation. 

The  posterior  tibial  muscle  can  be  most  readily  divided  about  two 
inches  behind  and  above  the  internal  malleolus ;  the  anterior  tibial, 
where  it  passes  over  the  ankle  joint ;  and  the  flexor  of  the  great  toe  on 
the  sole  of  the  foot,  where  it  may  be  seen  and  felt  projecting  like  a 
strong  cord. 

Contracted  Sinews. — A  contraction  of  the  flexors  of  any  part  of 
the  body  is  so  termed.  It  is  most  frequently  seen  in  the  fingera  or 
toes  over-riding  each  other.  The  fingers  are  also  contracted  from  in- 
flammation, and  a  "club-hand"  is  sometimes  met  with.  Some  of  the 
cases  may  be  relieved  by  an  incision  through  the  skin  ;  but  others  re- 
quire the  operation  of  dividing  the  tendon  or  muscle  affected — tenotomy 
or  myotomy. 


DISLOCATIONS.  886 


CHAPTER  IX. 

DISLOCATIONS. 

Technology. — A  displacement  of  one  bone  from  its  natural  articu- 
lation with  another  is  called  a  simple  dislocation,  when  unaccompanied 
with  external  laceration  or  fracture ;  and  compound  and  complicaLed, 
when  those  conditions  co-exist.  Its  readjustment  is  termed  reduction. 
The  mechanical  means  employed  in  reduction  are  extension — the  force 
applied  by  the  surgeon  on  the  luxated  part;  and  counter-extension — the 
force  employed  to  fix  the  body  in  position,  which  may  be  by  machinery, 
such  as  pulleys,  or  by  the  hands  of  assistants.  Dislocations  are  called 
partial  when  the  bone  is  moved  out  of  position  in  its  socket,  or  on  its 
articular  surface,  without  being  thrown  completely  out  or  off. 

Syinptoms. — A  dislocation  is  known  by  a  change  in  the  external 
form  of  the  joint;  an  alteration  in  the  length  of  the  limb;  the  altered 
axis  or  position  of  the  limb.  The  patient  ma}^  have  the  power  to  move 
the  limb  immediately  after  the  accident.  When  considerable  swelling 
has  taken  place,  it  is  often  extremely  difficult  to  distinguish  between  a 
dislocation  and  a  fracture  near  the  joint.  When  muscles  are  ruptured, 
there  is  gi'eat  effusion  and  inflammation  in  the  part. 

Treatment. — The  principal  obstacle  in  the  way  of  reduction  is  the 
contraction  of  the  muscles;  and  this  difficulty  increases  with  the  length 
of  time  the  part  has  been  displaced.  When  luxation  has  existed  for 
several  weeks,  adhesions  are  apt  to  occur,  forming  a  new  joint  or  an 
anchylosis,  and  rendering  reduction  impossible  without  a  new  disloca- 
tion, and  doubtful  with. 

Very  soon  after  the  accident  the  displaced  bone  can  generally  be 
replaced  with  very  little  force.  But  when  the  muscular  contraction  is 
strong,  we  must  employ,  in  addition  to  extension  and  counter-extension, 
warm  water  to  the  part  to  relax  the  muscles  particularly  implicated ; 
and  in  severe  cases,  the  full  warm-bath,  to  relax  the  whole  muscular 
system ;  and  in  extreme  cases,  the  patient  must  also  drink  plentifully 
of  warm  water,  and  have  the  throat  frequently  tickled,  to  excite  and 
maintain  considerable  nausea.  The  extending  force  should  always  be- 
gin gently,  and  be  gradually  increased,  while  the  counter-extension 
should,  of  course,  be  fixed  and  uniform.  The  limb  should  be  slightly 
flexed,  so  as  to  favor  relaxation.     In  dislocations  of  the  shoulder,  the 

n— 33 


g^  BURSERY. 

extension  bandage  should  be  applied  to  the  forearm ;  and  in  disloca- 
tions of  the  hip,  above  the  knee.  As  the  patient's  mind,  directed  tc 
the  injury  or  operation,  increases  the  contractility  of  the  muscles, 
adroit  surgeons  often  conti'ive  some  way  of  diverting  it,  at  the  moment 
when  extension  has  been  carried  U  a  sufficient  extent,  as  by  smashing 
a  window,  communicating  tidings  of  some  awful  accident,  etc.  When 
the  bone  returns  to  its  socket,  a  "  snap,"  like  that  of  a  lock  when  the 
key  is  turned,  can  be  heard,  and  generally  felt.  The  after-treatment 
is  5imj)ly  a  bandage  wet  with  cold  water  for  a  few  days. 

There  is  a  general  plan  by  which  many,  perhaps  a  majority',  of  dis 
locations,  can  be  replaced  by  persons  entirely  ignorant  of  anatomy 
This  consists  m  drawing  the  limh  oid  of  place  as  much  as  possible,  iu 
(he  first  place — that  is,  extending  it,  and  then,  while  the  patient's  mind 
is  diverted  to  something  else,  making  a  sudden  rotary  motion,  during 
which  the  bone  generally  slips  into  its  place.  Many  marvelous  stories 
have  been  told  of  Dr,  Sweet  and  other  "  natural  bone-setters,"  who 
have  frequently  succeeded  by  this  method,  after  the  scientific  surgeon 
liad  failed;  they  were  called  natural  bone-setters,  because  they  were 
not  professionally  educated. 

The  following  remarks  of  Mr.  Skey,  on  "The  Reduction  of  Disloca- 
tions Generally,"  are  exceedingly  valuable  : 

"In  the  endeavor  to  reduce  a  dislocation,  the  line  of  traction  should 
hold  reference  less  to  that  of  the  socket,  or  surface  from  which  the 
^one  has  been  displaced,  than  to  the  more  important  purpose  of  easing 
it  from  the  surface,  on  which  it  has  lodged.  For  example,  the  rim  of 
the  glenoid  cavity,  in  dislocation  of  the  humerus,  presents  an  obstacle 
to  the  extension  of  the  bone  in  the  immediate  line  of  that  cavity;  but 
if  the  bone  be  drawn  oflfit  by  extension  made  in  any  oblique  direction, 
the  instant  this  ridge  is  passed,  the  head  will  rush  back  into  its  natural 
cavity.  So,  also,  in  dislocation  of'the  femur  on  the  doi-sum  illi,  we  do 
not  attempt  to  draw  the  bone  in  a  direct  line  wnth  the  acetabulum,  but 
we  carry  it  below,  round  its  back  and  elevated  margin,  and  no  sooner 
does  it  rr^ach  the  lower  part  of  the  rim,  which  is  much  less  prominent 
than  the  upper  and  back  part,  than  the  muscles  immediately  restore  it 
to  its  socket.  The  same  rule  holds  in  dislocation  of  the  ulna  and  radius 
backward  at  the  elbow -ji  int.  I  believe  the  exact  line  of  extension  to 
be  much  more  readily  determined,  and,  in  truth,  a  less  important  sub- 
ject of  consideration,  than  it  is  generally  deemed.  I  believe  that  if  we 
liring  the  bone  suflficiently  downward,  and  place  it  in  the  neighborhood 
of  the  articulation,  the  muscles  will  replace  it  with  as  much  ease  fis 
that  whicli  originally  dislocated  it. 

"The  bone  appears,  as  it  were,  sucked  violenth  into  the  socket,  even 


DISLGC  AT]  JNS. 


38T 


at  the  instant  of  its  sustaining  the  gi-eatest  force  of  extension.  Then 
is  it  that  the  muscles,  acting  with  one  accord,  set  at  naught  the  extend- 
ing power,  and  complete  the  work  of  reduction,  in  defiance  of  all  the 
agents  employed  at  the  moment  to  prevent  it.  I  consider  that  the 
muscles  are  the  immediate  agents  of  reduction,  and  not  the  surgeon, 
whose  entire  duty  consists  in  placing  the  bone  in  a  position  to  give  them 
the  opportunity  of  displaying  this  harmony  of  action,  and  of  exercising 
a  power,  even  beyond  that  of  the  mechanical  agents  of  extension.  It 
is  this  power  that  succeeds  in  forcibly  drawing  backward  the  head  of 
the  femur  into  its  cavity,  when  it  has  fairly  reached  the  rim  of  the  ace- 
tabulum, notwithstanding  the  force  employed  at  that  instant  in  extend- 
ing it.  In  the  examples  of  the  larger  dislocations,  I  place  no  reliance  on 
any  of  the  above-mentioned  efforts  of  manipulation,  but  depend  almost 
entirely  on  the  act  of  simple  extension,  in  the  fullest  confidence  of  the 
disposition  of  the  joint  to  right  itself  if  the  obstacles  be  removed." 


Dislocation  of  the  Jaw. — This  accident  arises  from  yawning  Of 

gapine;,  or  from  a  blow  on  the 

.  Fijr.  216. 

chin  when   the    mouth  is   wide 

open.     It  may  affect  one  or  both 

sides.      Fig.  216  represents  the 

appearance   of  the    mouth   in   a 

dislocation  of  both    articulations. 

The  mouth  remains  wide  open, 

the    saliva   runs   constantly,   and 

there  is  often  alarming  but  not 

dangerous  pain. 

Treatment. — The  reduction  is 
easily  affected.  Place  two  pieces 
of  soft  wood,  or  large  corks,  as 
far  back  between  the  teeth  as 
possible,  to  act  i\s  fulcrums ;  then, 
while  the  head  is  held  by  an  as- 
sistant, press  the  chin  steadily 
upward  and  backward. 

Another  method  is  :  place  the 
thumbs  on  the  back  teeth,  and 
the  palms  of  the  hands  and  fin- 
gers on  the  sides  and  under  sur- 
face of  the  jaw;  then  press  downward  with  the  thumbs,  and  forward 
and  upward  with  the  hands ;  the  thumbs  must  be  removed  as  the  joint 
slips  in  its  place. 


DISLOCATION    OF    THE    JAW. 


888 


5URGERY. 


Fig.  217. 


DiSLOCATiOxN  OF  THE  Clavicle. — The  collar-bone  may  be  dis- 
placed at  its  sternal  or  scapular 
extremity ;  in  the  former  case  it 

--  ^-= 't-;  is  pushed  fonvard  or  backward, 
■^:??=^?ii\  and  in  the  latter  generally  up- 
ward. Fi^.  217  shows  its  situa- 
tion when  dislocated  at  the  breast- 
bone. In  thin  persons  the  nature 
of  the  injury  is  obvious  at  a  glance ; 
but  with  very  fleshy  individuals 
the  diagnosis  is  sometimes  diffi- 
cult. Moving  the  shoulder,  how- 
ever, occasions  great  pain  ;  and  it 
is  with  much  difficulty  that  the 
patient  can  move  it  at  all. 

Treatment.  —  By    pulling    tho 
shoulder    backward   and    slightly 

Fig.  219. 


CLAVICtTLO-STERNAL   DISLOCATION. 


outward,  the  collar-bone  is  drawn 
down  to  a  level  with  the  breast- 
bone, when  the  head  will  readily 
fall  into  its  proper  place. 

To  retain   it  in    position,  sur- 

Fig.  218. 


CLAVICLE    BANDAGE    BEHIND. 


CLAVICLE    BANDAGE    ANTERIORLY. 


geons  have  a  clavicle  bandage,  which  is  buckled  round  the  body  and 
found  the  shoulders  with  a  soft  pad   in   each  armpit,  and  another  on 


DISLOCATIONS. 


389 


each  shoulder.  It  is  applied  in  dilterent  modes  by  surgeons,  and  in- 
closes the  arm,  as  it  were,  in  a  sling.  A  back  view  of  it  is  seen  in  fig, 
218,  and  a  front  view  in  fig.  219,  which  will  enable  any  person  of  ordi- 
nar}'  tact  to  adjust  it  successfully.  The  arm  is  previously  supported  in 
a  sling. 

When  the  scapular  end  is  dislocated,  the  shoulder  on  the  injured 
side  is  depressed,  as  compared  with  the  other,  and  also  draion  btivard 
toward  the  sternum.  In  reducing  it,  the  surgeon,  standing  behind  the 
patient,  places  his  knee  betw^een  the  shoulders,  and  draws  them  both 
backward,  until  the  clavicle  sinks  into  its  place.  The  arm-sling  and 
clavicle  bandage  are  so  applied  as  to  keep  the  arm  pressing  slightly  up- 
ward, and  backward.  Some  degree  of  deformity  will  always  exist  after 
these  accidents. 


Fig  320. 


Dislocations  at  the  Shoulder-Joint. — The  head  of  the  hu- 
merus may  be  displaced  downward  into  the  axilla,  forward  under 
the  clavicle,  backward  upon  the  dorsum  of  the  scapula,  and  partially 
luxated  upward  against  the  outer  side  of  the  coracoid  process. 

Symptoms. — In  the  downward  luxation,  fig.  220,  the  head  of  the  bone 
is  readily  found  in  the  axilla,  or 
resting  on  the  lower  side  of  the  in- 
ferior costa  of  the  scapula;  there 
is  a  tumor-like  projection  in  the 
armpit,  and  a  corresponding  hol- 
low below  the  acromion  process. 
The  whole  form  of  the  shoulder  is 
changed,  the  muscles  being  flat- 
tened, and  the  arm  seemingly  elon- 
gated ;  the  elbow  cannot  be  brought 
to  the  patient's  side  without  great 
pain,  and  the  patient  inclines  to  sep- 
arate his  arm  from  the  body  and 
sui)port  it  with  the  other  hand. 
When  the  accident  has  existed  for 
a  considerable  time,  an  effusion  of 
lymph  into  the  joint  may  occasion 
a  crepitus  on  moving  the  arm, 
something  like  the  grating  sound  of  a  fracture.  In  the  forward  luxa^ 
tion,  fig.  221,  the  head  of  the  humerus  can  be  plainly  felt,  and  gen- 
erally seen  upon  the  pectoral  muscle  below  the  clavicle.  The  point 
of  the  acromion  process  is  very  distinct,  and  beneath  it  is  a  considera- 
ble ho  low.     The  coracoid  process  is  on  *^he  outside  of  the  displaced 


DOWNWARD  LUXATION. 


890 


SURGERY. 


head,  which,  when  the  arm  is  rotated,  can  be  observed  to  move.  The 
elbow  is  thrown  further  back  tlian  in  the  downward  luxation,  the  arm 
is  much  siiortened,  and  tliere  is  gi-eat  difficulty  in  moving  the  arm  in 
any  direction. 

In  the  backward  luxation,  fig.  222,  the  projection  of  the  head  of  the 
Fig.  221.  Fig.  22" 


FORWARD  LUXATION.  BACKWARD  lA^KTlOTH. 

bone  is  apparent  at  first  sight,  and  when  the  elbow  is  rotated  it  is  seen 
to  move.     It  may  also  be  felt  by  app'ying  the  finger  just  below  the 

Fig.  223. 


-^=2^^ 


REDUCTIO    OF  AXILLARI   I.UXATIOKS. 


D I  S  L  0  C  A  T 1 0  X  S. 


391 


spine  of  the  scapula,  and  the  change  in  the  axis  of  the  limb  is  quite  ob- 
vious.    This  variety  of  dislocation  is  extremely  rare- 

T'reatment. — The  general  plan  of  reducing  luxations  at  the  shoulder 
joint,  adopted  by  modern  surgeons,  is  represented  in  fig.  223.  The 
patient  is  placed  in  a  recumbent  position,  and  tlie  surgeon,  sitting  be- 
fore him,  puts  his  unshod  heel  on  the  head  of  the  bone  in  tlio  axilla, 
Rnd  presses  it  upward,  while  he  pulls  steadily  and  lirmly  on  the  arm 
until  the  head  of  the  bone  slips  into  the  glenoid  cavity.  By  this  simplo 
management,  almost  any  person,  although  entirely  ignorant  of  anat- 
omy, may  reduce  nearly  all  the  luxations  that  occur* at  this  joint,  by 
taking  the  case  very  soon  after  the  accident.  If  greater  force  is  re- 
quired than  one  person  can  exert,  he  may  be  assisted  by  others  pulling 
behind  him,  by  means  of  additional  straps  or  bandages  placed  upon  the 
arm.  If  this  plan  fails,  greater  force  can  be  brought  to  bear  by  the 
method  represented  in  fig.  224.     The  patient  is  seated  in  a  chair,  and 

Fig.  2'2A. 


EXTENSION'  AND  COITNTER-EXTENSION. 

C07infer-cxte7iding  bandages  so  applied  as  to  let  the  arm  pass  through 
them.  For  the  extendi n, a  bandage,  a  wetted  roller,  placed  around  the 
arm  above  the  elbow,  with  straps  or  slips  of  cloth  attached,  will  answer 
The  arm  is  then  raised  so  that  the  elbow  is  a  little  above  the  horizon- 
tal line  with  the  shoulder,  and,  while  in  this  position,  two  or  more  as- 
sistants make  gradua'  and  steady  extension  upon  it,  an  equal  amount 


892 


SI  KG  Ell  T. 


of*  force  being  emplavetl  in  prfxlucing  counter-extension  at  tlie  some 
time.  After  tljs  slniin  ujx>n  the  muscles  hns  been  continued  for  some 
Time,  the  surgeon,  resting  his  foot  on  tlie  chair,  pushes  his  knee  'imo 
the  HxillJi  and  presses  up  the  he;jd  of  the  bone,  wliije  he  presses  down 
on  the  ncroinion  with  one  hand  ;   making  also  slight  rotation  upon  the 


There  is  another  methc  J  by  which  a  majority  of  recent  dislocations 
can  be  easily  repkiced  without  waiting  for  the  regular  sui-geon.  Plac» 
the  patient  in  a  chair,  fig.  225,  extend  the  luxated  arm  as  far  as  possi 

Fig.  225. 


REDUCTION  OK  RECENT  LUXATIONS.  , 

ble  from  the  side,  then,  .vith  tlie  kuee  in  the  axilla — the  foot  being  sup 
ptjrted  on  a  chair,  and  the  heel  raised  so  as  to  press  the  knee  upward 
— grnsp  the  humerus  above  the  elbow  with   the  hand,  pressing  down 
\i\xm  the  shoulder  at  the  same  time.     The  pulley  and  counter-extend- 
ing bandage,  seen  in  the  cut,  may  also  be  employed  if  necessary. 

In  the  forward  luralicm,  the  extension  is  to  be  made  obliquely  down- 
ward !ind  slightly  b.ickward.  The  resistance  is  usually  stronger  tJian 
in  axillary  dislocatioiw  ;  hence  extension  must  be  kept  up  somewhat 
longer.  When  the  head  of  the  bone  is  observed  to  move,  the  surgeon 
should  place  his  knee  or  heel  against  it,  and  press  it  backward  into  ita 
cavity.  Tn  other  respects  the  management  is  the  same  as  for  the  pre- 
ceding variety. 


D  1  S  L  0  C  A  T  I  C  N  S. 


393 


In  the  backward  luxation  the  reduction  is  easy.  After  the  shoulder 
is  fixed,  gradual  extension  is  made  directly  outward,  the  head  of  the 
bone  being  thus  moved  slowlv  forward  into  the  glenoid  cavity.  This 
dislocation  has  been  replaced  by  merely  raising  the  arm,  and  turning 
the  hand  to  the  back  of  the  head. 

After  reduction,  the  arm  should  be  carried  in  a  sling  for  several 
dijys,  and  all  motion  at  the  joint  prevented  by  suitable  bandages. 

Dislocations  at  the  Elbow. — Injuries  at  this  joint  are  very  fre- 
quently complications  of  dislocation,  fracture,  aad  laceration.  Sur- 
geons distinguish  five  varieties  of  dislocation.  Both  bones  of  the  fore- 
arm ma}'  be  pushed  backtvard,  or  to  one  side  ;  the  radius  may  be  dis- 
placed forward  ;  the  ulna  alone  may  slip  backward  over  the  cond^yle  of 
the  humerus;  and  the  radius  alone  may  slip  from  its  connection  at  the 
elbow  joint. 

Symptoms. — When  the  radius  and  ulna  are  both  dislocated  backward^ 


Fig.  226. 


Fig.  227. 


KLBOW    LUXATION    BACKWARD. 

fig.  22C,  the  posterior  pi'ojection  k  very  prominent. 
The  olecranon  process  is  above  the  external  con- 
dyle, and  a  deep  hollow  may  be  felt  on  each  side 
of  it;  while  in  front,  under  the  tend^s,  the  con- 
dyles  appear   like    hard   tumors.     The   hand  and 
forearm  are  supine,  and  cannot  be  entirely  turned. 
In  the  lateral  dislocations  of  both  bones,  whether 
inward  or  outward,  they  are  driven  more  or  less 
backicard.     In  the  outivard   dislocation,  fig.  227, 
the  projection  of  the  ulna  is  still  greater;  the  co- 
ronoid  process  is  fixed  at  the  external  condyle;  an^f 
the  flat  head  of  the  radius  forms  a  projection  outside 
and  behind  the  elbow,  with  an  abrupt  cavity  above  lateral  eisloca* 
it.     In  the  nm-cri  luxation,  fig.  228,  the  head  of     tion  outward. 
t..e  ulna  is  displaced  behind  or  )ver  the  internal  condyle,  projecting  ic 


^94 


SURGERY, 


■\ 


^ 


tliat  direction,  while  the  external  Condyle  is 
miule  equally  prominetit  on  its  side  by  the  radius 
occuyping  the  place  of  the  ulna. 

When  the  idna  is  dislocated  backward,  the 
olecranon  can  be  easily  felt  behind  the  humerus  ; 
the  arm  cannot  be  straightened,  nor  can  it  be 
flexed  to  more  than  a  right  angle ;  the  forearm 
nnd  hand  are  also  tw'*?ted  inward. 

In  dislocations  of  the  radius  forward,  fig. 
•2-29,  the  forearn:  is  more  or  less  bent,  but  in 
Tempting  to  flex  it  further,  it  is  suddenly  stop- 
ped before  k  gets  to  a  right  angle  ;  the  elevated 
head  of  the  radius  bears  against  the  fore  part  of 
the  humerus,  where,  if  a  finger  be  pressed  into 
the  bend  of  the  arm,  it  may  be  felt  moving. 
The  hand  is  also  in  a  state  of  pronation. 

In  the  backward  dislocation  of  the  radius, 
fig.  230,  the  head  of  the  bone  may  be  seen  and 
felt  behind  the  external  condyle  of  the  hu- 
merus ;  the  arm  is  nearly  straight,  and  cannot 
be  flexed  ;  the  liand  is  pronate,  and  cannot  be 

LATERAL  DISLOCATION  tumed. 

i-NWARD.  Treatment. — The  first  variety  is   easily  re- 

Fig.  229. 


FORWARD    LUXAllu.N 
Fig.  230. 


U!     FHE    RADIUS. 


BACK-WARD    LUXATI.X    OJ     THE    R.^DIVi 


duced.  The  sur- 
geon places  his 
knee  on  the  inner 
side  of  the  elbow, 
pressing  chiefly  on 
the  displaced  bones 
so  as  to  keep  them 
from  bearing  on 
the  end  of  the  hu 


D I  S  L  0  C  A  r  1 0  N  S. 


merus.  and  to  bring  the  coronoid  process  out  of  the  posterior  fossa,  so 
that  it  can  pass  over  the  condyles,  while  the  arm  is  hent  slowly  and 
steadily  with  considerable  force.  This  fnriit  of  luxation  can  generally 
be  reduced  with  tlie  aid  of  suitable  hot  water  relaxant  processes,  a  loiyy 
time  after  the  accident. 

The  second  variety  is  mainly  reduced  by  bending  the  arm  over  the 
surgeon's  knee,  as  in  the  preceding  case  ;  less  pressure,  however,  is 
usually  required,  as  the  bones  do  not  require  the  same  separation  from 
the  humerus. 

The  third  variety  is  replaced  still  more  readily  by  the  same  general 
plan.  Here  the  bending  of  the  arm  is  the  principal  pait  of  the  oper- 
ation, the  fixed  radius  acting  like  a  levei-  to  push  the  humerus  back  ink< 
its  place  on  the  ulna.  * 

To  reduce  the  fourth  variety,  the  surgeon  takes  the  patient's  hand, 
as  in  "shaking  hands,"  and  makes  steady  extension,  while  his  other 
hand  is  pressed  strongly  on  the  ulnar  side  of  the  head  of  the  radius, 
pushing  it  outward  and  wpicard.  It  will  facilitate  the  reduction  to  have 
the  arm  slightly  bent. 

In  the  fifth  variety  ei'tension  is  to  be  made  upon  the  radius,  and 
counter-extensio7i  upon  the  humerus,  while  firm  pressure  is  made  on 
the  head  of  the  bone,  until  it  slips  into  its  place.  One  assistant  may 
make  the  extension,  another  the  counter-extension,  and  the  surgeon 
make  the  pressure  and  direct  the  movements  of  the  bone. 


Dislocations  at  the  Wrist. — Six  varieties  of  luxation  occur  at 
this  joint.  The  radius  and  ulna  may  together  be  displaced  forward  or 
backward,  or  either  of  them  separately  in  either  direction. 

Symptoms. — When  hoth  hones  are  displaced  forward.,  their  projec- 
tion is  seen  and  felt  under  the^^carpus.  This  accident  is  caused  by 
falling  on  the  palm  of  the  hand.  When  hoth.  hones  are  displaced  haclc- 
it^arrof,  they  project  oyer  the  carpus ;  the  carpal  bones  are  thrown  for- 

Flar.  2^51. 


BACKWARD    LUXATION    AT    THK    WRIST. 

ward  and  upward  under  the  flexor  tendons,  in   front  of  the  forearm 
This  luxation  is  represented  ir.  fig    231.     TMiosic   luxations   may  be  dis- 


396  SURGERY. 


tinguished  from  sprains,  or  strains,  by  the  more  sudden  occurrence 
and  more  uneven  appearance  of  the  swelling. 

Wlieii  the  radius  alone  is  displaced,  the  external  or  thumb  side  of 
llie  hand  is  backward,  and  the  opposite  side  inward  or  forward,  the  ex- 
tremity of  the  radius  may  also  be  seen  to  form  a  prominence  in  the 
front  of  thf>  wrist.  When  the  ulna  alone  is  detached,  which  more  fre- 
queiilly  liappens,  the  connecting  ligament  is  necessarily  ruptured:  iho 
liand  is  twisted,  tlie  bone  projects  at  its  back,  from  where  it  may  be 
easily  jiressed  down;  but  when  the  j)ressure  is  removed,  the  deformity 
wif  reappear. 

Treatment. — The  process  of  reduction  is  similar  when  both  bones 
are  displaced  either  forward  or  backward.  The  surgeon  holds  the 
hand  of  the  patient  in  one  of  his,  and  with  the  other  supports  the  fore- 
arm, while  an  assistant  holds  the  arm  at  the  elbow,  and  keeps  that  joiiri 
slightly  flexed.  When  sufficient  extending  and  counter-extending 
force  is  applied,  the  bones  are  drawn  into  place  by  the  contraction  of 
the  muscles.  Compresses  should  then  be  placed  upon  the  wrist,  and 
secured  by  a  roller  which  should  inclose  the  limb  from  the  tips  of  the 
fingers  to  the  elbow  ;  after  which  a  splint  should  be  added,  and  the  fore- 
arm suspended  in  a  sling.  The  same  ti'eatment  precisely  is  required 
when  the  radius  alone  is  dislocated.  To  reduce  the  dislocated  ulna,  it 
is  only  necessary  to  press  the  ulna  down  in  its  proper  cavity  at  the  side 
of  the  radius,  and  retain  it  there  by  compresses,  bandages,  and  splints. 
The  spiint3  should  be  well  padded,  extend  along  the  forearm  in  a  line 
with  the  back  of  the  hand,  and  be  well  secured  with  a  roller. 

Carpal  and  Mktacarpal  Dislocations. — Displacements  of  the 
bones  of  the  wrist  are  extremely  rare ;  but  when  they  do  occur,  the 
hand  is  to  be  extended,  and  the  bone  pressed  down  into  its  place,  and 
then  secured  by  proper  compresses  and  bandages. 

Luxations  may  occur  at  any  of  the  phalangeal  joints,  and  the  smaller 
bone  may  project  over  or  under  the  larger,  constituting  the  post erixvr 

Fig.  232. 


POSTERIOR    PHALANGEAL    LUXATIOW. 


D I S  L  0  C  A  r  I  0  N  s. 


897 


luxation,  fig.  232,  or  the  anterior,  fig.  233      The  nature  of  the  accident 
will  be  readily  distinguished  at  the  first  sight. 

Treatment — The  general  plan  of  reducing  dislocated  fingers  and 

Fig.  233. 


ANTERIOR    PHALANGEAL    LUXATION. 

toes  is  as  follows :  The  surgeon  places  his  thumb  at  one  of  the  divided 
extremities,  and  his  finger  at  the  other,  fig.  234,  then  makes  extension, 
while  the  joint  is  moderately  flexed.     The  reduction  will  usually  be 


Fig  234. 


Fig.  235. 


REDUCTION  OF  DISLOCATED  FINGERS  AND  TOES. 

easily  affected;  but  if  a  long  time  has  elapsed  since  the  accident,  the 
extension  may  require  to  be  kept  up  perseveringly  for  a  considerable 
length  of  time.  In  such  cases,  a  piece  of  tape  is  usually  employed  ;  it 
is  fixed  to  the  finger  by  what  is  called 
the  "clove- hitch,"  fig.  235,  and  to  this 
the  extending  force  is  applied. 

The  thumb,  which  is  seldom  dis- 
located, is  with  more  difficulty  re- 
duced. It  1  inquires  great  extending 
force,  during  which  i*  should  be  flex- 
ed toward  the  pahr  of  the  hand.  It 
should  also  be  wp  i  covered  with  wet 
tape  before  the  clove-hitch  tape  is 
applied. 

Dislocations  at  the  Hip-Joint.  clove-hitch. 

— ^I'he  head  of  the  femur  may  be  displaced  upward  ov  the  dorsupt?  of 
34 


398 


SURGERY 


the  ilium,  fig.  236,  or  downward,  into  the  foramen  ovale,  fig.  237, 

Fi-  236.  Fig.  237. 


or 


\ 


UPWARD    LTJXATIC  "«r. 

Fig.  238. 


BACKWARP  LUXATXOJf 


OOWITWAHD   LUXATIOjr. 


Fig.  239. 


»VRWARD  LVXAWOW, 


DISLOCATIONS. 


backward,  into  the  iscliiatic  notch,  fig.  238,  or  forwc^d,  on  to  the 
pubes,  fig.  239,  in  which  case  it  is  Also  thrown  upward.  The  first  va- 
riety is  the  most  frequent,  being  the  result  of  violence  in  an  upward 
and  outward  direction. 

Syinptoms. — In  the  j^?  67.  variety  Xh.&  femur  rests  on  the  concave  side 
of  the  pelvis ;  the  limb  is  shortened  from  an  inch  and  a  half  to  two 
inches;  the  knee  closely  approximates,  yet  does  not  touch  that  of  the 
other  leg  ;  the  foot  is  turned  inward  ;  the  thigh  can  be  bent  over  the 
opposite  one,  and  the  round  head  of  the  bone  can  be  felt  moving  upon 
the  ilium.  Fig.  240  represents  the  appearance  of  the  limb  while  the 
patient  is  in  the  standing  position. 

In  the  downward  dislocation,  the  head  of  the  bone  can  be  felt  by  ex- 
amining the  inside  of  the  thigh,  especially  in  thin  persons  ;  the  leg  oi* 
the  affected  side  is  about  two  inches  longer  than  the  other ;  the  tro- 
chanter is  less  prominent  than  on  the  sound  side;  the  body  is  bent  for- 
ward; and  when  the  patient  stands  erect,  the  knee  projects  in  ad- 
vance of  its  fellow,  and  is  kept  wide  apart  from  it;  the  foot,  though 
separated,  is  turned  neither  in  nor  out,  fig.  241. 

Fig.  240.  Fig.  241. 


VPWARD  J.TJXATIOX. 


JIOTVNWART  LUXATION 


iOO 


5  U  R  G  E  R  Y 


In  the  back'-ard  luxation,  the  head  of  the  femur  can  rarely  be  felt; 
flio  trochanter  will  be  found  further  back  than  natural ;  the  foot  and 
knee  are  turned  inward  ;  the  knee  is  slightly  flexed  and  advanced  for- 
ward ;  the  heel  is  raised,  and  the  ball  of  the  great  toe  rests  on  the  base 
of  the  other  grea»-  toe,  and  the  limb  is  shortened  from  half  an  inch  to 
an  inch,  fig.  24'2. 

In  the  forward  and  upward  luxcation,  the  head  of  the  bone  is  at  once 
discovered  in  front,  and  a  little  above  the  level  of  Poupart's  ligament, 
which  circumstance  distinguishes  the  case  from  a  fracture  of  the  neck 
of  the  femur  ;  the  limb  is  shortened  from  one  to  one  and  a  half  inches; 
the  knee  is  everted  ;  the  foot  and  knee  cannot  be  rotated  inward,  bat 
the  thigh  can  be  flexed,  bringing  them  forward.  In  the  erect  position 
this  patient,  fig.  243,  contrasts  strikingly  with  the  preceding  one. 

Treatment. — As  the  muscles  concerned  in  this  articulation  are  large. 
and  their  resistance  powerful,  it  is  always  prudent  to  relax  the  whole 


Fig.  242. 


Fi?.243. 


BACKWARl     -.UXATION. 


!■  R\V.4:RD  LUXATI01» 


DISLOCATIONS. 


401 


musculai  system  before  atteinpting  reduction.  An  admu'able  and  very 
pleasant  method  of  doing  this  is  to  envelop  the  patient  in  the  warm 
wet-sheet  pack,  placing  hot  bottles  to  his  feet  and  sides,  and  covering 
him  well  with  bedding,  the  affected  limb  being  sustained  in  an  easy  po- 
sifcon  by  pillows  ;  while  in  the  pack  the  patient  should  drink  abundant- 
ly of  wai-m  water,  and  after  being  sufficiently  relaxed  for  the  opera- 
tion, he  should  be  kept  well  covei-ed  in  flannel  blankets  to  retfiin  the 
heat  and  moisture,  and  prolong  the  relaxation.  All  of  these  hip  dislo- 
cations can  frequently  be  reduced  by  the  rotary,  or  "Sweet  plan;" 
but  surgeons  have  a  specific  and  surer  method  for  each  variety. 

In  the  vjpward  displacement  the  patient  is  laid  on  a  table,  or  placed 

Fi£.  244 


REDUCTION  OF  UPWARD  LUXATION. 

on  a  board,  fig.  244,  covered  with  a  quilt  or  blanket ;  a  strong  counter- 
extending  strap  is  passed  between  the  legs — a  sheet  split  in  two,  and 
folded  into  the  width  of  four  or  five  inches,  will  answer;  this  is  passed 
up  before  and  behind  the  hip;  so  placed  as  to  press  upward  on  the 
perineum,  at  the  inside  of  the  dislocated  limb,  and  listened  to  some 
unyielding  point.  A  wet  bandage,  of  eight  or  ten  turns,  is  applied 
around  the  limb,  above  the  knee,  and  to  this  the  extendh^g  straps  are 
attached.  These  are  to  be  draw^n  upon  by  the  assistants  in  the  direct 
line  of  the  limb ;  or,  what  is  better,  attached  to  a  pulley,  so  stationed 
^bat  the  extension  may  draw  in  a  direct  line  with  the  fastening  of  the 
rounter-extension.  The  force  is  to  be  steadily  increased  as  long  as  tlie 
patient  can  well  bear  it,  then  held  stationary  for  a  few  moments,  until 
he  ceases  to  complain,  then  again  increased,  and  so  continued  until  the 
bead  of  the  bone  reaches  the  edge  of  the  socket,  when  the  surgeou 
rotates  the  limb  a  little,  and  elevates  the  head  until  it  entei's  the  aceta- 
bulum. The  snapping  noise,  as  the  head  of  the  femur  slips  into  its 
socket,  when  the  extension  is  made  by  rr»a  aual  force,  is  not  always 


402 


SURGEPa 


he:ird  when  the  force  is  more  steadily  and  gradually-  apphed  by  the 
piilif'Vs;  honce  it  is  sometimes  necessary  to  ascertain  the  fact  of  its 
repliujenient  by  actual  measurement;  and  until  this  point  is  settled  the 
ejwtension  should  not  be  abated.  In  some  cases  the  head  of  the  bone 
is  held  fast  over  the  edge  of  the  socket;  to  prevent  this  a  towel  or 
handkerchief  may  be  placed  round  the  thigh,  as  high  up  as  possible, 
and  the  bone  lifted  by  it  at  the  proper  moment. 

The  above  is  the  plan  approved  and  recommended  by  the  best 
"standard  authorities;"  but,  after  all,  it  is  probably  neither  the  best 
method,  nor  founded  on  true  mechanical  nor  physiological  principles. 
A  very  different  and  much  more  easy  plan  for  both  surgeon  and  pa- 
tient, which  dispenses  with  the  torture  of  traction  entirely,  was  prac- 
ticed successfully  many  years  ago  by  the  late  N.  Smith,  of  Yale  Col- 
lege, and  has  since  been  adopted  by  Dr.  Cartwright,  of  Natchez,  and 
recently  explained  by  Dr.  Reid,  of  Rochester.  It  is  as  follows  :  Place 
the  patient  on  his  back,  without  fastenings  of  any  Jdnd,  the  leg  flexed 
on  the  thigh,  and  then  strongly  adducted — carried  inward;  in  this  con- 
dition the  adduction  is  continued  by  flexing  the  thigh  on  the  pelvis, 
until  the  knee  is  as  high  as  the  umbilicus.  This  plan  is  predicated — 
correctly,  I  think — on  the  idea  that  the  distention  of  the  small  muscles 
constitutes  the  main  obstacle  to  reduction,  instead  of  the  contraction 
and  resistance  of  the  large  ones. 

The  reduction  of  the  downward  luxation  is  much  easier  than  that 
Qf  the  upward.     The  patient  is  placed  on  the  back,  the  thighs  sep- 

Fig.  245. 


REDUCTION    OF    DOWNWARD    LUXATION.  ] 

arated,  f\<r.  245;  a  folded  cloth  is  placed  over  the  perineum,  bO  that       1 
when  the  ends  are  drawn  upor  the  force  will  bear  against  the  inner      I 


DISLOCATIONS. 


403 


and  back  surface  of  the  bone.  Another  strong  band  is  passed  transvers«- 
]y  around  the  pelvis,  above  the  acetabulum,  the  front  end  passing  over 
the  former  strap,  so  as  to  give  to  it  a  more  upw^ard  direction.  The  force 
is  then  applied,  as  in  the  former  case,  and  as  the  head  of  the  bone  be- 
gins to  rise,  the  surgeon  passes  his  hand  under  the  opposite  leg,  and, 
seizing  the  ankle  of  the  affected  one,  brings  it  gently,  yet  firmly,  to- 
ward the  other ;  by  all  of  which  movements  combined,  it  is  brought 
into  its  socket. 

The  third  variety,  dislocation  backward  into  the  ischiatic  notch,  is  the 
most  difficult  of  all  to  reduce.     The  patient  is  placed  on  his  sound  side 

Fig.  246. 


MilU'.li       1,11  ^'^iMIllilli  -     \\V 

REDUCTION    OF    BACKWARD   LUXATION. 

on  a  board  or  table,  fig.  246,  with  the  affected  thigh  drawn  over  the 
middle  of  the  other.  Extension  and  counter -extension  are  made  in  the 
same  way  as  in  the  first  variety,  with  the  addition  of  a  strap  around  the 
upper  part  of  the  thigh,  which  is  carried  over  the  shoulders  of  an  assist- 
ant, to  raise  the  head  of  the  bone  at  the  commencement  of  the  opera- 
tion, out  of  the  notch,  or  impart  a  lifting  direction  to  the  extending  force. 
The  surgeon  may  also  press  the  trochanter  forward  with  his  hand. 
In  reducing  the  forward  and  upward  luxation,  the  patient  is  placed 

Fiff.  047. 


REDTjr.TION    OF    FORWARD    LUXATION 


i04 


SURGERy. 


on  his  sound  side,  the  counter -ex  ten  divg  foi-ce  fixod  somewhat  in  front 
of  a  line  with  the  body,  the  point  of  extension  being  as  much  behind, 
f\g.  247.  The  forces  are  intended  to  be  so  an-auged  as  to  draw  tlie 
limb  backward  as  well  as  downward.  The  lifting  strap  is  to  be  em- 
Fig  248.  ployed  as  the  extension  progresses,  an  assistant 
pressing  down  on  the  pelvis,  as  the  surgeon  raises 
the  head  of  the  femur  over  the  pubis  and  edge 
of  the  acetabulum. 


Dislocations  at  the  Knee-Joint. — The  jJci- 
tella  may  be  displaced  outward,  inward,  or  up- 
icard ;  and  the  tihia  may  be  dislocated  from  the 
iemnv  forward,  backward,  or  to  either  side;  the 
lateral  displacements,  however,  are  only  partial. 

Syrnplo7ns. — The  outivard  dislocation  of  the 
patella,  fig.  248,  is  more  frequent  than  the  inward  ; 
but  in  either  case  the  knee  is  partially  flexed,  and 
the  joint  immovable  ;  the  patient  also  complains  of 
a  sickening  pain  in  it.  The  upward  displacement, 
which  is  attended  with  rupture  of  the  ligament/ 
is  perfectly  obvious  to  the  sight. 

In  ihe  forward  dislocation  of  the  tibia,  fig.  249, 
the  head  of  the  bone  is  seen  and  felt  above  the 

Fig.  250. 


|i  i^'''' 


OXTTWABD   LVXATION 
OF    FATCLLA. 


Fig.  249. 


LUXATIOX    FORWARD. 


LTTXATIGX    BACKWARD 


DISLOCATIONS. 


406 


front  or  'he  condyles,  these  being  perceived  in  the  popliteal  s^^ace. 
There  is  also  numbness  of  the  foot,  from  pressure  on  the  nerves  and 
poplitenl  arlGiy. 

In  the  backward  luxation,  fig.  250,  the  limb  is  sensibly  bent,  and 
somewhat  shortened;  the  condyles  project;  and  the  flexure  ©f  the 
limb  is  backward  instead  of  forward,  the  foot  being  drawn  forward. 

In  the  lateral  displacements  one  condyle  of  the  femur  rests  on  the 
head  of  the  tibia,  where  the  other  condyle  belongs,  the  displaced  on* 
projecting  externally  or  internally,  as  in  fig.  251  and  fig.  252. 


Fig.  251. 


FiR.  252. 


LATERAL  LX7XATI0?f  EXTERXALLY. 


Stliif 


LATERAL  LUXATION  INTERNALLY. 


Treatmejit. — To  reduce  the  outward  dislocation,  the  patient  is  placed 
iu  a  recumbent  posture,  the  limb  raised  by  the  heel,  to  relax  the  ex 
tensor  muscles,  and  then  the  displaced  bone  is  pressed  down  to  its 
place,  the  force  being  applied  to  the  edge  most  distant  from  the  joint. 
The  vpward  dislocation  is  easily  reduced,  but  with  difficulty  kept  in  its 
place,  on  account  of  the  rupture  of  the  ligament.  The  roller,  skill- 
fully applied  from  the  toes  to  the  groin,  will  generally  answer;  and 
this  may  be  assisted  by  a  straight  splint  fastened  under  the  whole 
length  of  the  leg. 

All  the  varieties  of  luxated  tibia  are  reduced  by  the  same  plan,  which 
is  chiefly  that  of  simple  extension.  The  pelvis  is  fixed,  and  a  bandage 
placed  round  the  ankle  by  which  the  extension  is  made.  While  the 
assistant  pulls  upon  the  ankle,  the  surgeon  presses  upon  the  separated 
head  of  the  bone  with  his  hands. 


406 


SURGERY. 


Dislocations  at  thp:  A.mvle. — The  ankle  joint  may  be  displaced 
inward,  outward,  foncard,  or  backward.  The  accident  is  frequently 
compiicHted  \\\\\\  fnicture. 

Si/mploms. — In  the  inward  dislocation,  fig.  253,  which  is  the  most 
common,  the  foot  is  turned  out,  and  a  tumor  is  formed  by  the  internal 
malleolus  pressing  strongly  against  the  skin,  which  seems  ready  to 
burst;  the  joint,  however,  is  still  movable.  A  depression  may  gen- 
emlly  be  felt  about  three  inches  above  the  ankle,  in  which  case  the 
fibula  is  fractured.  The  outward  dislocation  is  known  by  a  corre- 
sponding deformity  on  the  other  side.  In  the  forward  dislocation,  fig. 
254,  the  foot  is  shortened,  the  heel  elongated,  and  the  toes  point  down- 
ward. The  backward  dislocation,  which  rarely  occurs,  is  manifest  to 
the  sight. 

Treatment. — The  manner  of  reduction  is  essentially  the  same  in  all 
cases.  An  assistant,  holding  the  foot  by  the  heel  and  toes,  flexes  the 
leg  to  a  right  angle  with  the  thigh,  and,  while  the  thigh  is  held  ftist  by 
another  assistant,  just  above  the  knee,  makes  extension  at  the  ankle,  the 
surgeon  at  the  same  time  pushing  the  end  of  the  tibia  into  its  place 


Fig.  253. 


Fig.  254. 


IJfWAKD  LnZATION. 


»X)RWARD  LUXA^KWr. 


FRACTURES.  407 


Splints  and  bandages  ai-e  necessaiy,  and  wet  cloths  must  be  frequently 
applied,  as  there  is  usually  considerable  inflammation. 

Dislocations  of  tup:  Foot. — When  the  tarsal  or  metatarsal  bones 
are  displaced,  the  nature  of  the  injury  is  obvious.  Reduction  is  ef- 
fected by  extending  the  foot  and  pressing  upon  the  displaced  bone  at 
the  same  time.     Compresses  and  bandages  are  necessary. 

Dislocations  of  the  toes  are  managed  precisely  in  the  same  way  as 
dislocated  fingers. 


CHAPTER  X. 

FRACTURES. 

Technology. — A  fracture  is  called  transverse  when  the  bone  is  bro- 
Ken  directly  across ;  longiludinal  when  it  is  split  lengthwise  ;  and 
oblique  when  broken  in  other  directions.  When  the  fracture  is  not 
accompanied  with  an  external  wound,  it  is  called  simple ;  when  the 
soft  parts  are  so  lacerated  that  the  fractured  bones  protrude,  it  is  termed 
compound ;  when  occurring  in  connection  with  a  dislocated  joint,  it  isf 
termed  complicated ;  and  when  the  fractured  bone  is  divided  into  sev- 
eral fragments,  it  is  called  comminuted. 

General  Management  of  Fractures. — Although  a  few  genera^ 
principles  are  applicable  to  all  cases,  so  great  is  the  diversity  of  circum- 
stances attending  these  accidents,  iiat  much  must  be  left  to  the  sound 
judgment  and  mechanical  skill  of  the  operator.  A  great  variety  of 
splints,  bandages,  and  other  apparatus  have  been  invented,  all  intended 
to  keep  the  injured  parts  in  contact  until  the  broken  parts  of  the  bone 
unite. 

The  process  of  re-union  is  as  follows  :  Coagulable  lymph,  fibrin,  and 
blood,  thrown  out  by  the  vessels  of  the  part,  form  a  matei-ial  which 
slightly  glues,  as  it  were,  the  bones  together  soon  after  the  injury;  in 
the  next  place,  ^provisional  cartilage  is  formed  around  the  parts  like 
a  capsule,  firmly  supporting  them;  this  gradually  hardens,  by  ossific 
deposits,  into  a  bony  ring,  called  the  provisional  callus,  which  binds  the 
parts  still  more  firmly  together.  After  this  the  proper  substance  of 
the  bone  is  formed,  the  ossific  process  going  on  for  several  months  or  a 


♦08 


SURGERY 


j'ear  ;  and  when  it  is  completed,  the  provisional  support  is  removed  by 
absorption. 

The  period  at  which  the  reparative  process  commences  and  termi- 
nates, varies  with  the  structure  of  the  bone,  age,  and  habits  of  the  in- 
dividuid,  etc.  The  provisional  union  ordinarily  begins  between  the 
sixlh  and  tenth  day,  and  is  completed  in /oar  to  six  weeks.  The  soon- 
er, however,  that  fractures  are  adjusted,  the  better ;  and  about  the 
sut/i  or  seventh  dfiy,  when  the  "  knitting"  may  be  expected  to  com- 
mence, the  part  should  be  examined  and  accurately  adjusted,  if  need 
be  :  after  which  it  only  requires  to  be  kept  quiet.  Great  care  must  be 
taken  to  have  the  part  easy  and  quiet  from  the  sixth  to  the  twelfth  day 
— in  old  persons  for  eight  or  ten  days  longer — after  which  slight  mo- 
tion may  be  allowed.  The  symptoms  of  the  provisional  ossification, 
"  knitting  of  the  bone,"  are  itching  nnd  2)TicJtling  sensations  in  the  part. 

Fractures  of  the  Cranium. — Any  of  the  bones  of  the  skull  may 
be  crushed,  the  fracture  extending  in  different  directions  fmm  a  central 
point;  or  cracked  through  one  or  both  plates  in  a  straight  line.  The 
skull  bone  may  also  be  bent  without  being  fractured.  In  the  case  of 
fracture,  a  crepitus  can  be  felt  through  the  skin  ;  and  if  any  portion  of 
bone  is  driven  in  upon  the  brain,  symptoms  o?  compression  will  be  present. 

Treatment. — All  the  constitutional  and  local  measures  heretofore 
reconunended  for  comj)ression  must  be  employed  in  conjunction  with 
the  appropriate  treatment  for  any  degree  of  inflammation  that  may  at- 
tend. But  if  the  sj^rjptoms  of  compression  continue  after  tlie  inflam- 
mation has  subsided,  the  depressed  bone  must  be  elevated  by  trephi- 
ning, whicii  should  only  be  attempted  by  a  skillful  anatomist. 


Fractures  of  the  Nose. — These  accidents,  though  occnsionallv 
severe,  are  not  usually  dangerous,  and  their  nature  is  apparent  from  the 
Pj    „55  resulting  deformity.     They  can 

be  adjusted  by  pushing  out  the 
depressed  bone  by  a  silver  cathe- 
ter, or  some  similar  instrument, 
introduced  within  the  nostril, 
while  the  fingers  support  them 
on  the  outside. 


Fracture  of  the  Lower 
Saw. — The  accident  commonly 
occurs  at  the  middle  of  the  chin, 
fig.  255,  although   it   may   take 


FRACTURE  OF  THE  LOWEIi   JAW 


FRACTURES. 


409 


place  in  any  part.  The  crepitus  felt  on  moving  the  bone  will  deter- 
mine the  exact  locality  of  the  fracture  ;  a  depression  may  also  be  felt  at 
the  place. 

Treatment. — The  adjustment  is  effected  by  elevating  or  depressing 
until  n\\  the  teeth  are  arranged  properly  with  respect  to  each  other  and 
to  those  of  the  upper  jaw.  Should  one  of  the  condyles  be  displaced 
at  the  same  time,  it  must  be  reduced  previously  to  setting  the  broken 
bone.  The  jaw  must  be  secured — the  mouth  being  kept  shut — by 
neans  of  a  strip  of  adhesive  plaster,  two  and  a  half  inches  wide   ex- 

Fiff.  256. 


H— 35 


ADJUSTMENT    OF   FRAr  TITKED    LOWKR    *A^ 


410  SURGERY. 

tending  from  ear  to  ear  over  the  chin.  The  plaster  should  be  spread 
on  fine  leather,  as  calf-skin  ;  and  over  this  a  jandage  of  sti'ong  muslin, 
two  yards  long  and  two  and  a  half  inches  wide,  split  from  each  end  to 
within  six  inches  of  the  middle,  is  to  be  applied.  A  hole  is  made  in 
the  rontor  for  the  chic  ;  the  two  lower  ends  are  brought  up  over  the 
top  of  the  head,  and  the  two  upper  ends  are  carried  horizontally  round 
to  the  back  of  the  neck ;  several  turns  with  each  pair  are  then  made, 
over  and  around  the  head,  where  they  are  fastened  at  their  ends  and 
also  at  each  crossing.  In  the  absence  of  adhesive  plaster  the  com- 
press and  roller,  fig.  25G,  will  answer  all  purposes.  The  compress 
under  each  ramus  is  held  by  an  assistant  until  fastened  by  the  first 
turns  of  the  roller,  which  is  an  inch  and  a  half  in  length  and  four 
or  five  yards  long ;  the  first  vertical  turns  ai'e  repeated  over  each  other 
several  times,  followed  by  the  horizontal  ones  above  the  ear  over  the 
occiput  and  forehead,  and,  lastly,  several  turns  below^  the  ear  and  lip. 
Pins  or  stitclies  are  applied  wherever  the  roller  crosses  or  changea 
direction. 

Fractures  of  the  Scapula. — When  the  body  of  the  bone  is 
fractured  across,  there  is  scai'cely  any  deformity,  but  a  crepitus  is  easily 
recognized  on  pressure.  The  only  surgery  required  is  a  bandage  so 
applied  as  to  restrain  those  motions  of  the  chest  and  shoulders  which 
alTect  the  fractured  bone. 

When  the  acromion  process  is  fractured,  a  depression  is  manifest ; 
the  separated  ix)rtion  of  bone  is  drawn  downward  and  forward ;  and, 
on  pressing  the  arm  upward,  a  crepitus  may  be  felt.  The  adjustment 
consists  in  pressing  the  head  of  the  humerus  up,  by  which  the  frag- 
ment is  carried  to  its  place,  and  securing  it  by  the  clavicle  bandage, 
omitting  the  pads  or  compresses  under  the  arm. 

When  the  neck  of  the  scapula  is  broken,  the  head  of  the  humerus 
can  be  felt  in  the  axilla,  as  in  dislocations,  and  the  acromion  appears 
very  conspicuous  from  the  depression  beneath.  The  fracture  may  be 
distinguished  from  dislocation  by  the  crepitus  perceived  on  pushing  the 
.irm  ui)ward  and  outward,  with  the  thumb  placed  on  the  coracoid  pro- 
cess, and  the  fingers  in  the  axilla.  The  parts  can  easily  be  replaced 
and  held  in  apposition  by  the  clavicle  bandage  and  a  wedge-shaped 
pad  under  the  arm. 

Fracture  Or-  the  Clavicle. — A  fracture  of  the  collar-bone,  which 
is  usually  oblique,  and  occurs  near  its  middle,  fig.  257,  is  readily  de- 
tected by  passing  the  finger  along  the  edge  of  the  bone.  Crepitus  oo 
..ars  on  movino;  the  shoulder. 


FRACTURES. 


411 


The  adjustment  and  dressing  are  essentially  the  same  as  in  the  case 
of  a  dislocated  clavicle  at  its  scapulai*  extremity.     The  surgeon,  placing 


Fig.  257. 


FRACTURED    CLAVICLE. 


his  knee  between  the  sho:ilders,  draws  them  both  back  until  the  parts 
of  the  broken  bone  come  into  their  proper  position,  and,  while  th8 
shoulders  are  kept  back  and  the  arms  down,  by  suitable  apparatus,  or 
the  hands  of  assistants,  the  bandage  is  applied. 

Fracture  of  ihe  Sternum. — The  breast-bone  is  never  broken, 
except  by  great  force  directly  applied.  The  accident  is  manifested  by 
a  depression  at  the  injured  point,  and  pain  and  crepitus  which  attend 
the  movements  of  the  thorax  in  respiration.  Its  adjustment  requires 
the  roller  around  the  chest,  so  applied  as  to  stop  all  motion ;  the  res 
piration  being  carried  on  wholly  by  the  abdominal  muscles. 


Fracture  of  the  Ribs. — The  ribs  nay  be  fractured  at  their  ver- 
tebral or  sternal  extremity.  The  formet  case  is  frequently  accompa- 
nied with  dislocation.  The  latter,  though  generally  called  "dislocation 
of  the  cartilage,"  is  really  a  rupture,  and  a  rupture  is  much  more  like 
a  fracture  than  a  dislocation.  A  depression  and  crepitus  may  be  de- 
tected by  passing  the  finger  along  the  rib.  If  the  cartilage  is  torn 
from  the  rib,  this  bone  will  project. 

Treatment. — In  a  majority  of  cases  a  broad  roller,  applied  around 
the  chest  so  firmly  as  to  prevent  all  motion  of  the  intercostal  muscles, 
will  be  sufficient.  When  a  rib  projects,  the  compress  must  be  ap- 
plied ;  and  tapes,  carried  ovei  the  shoulder  and  fastened  to  the  roller, 
near  the  spine  and  sternum,  &ro  necessary  to  prevent  it  from  slipping 


412  SURGERY. 


down.  In  extensive  or  complicated  fractures,  stiff  adhesive  plaster,  or 
even  gum-shellac  cloth,  or  wetted  pasteboard,  fitted  to  the  part,  are 
useful  additions.  Preceding  the  operation  of  pressing  the  bones  or 
cartila^^es  down  to  their  proper  position,  the  patient  should  in  all  cases 
be  directed  to  take  a  rather  deep  insph-ation,  and  also  to  hold  his  breath 
as  long  as  possible  during  the  adjustment. 

Fractures  of  the  Spine. — The  transverse  processes  of  the  ver- 
tebrae may  be  broken  off  without  serious  inconvenience,  and  may  be 
treated  like  fractured  ribs.  When  the  body  or  articulating  surface  is 
fractured,  the  injury  is  irremediable.  Fractures  about  the  fourth  ver- 
tebrae of  the  neck  cause  instant  death ;  above  the  lumbar  vertebrae, 
they  are  fatal  in  a  few  days ;  and  when  these  are  fractured,  the  patient 
seldom  survives  long.  Pai'alysis  affects  all  the  parts  whose  nerves  are 
derived  from  the  spinal  cord  beloic  the  point  of  injuiy. 

Fractures  of  the  Pelvis. — These  are  only  produced  by  extreme 
violence,  of  a  crushing  kind.  They  are  always  dangerous.  The  pa- 
tient should  be  placed  in  an  easy  horizontal  position,  and  handled  as 
little  as  possible.  The  nature  of  the  injury  will  aid  the  diagnosis  as  to 
the  particular  point  of  fracture ;  and  generally  crepitus  can  be  felt  by 
placing  the  hand  on  the  crest  of  the  ilium,  while  motion  is  made  at 
the  spine  or  lower  extremities.  A  roller  around  the  pelvis,  with  a 
strap  under  the  nates,  and  attached  to  a  pulley  over  the  bed,  so  that 
the  pelvis  can  be  raised  without  effort  on  the  part  of  the  patient,  con- 
stitute the  principal  surgery. 

Fractures  of  the  Humerus. — This  bone  is  usually  fractured  near 
its  middle,  but  may  be  broken  near  either  extremity ;  when  fractured 
near  the  neck,  the  injury  is  not  easily  distinguished  from  disloca- 
tion. 

Symptoms. — A  fracture  in  any  part  of  the  shaft,  as  in  fig.  258,  may 
be  detected  by  the  obvious  deformity;  the  parts  of  the  bone  are  drawn 
out  of  line  ;  the  patient  experiences  pain  at  the  injured  point ;  he  is 
unable  to  move  the  limb ;  and  a  crepitus  can  be  noticed  by  rotating 
the  lower  portion  of  the  arm,  while  the  upper  part  is  fixed.  The  di- 
rection and  extent  of  the  fi-acture  may  be  ascertained  by  ti'acing  from 
the  condyles  upward  with  the  finger. 

Fi-acture  of  the  neck,  fig.  259,  seldom  occurs  except  in  old  persons. 
By  rotating  the  arm  below  the  elbow,  a  crepitus  will  be  felt.  The 
roundness  of  the  shoulder  is  not  diminished,  as  in  dislocation. 


FRACTURES. 


418 


Fig.  258. 


Fig.  259. 


'pUh 


FRACTURED    SHAFT. 


FRACTURED  IfECK. 


Fractures  near  the  condyles,  fig.  260,  are  liable  to  be  mistaken  for 
dislocation  of  the  forearm.     When  the  fracture  is  above  the  sondyles, 

Fig.  260. 


FRACTURE    ABOVE    THE    CONDYLES. 


the  arm  will  be  shortened ;  and  in  all  cases  the  grating  of  the  broken 
pieces  can  be  felt ;  the  notions  of  the  elbow  are  but  little  impeded  io 
fracture,  which  is  not  the  case  in  dislocation. 


414 


3URGERY. 


Treatment. — When  the  shaft  has  been  broken,  sufficient  extension 
must  first  be  made;  the  fractured  arm  is  next  to  be  accurately  adjusted, 
so  that  the  appearance  and  length  of  the  limb  will  compare  well  with 
its  fellow;  the  roller  is  then  to  be  applied — the  parts  being  held  injux- 
tajjosition,  meanwhile,  by  an  assistant — rather  loosely  fi-om  the  elbow 
to  the  shoulder;  two  or  four  splints — four  are  better — about  a  quarter 
of  an  inch  in  thickness,  are  then  placed  at  convenient  distances,  so  as 
nearly  to  inclose  the  arm;  the  roller  is  then  continued  down  over  the 
splints,  and  back  and  forward,  until  the  splints  are  sufficiently  secured  ; 
the  forearm  and  hand  are  lastly  to  be  suspended  in  a  sling  from  the  neck. 
When  the  neck  of  the  bone  is  broken,  a  wedge-shaped  pad  in  the 
axilla  is  necessary ;  the  shellac  or  pasteboard  splint  should  be  applied 
on  the  outside  and  over  the  top  of  the  shoulder,  and  the  whole  fastened 
by  the  clavicle  bandage. 

In  the  case  of  fracture  above  the  condyles,  after  the  proper  adjust- 
ment, the  roller  is  to  be  first  applied  loosely  around  the  arm  and  fore- 
arm, and  then  over  two  angular  splints,  which  should  reach  nearly  from 
the  shoulder  to  the  wrist,  one  being  applied  on  the  front  and  the  other 
on  the  back  of  the  arm. 

When  the  condyles  themselves  are  fractured,  the  separated  portions 
Fip.  261.  of  bona  are  to  be  pressed  together,  and  a 

splint  or  cloth  cap  applied,  reaching  to  the 
wrist,  preceded,  of  course,  by  the  roller. 
Some  degree  of  deformity  will  always  exist 
after  these  injuries. 

Fractures  at  the  Elbow  Joint. — Fig. 
261  represents  the  olecranon  'process  broken 
oft'  and  drawn  up  on  the  back  of  the  arm, 
attended,  "'f  course,  with  a  rupture  of  the 
ligaments.  The  patient  can  bend  the  arm 
easily,  but  cannot  straighten  it.  There  is 
also  gi-eat  pain  at  the  point  of  injury. 

Treatment. — The  inflammation  must 
OLECRANON  FRACTURE,  first  bo  subduod  ;  "hen  the  arm  is  to  be 
bandaged  ratlier  tightly  from  the  ends  of  the  fingers  to  the  elbow  ; 
the  broken  end  of  the  bone  is  next  to  be  brought  to  its  place,  and  in- 
cluded in  the  turns  of  the  roller,  which  should  be  continued  half  way 
up  the  arm  ;  the  roller  is  then  turned  back  and  passed  above,  and  the 
elbow  Joint  about  a  dozen  times  in  the  form  of  the  figure  8  ;  after  it  is 
contin«ed  upward,  including  the  whole  arm.  Lastl}^  a  strong  splint 
is  to  be  placed  in  front  of  the  joint  over  the  bandage  to  prevent  flexix)i? 


FRACTUKES 


415 


The  coronoid  process  is  sometimes  fractuied  separately,  attended 
necessarily  with  a  backward  luxation.  It  impedes  the  bending  of  the 
elbow.  Its  adjustment  only  requires  the  flexure  of  the  forearm,  and  its 
retention  in  that  position  by  proper  bandages  and  splints.  This  fracture, 
and  also  the  two  preceding,  unite  by  a  ligamentous,  instead  of  bony 
connection. 

Fractures  of  the  Forearm.-  -Both  bones  may  be  fractured  to- 


Fisr.  262. 


> 


gether,  or  either  of  them  singly.  Fig.  262  repre- 
sents a  fracture  of  both  bones,  with  a  view  of  the  in- 
terosseous muscles,  whose  contraction  tends  to  draw 
the  bones  together,  so  as  to  prevent  the  circular 
movement  of  the  radius  round  the  ulna. 

Wlien  the  radius  alone  is  fractured,  fig.  263,  the 
depression  and  crepitus  readily  points  out  the  place 
of  injury;  and  the  same  symptoms  on  the  opposite 
side  of  the  arm  denote  a  fractured  ulna,  fig.  264. 
The  surgeon,  in  all  these  accidents,  has  only  to 
ti-ace  the  bones  up  from  the  wrist,  until  the  finger 
comes-  to  the  divided  part,  when  a  depression  will 
be  felt ;  and  by  fixing  the  elbow,  and  rotating  the 
wrist,  the  crepitus  will  be  experienced. 

The  lower  end  of  the  radius  is  sometimes  frac- 
tured near  the  wrist,  where  the  hand  is  distorted, 
and  appeai-s  very  much  like  a  dislocation,  fig.  265; 

Fig.  263. 


>*•  >  ■ — i  \ 

FRACTURE  OF  THE 
ULNA  AND  RADIUS. 


FRACTURE  OF  THE  RADIUS. 


but,  on  moving  the  hand,  the  styloid  process  of  the  radius  moves  with 
't,  which  is  not  the  case  when  the  bone  is  dislocated. 

Fig.  264. 


F3  .^.CTURE    OF    THE    ULNA. 


410  SCJRGERT. 

Treatment. — In  the  fust  vni'iety— fracture  of  both  hones — the  most 
important  point  in  the  tieatment  is  to  keep  the  bones  apart.     After  ad- 
Fig.  265. 


FRACTURE  OF  LOWER  END  OF  THE  RADIUS 

justing  the  bones,  by  making  the  necessary  extension  at  the  wrist  ^le 
arm  sliould  be  bent  at  a  right  angle,  with  the  thumb  midway  bet-  een 
pronation  and  supination ;  the  loose  roller  is  to  be  applied,  and  thVs,  fo' 
lowed  by  two  splints,  one  on  the  inside,  and  the  other  opposite,  which 
should  be  convex  on  the  side  next  the  arm,  and  well  padded  with  cot- 
ton ;  the  splints  are,  lastly,  to  be  secured  by  a  roller  extending  from  the 
hand  to  the  elbow. 

When  the  radius  alone  is  fractured  the  hand  may  hang  k)ose,  and 
thus  exert  some  degree  of  extending  force  on  the  bone.  When  the 
ulna  alone  is  broken  the  hand  and  forearm  should  be  kept  in  the  same 
line,  and  the  splint  and  bandage  should  extend  to  the  ends  of  the 
fingers. 

The  s])lints  should  in  all  these  cases,  as  a  general  rule,  be  worn  ten 
or  twelve  days ;  but  the  compress  and  bandage  should  be  continued  a 
week  or  two  longer. 

The  only  point  of  difference  in  the  treatment  of  a  fi-acture  at  the 
lower  end  of  the  radius,  is  in  so  adjusting  the  pads  and  compresses 
that  they  may  aid  in  keeping  the  two  bones  apart  and  the  fractured 
portions  together  at  the  same  time.  Though  passive  motion  may  be 
employed  ]n  Shree  or  four  weeks  to  prevent  anchylosis,  no  great  exer- 
tion should  be  made  by  the  hand  for  several  months. 

FnACTURKS  OF  THE  Wrist,  Hand,  AND  FiNGERS. — These  acci- 
dents require  a  broad  splint  fitted  to  the  front  of  the  wrist  and  hand, 
with  the  ends  slit  for  the  fingers,  the  parts  being  well  padded  to  secure 
equal  pressure,  and  the  splints  fastened  by  the  roller.  Splints  may 
also  be  adjusted  to  the  sides  and  back  of  the  fingers.  A  single  finger 
bone  may  be  fixed  with  four  small  splints  secured  by  tape. 

Fractures  of  the  Thigh. — The  neck  of  the  ftmur  may  be  frac« 
tured  irillii?'  or  without  the  cavsulcr  ligament;  the  trochanter  majo' 


FRACTURES. 


417 


FRACTURE    WITHIN    THE    CAPSULE. 

Fig.  267. 


may  be  broken  obliquely;  and 
the  shaft  at  or  near  the  tro- 
chanters, in  its  middle,  or  near 
the  condyles. 

Symptoms.  —  The  fi'acture 
icithin  the  ligament,  as  repre- 
sented in  fig.  266,  generally 
unites  by  a  ligamentous  sub- 
stance, or  a  double  joint  is 
formed,  and  the  limb  perma- 
nently shortened. 

The  accident  is  known  by 
the  inability  to  stand  on  the 
leg,  the  limb  being  shortened 
one  or  two  inches,  the  knee 
and  foot  turned  out,  and  the 
heel  inclining  to  rest  on  the 
other  limb  above  and  behind 
the  malleolus,  fig.  267.  Severe 
pain  is  felt  on  moving  the  limb,  and  a  crepitus 
will  be  recognized  on  rotating  it.  Sometimes, 
however,  the  shortening  of  the  limb  does  not 
occur  until  seveml  hours  after  the  accident ;  and 
in  some  rare  cases  it  is  said  the  foot  turns  in  in- 
stead of  being  everted. 

In  fracture  outside  the  ligament,  the  pain  and 
swelling  are  greater — often  extreme ;  the  limb 
is  not  materially  shortened  nor  everted,  and 
crepitus  is  more  easily  felt. 

When  the  bone  is  fractured  obliquely  through 
die  trochanter  major,  the  leg  is  everted,  a  little 
shortened,  and  a  fissure  can  be  felt  between  the 
shaft  and  ti'ochanter. 

When  the  shaft  is  broken  just  below  or  near 
the  trochanters,  the  psoas  and  internal  iliac  mus- 
cles draw  the  superior  fragment  of  bone  upward 
and  forward,  causing  great  pain  and  deformity. 

When  the  shaft  is  broken  betiveen  the  tro- 
chanters and  condyles,  the  deformity,  crepitus 
on  extension  or  rotation,  and  inability  to  bear 
weight  upon  the  limb,  determine  the  nature  of 
the  case.  If  the  fracture  be  oblique,  the  limb 
will  be  much  shortened  by  che  broken  parts  slip- 


FRACTURED  NECK  OF 
THK  FICMirH. 


418  SUR3ERY. 

ping  by  each  other;  and  this  mmj  be  the  case  also  in  transverse  frac- 
tures. *  The  condyles  of  the  femur  are  seldom  bi'okeu  except  in  old  per- 
sons, and  the  accident  is  not  unfrequently  fatal. 

Treatmoit. — Sir  Astley  Cooper,  in  speaking  of  the  various  methods 
for  treating  fracture  of  the  neck  of  the  femur  ivithin  the  capsular  liga- 
ment, says:  "  Baftled  in  all  our  attempts  at  curing  these  cases,  and 
finding  the  life  of  the  patient  occasionally  sacrificed  under  the  trials 
made  to  unite  them,  I  should,  if  I  sustained  this  accident  in  my  own 
person,  direct  that  a  pillow  should  be  placed  under  the  limb  throughout 
its  lent^rh;  that  another  should  be  rolled  up  under  the  knee,  and  that 
the  limb  should  be  thus  extended  until  the  pain  and  inflammation  had 
subsided.  I  should  then  daily  rise  and  sit  in  a  high  chair,  in  order  to 
prevent  a  degi'ee  of  flexion  which  would  be  painful ;  and,  walking  with 
crutches,  bear  gently  on  the  foot  at  first,  then  gradually  more  and 
more,  until  the  ligament  became  thickened,  and  the  muscles  increased 
in  their  powei".  A  high-heeled  shoe  should  be  next  employed,  by 
which  the  halt  would  be  much  diminished.  Our  hospital  patients, 
treated  Eifter  this  manner,  are  allowed  in  a  few  weeks  to  walk  with 
crutches ;  after  a  time  a  stick  is  substituted  for  the  cixitches ;  and  in  a 
few  months  they  ai'e  able  to  use  the  limb  without  any  adventitious 
support." 

Fracture  of  the  neck  outside  the  capsular  ligament,  admits  of  ossific 
union,  though  this  does  not  always  result.  Sir  Astley's  plan  of  adjust- 
ment, as  simple  and  practical  as  an}^  is  thus  described :  "  In  the  treat- 
ment of  this  injury,  the  principles  are  to  keep  the  bones  in  approxima- 
tion, by  pressing  the  trochanter  toward  the  acetabulum,  and  to  pre- 
serve the  length  of  the  limb.  The  foot  and  ankle  of  the  injured  side 
should  be  firmly  bound  with  a  roller  to  the  foot  and  ankle  of  the  other 
leg  [which  is  to  be  kept  straight],  and  thus  the  uninjured  side  will 
serve  as  a  splint  to  that  which  is  fractured,  giving  it  a  continued  sup- 
port, and  keeping  it  extended  to  the  proper  length.  A  broad  leatherc 
strap  should  also  be  buckled  around  the  pelvis,  including  the  ti'ochan- 
ter  major,  to  press  the  fractured  portions  of  the  bone  firmly  together ;  and 
the  best  position  of  the  limb  is  to  keep  it  in  a  straight  line  with  the  body." 

Mr.  Listen's  jilan,  applicable  to  all  cases,  as  detailed  in  his  own  lan- 
guage, is  as  follows  :  "  Whethor  the  fractjire  is  suspected  to  be  within 
or  without  the  joint,  either  entire!-  or  partiaiiy,  the  biOKen  surfaces 
are  to  be  brought  in  contact  and  retained  immovably  in  apposition  for  a 
time  sufficient  to  admit  of  union.  The  limb  is  put  up  in  apparatus  not 
requiring  removal,  and  but  little  adjustment.  This  can  be  effected  only 
in  the  extended  position.  Many  splints,  with  foot-boards,  straps,  and 
screws,  are  intended  for  this  purpose,  soma  to  be  attached  to  the  in- 


7KACTURES. 


419 


juved  iimb,  others  to  the  sound  one;  but  the  apparatus  which  is  most 
simple,  easily  to  be  procured  at  all  times  and  in  all  circumstances,  is  at 
once  the  best  and  most  efficient.  This  is  a  straight  wooden  bo-ird,  not 
so  thick  as  to  feel  cumbrous,  and  not  so  thin  as  to  be  pliable  or  easily 
broken  ;  in  breadth,  corresponding  to  the  dimensions  of  tlie  limb  ;  in 
length,  sufficient  to  extend  from  two,  three,  or  four  inches  beyond  the 
heel,  to  near  the  axilla ;  deeply  notched  at  two  places  at  its  lower  end, 
and  perforated  by  two  holes  at  the  upper.  The  splint,  well  padded,  is 
applied  to  the  extended  limb,  the  ankles  being  protected  by  proper  ad- 
•ustment  of  the  pads.  The  apparatus  is  retained  by  bandagmg,  fig. 
268,  a  common  roller  is  applied  round  the  limb,  from  the  toes  to  n-ear 
the  knee,  so  as  to  prevent  infiltration,  which  would  otherwise  follow 

Fig.  268. 


ADJUSTMENT    OF    FRACTURED    NECK    OF    THE    FEMUR. 

pressure  above  by  the  rest  of  the  apparatus.  The  splint  is  then  attach- 
ed to  the  rest  of  the  limb  by  involving  both  in  a  roller  from  the  foot  to 
above  the  knee  ;  and,  in  doing  this,  the  bandage,  after  having  been 
turned  round  the  ankle,  should  be  passed  through  the  notches,  so  as  io 
be  firmly  attached  to  the  end  of  the  splint,  thereby  preventing  the  foot 
from  shifting.  A  broad  bandage  is  applied  round  the  pelvis,  over  the 
groin  and  down  the  thigh,  investing  all  that  part  of  the  limb  left  uncov- 
ered by  the  previous  bandaging.  A  broad  band,  like  a  riding-belt,  is 
fastened  round  the  pelvis,  so  as  to  bind  the  splint  to  the  trunk,  and 
thereby  keep  the  broken  surfaces  of  the  bone  in  contact.  A  large 
handkerchief  or  shawl  is  brought  under  the  perineum,  and  its  ends  se- 
cured through  the  openings  at  the  top  of  the  board.  It  is  evident  that 
the  splint,  being  thus  securely  fixed,  and  made  as  part  of  the  limb,  tight- 
ening of  the  perineal  band  will  extend  the  member  and  preserve  it  of 
its  proper  length.  By  care  and  attention  in  applying  the  apparatus, 
and  in  adjusting  the  cushions  about  the  ankle  and  perineum,  there  is  lit- 
tle or  no  risk  of  the  skin  giving  way.  The  bandages  will  require  to  bft 
reapplied  once  or  twice  durmg  the  cure  ;  and  the  perineal  band  should 
be  tightened  frequently.  The  apparatus  is  retained  for  six  or  eigh^ 
weeks,  the  time  necessary  for  union  varying  according  to  circumstan- 
ces     Afte'   its  removal  great  care  must  be  t^iken  a   first  in  moving  the 


120 


SURGERY. 


limb  mid  putting  weight  upon  it;   it  should  be  accustomed  to  its  formeif 
functions  very  gradually." 

Another  convenient  mode  of  fixing  the  thigh  bone,  is  the  concave 
duuble-inclined  splint,  recommended  by  Dr.  Beach,  with  the  foot- 
board added  by  Dr.  Hill,  fig.  269.  The  manner  of  using  it  must  be  ob- 
vious at  a  glauce. 

Fiff.  269. 


DOUBLE-INCLINED  CONCAVE  SPLINT. 

The  ohliqiLC  fracture  of  the  trochanter  major  is  managed  precisely  like 
the  preceding  case. 

When  the  shaft  is  fractured,  the  most  important  point  in  surgery  ia 
to  prevent  the  shortening  of  the  limb.  The  patient  is  placed  in  a  sit- 
ting position,  by  which  the  psoas  and  iliacus  muscles  are  relaxed,  and 
the  ends  of  the  bones  approximated.  Extension  is  then  made  until  the 
two  limbs  correspond ;  the  roller  is  next  applied,  from  the  toes  to  the 
hip ;  three  splints  are  then  placed  over  the  first  bandage  ;  one  in  front 
from  the  patella  to  the  pelvis  ;  one  from  external  condyle  to  the  tro- 
chanter major ;  and  one  from  the  internal  condyle  to  the  perineum. 
Dr.  Hill — I  think  judiciously,  too — recommends  a  fourth  splint  of  stout 
gum-shellac  cloth  to  be  applied  on  the  inferior  surface,  from  the  tube- 
rosity of  the  ischium  to  the  hollow  of  the  knee,  wide  enough  to  cover 
one  third  of  the  thigh,  and  perfectl}^  adapted  to  the  surface.  All  the 
splints  are  to  be  firmly  fastened  with  a  roller,  when  the  limb  should 
bo  placed  on  the  inclined  splint,  or  supported  by  some  similar  appara- 
tus. Three  separate  rollers  are  commonly  employed  ;  the  first  is  so 
applied  about  the  knee  as  to  admit  of  its  being  bent.  The  patient 
should  not  lie  down  for  ten  or  twelve  days,  as  that  posture  is  exceed- 
ingly liable  to  displace  the  broken  bones. 

When  one  or  both  condyles  are  fractured,  the  limb  is  to  be  straight- 
ened so  that  the  hfad  of  the  tibia  will  press  upon  the  condyles,  and  se 
cured  with  rollers  and  splints. 


Fracture    of    the    Patella. — This   bone   is   generally  broken 
transversely  ;  the  upper  fragment  is  drawn  up  by  the  rectus  femoris* 


FRACTURES. 


421 


the  patient  cannot  straighten  the  limb ;  and  the  fissure  between  the 
brolien  portions  can  Le  seen  and  felt,  fig.  270. 

Treatment. — The  usual  method  of  adjustment  is  to  secure  the  limb 


in  a  perfectly  straight  position  by  a 
stiff  splint  extending  down  the  back  of 
the  thigh  to  the  calf  of  the  leg,  around 
which  a  roller  is  applied.  The  divided 
parts  may  be  brought  together  by 
straps  buckled  around  the  limb  above 
and  below  them,  and  drawn  together 
by  other  straps  attached  to  them,  which 
pull  the  circular  ones  up  and  down  un- 
til coaptation  is  complete.  When  the 
broken  parts  ai-e  not  accurately  adjust- 
ed, the  union  will  be  ligamentous  in- 
stead of  osseous. 

When  fractured  longitudinally,  the 
leg  is  to  be  extended,  the  parts  brought 
together,  and  secured  by  bandage, 
compresses,  and  paste-board  splints. 


Fiar.  270, 


FRACTURED  PATELLA. 

Fig.  271, 


Fractures  of  the  Tibia  and  Fibula. — 
These  accidents  are  readily  detected  by  the  de- 
formity, pain,  crepitus,  etc. 

Treatment. — When  the  head  of  the  tibia  is 
fractured,  the  management  is  the  same  as  for 
fractured  condyles  of  the  femur.  What  is  com- 
monly termed  "broken  leg,"  is  a  fracture  of  one 
or  both  bones  between  the  knee  and  ankle.  The 
double-inclined  splint  apparatus,  or  some  similar 
contrivance,  is  here  necessary.  The  application 
of  the  roller,  fig.  271,  which  is  the  first  part  of 
the  dressing,  need  not  begin  at  the  toes,  as  in 
the  case  of  ulcers,  nor  be  as  firmly  bound.  This 
bandage  is  applied  before  the  bones  are  ftilly  ad- 
justed, and  not  so  tight  as  to  prevent  further  ex- 
tension. In  all  fractures  the  great  toe  is  to  be 
kept  in  a  line  v/ith  the  inner  edge  of  the  patella. 
In  oblique  fi-actures,  after  the  provisional  appli- 
cation of  the  roller,  the  limb  should  be  placed  on 
the  inclined  splints,  and  extended  until  the  two 
limbs  compare  exactly  ;  the  f>ot  is  then  to  be 
2G 


THE  ROLLER 


422 


SURGERY 


fixed  (o  the  foot-board  by  straps  that  will  not  stretch ;  and  after  the  ad- 
justment of  the  bones  is  completed,  two  or  three  splints  are  to  be  ap- 
plied and  bound  with  a  roller,  which  is  also  to  extend  around  the  in- 
clined or  supporting  sj)lints.  Any  ingenious  mechanic  can  make  a  ma- 
chine in  ill!  hour  or  two  which  will  serve  as  an  inclined  plane,  and  an- 
swer as  a  substitute  for  the  double  concave  splints  before  mentioned. 

Fractures  about  the  Ankles. — By  twisting  the  foot  outward, 
the  Jib  III  a  is  sometimes  broken  about  three  inches  above  the  ankle,  ac- 
companied with  i)artial  or  complete  dislocation  of  the  ankle,  fig.  272. 
I'he  internal  malleolus,  by  projecting,  forms  a  tumor,  and  when  the 
foot  is  moved,  crepitus  can  be  felt  just  above  the  external  malleolus. 

Fig-  272. 


Fig.  273L 


FRACTURE  OF  THE  FIBULA. 


FRACTURED  TIBIA. 


The  tibia  is  sometimes  fractured  near  its  lower  end;  i6  may  be 
transverse,  extending  through  the  fibula ;  but  is  generally  oblique  with 
the  internal  malleolus  also  broken,  fig.  273.  The  foot  is  turned  in- 
ward, .'uul  the  crepitus  is  felt  on  the  inside. 

Treatment. — In  the  first  variety  the  dislocation  must  be  reduced  be- 
fore the  frnctui-p  is  adjusted.     The  fractured  parts  are  to  be  kept  in 


PARTICULAR   OPERATIONS.  423 


place  by  one  splint  at  the  back  of  the  leg,  another  along  the  fibula,  the 
foot-board,  and  the  usual  bandages.  In  the  second  variety  a  splint  is 
to  be  applied  on  the  side  of  the  tibia. 

Fractures  of  the  Foot. — Nearly  all  of  these  cases  are  connected 
with  severe  contusions  and  lacerations.  The  medical  treatment  is  as 
important  as  the  surgical.  The  cold  water-dressings  and  bandages  must 
be  employed  with  a  vigor  proportioned  to  the  intensity  of  the  inflam- 
mation; and  the  fractured  bones  kept  in  their  places  by  pasteboard  or 
shellac  splints,  compresses,  and  bandages  applied  to  meet  the  indica- 
tions of  each  case. 

Note. — There  are  some  iiircumstances  which  the  practitioner  should 
always  bear  in  mind,  although  they  have  not  always  been  specified  in 
treating  of  particular  fractures  and  dislocations.  In  the  first  place,  any 
injury  of  the  kind,  and  especially  those  about  the  wrist,  knee,  and  an- 
kle, as  well  as  complicated  cases  generally,  are  liable  to  severe  inflapi- 
mation.  When  fractured  or  dislocated  parts  are  very  painful  or  badly 
swelled  from  inflammation,  this  must  be  subdued  before  adjustment  or 
reduction  is  attempted.  In  the  second  place,  adjustment  or  reduction 
is  always  greatly  facilitated  by  previously  bathing  the  part  in  as  warm 
water  as  can  well  be  borne.  Thirdly,  in  all  cases  of  fracture  or  dislo- 
cations involving  the  sti'ucture  of  a  ioint,  very  gentle  or  passive  motion 
should  be  made  at  the  joint  as  eari)  is  is  consistent  with  safety,  to  pre- 
vent anchylosis,  or  stiff  joint.  If  made  too  soon,  however,  there  is  dan- 
ger of  re-displacement.  The  time  and  extent  of  this  motion  must  be 
determined  by  the  nature  and  place  of  the  injured,  the  age  and  health 
of  the  patient,  ect. 


CHAPTER  XI. 

PARTICULAR  OPERATIONS. 


Trephining. — When  performed  for  a  fracture  of  the  skull,  a  small 
opening  is  sufficient;  but  when  the  object  is  to  evacuate  matter,  it 
should  be  larger.  The  requisite  instruments  are,  a  large  and  small 
trephine,  a  Hay's  saw,  an  elevator,  a  scalpel,  with  the  common  pocket- 
case.  A  flap  is  made  through  the  scalp  in  the  shape  of  the  letter  D, 
the  circular  side  of  which  is  raised,  when  loose  fragments  of  bone,  if 


424  SURGERY. 


present,  are  to  be  removed.  The  lining  membrane  of  the  bones — per- 
icranium— is  next  to  be  separated,  or  a  circular  incision  made  through 
it  for  the  edge  of  the  instrument.  The  trephine  is  to  be  applied  so 
that  the  centre-pin  will  rest  on  a  sound  portion  of  the  skull ;  the  instru- 
ment is  then  turned  steadily  forward  and  backward,  gentle  pressure 
being  made  upon  it  at  the  same  time,  removing  it  frequently-,  and 
clearing  the  teeth  with  a  brush  ;  the  groove  must  also  be  examined 
frequently,  and  the  dust  and  blood  removed  with  a  piece  of  wetted 
sponge.  When  the  groove  is  deep  enough  to  steady  the  instrumeni:, 
the  centre-pin  is  to  be  withdrawn;  and  as  soon  as  any  point  of  the  bone 
is  cut  through,  an  attempt  should  be  made  to  raise  the  piece  of  bone 
within  the  circle  ;  but  if  it  does  not  succeed,  the  sawing  should  be  very 
cautiously  continued  until  the  bone  is  nearly  cut  through  all  round, 
when  it  may  be  detached  with  ease.  After  purulent  matter  or  ex- 
travasated  blood  is  removed,  or  the  depressed  portion  of  bone  elevated, 
the'  scalp  is  to  be  replaced  and  secured  with  the  wet  compress.  The 
trephine  should  not  be  applied  over  a  suture,  nor  over  the  course  of  the 
middle  meningeal  arteries. 

Paracentesis  Capitis. — The  operation  of  puncturing  the  head  has 
been  resorted  to  in  some  cases  of  external  dropsy.  One  of  the  fonta- 
nelles  is  the  point  usually  opened  ;  the  fluid  is  drawn  alf  very  gradual!}-, 
80  as  to  avoid  fainting.  The  wound  heals  readily,  but  the  operation 
seldom  succeeds  in  effecting  a  cure. 

Paracentesis  Oculi. — Tapping  the  eye  to  let  out  the  humors  is 
among  the  regular  resources  of  chirurgery,  w-hen  the  inflammation  is 
80  intense  that  the  "ordinary  means"  fail;  but  as  the  hydropath  has 
ample  and  e.r^raordinary  means  to  subdue  inflammation, /te  will  have  no 
occasion  to  "operate"  in  this  way. 

In  dropsical  affections  of  the  eye,  attended  with  a  gradual  and  per- 
manent enlargement  of  the  globe,  protuberant  eyeball,  and  excessive 
pain,  the  eye  may  be  properly  punctured.  A  common  lancet,  or 
couching  needle,  may  be  introduced  "behind  the  junction  of  the  cornea 
with  the  sclerotic  coat,  into  the  posterior  chamber.  Some  surgeons 
puncture  the  anterior  chamber  through  the  cornea. 

Fistula  Lachrymalis. — A  small,  sharp-pointed  bistoury,  or  cata- 
ract knife,  is  held  perpendicularly  to  the  eyebrows,  the  point  directed 
to  the  lower  margin  of  the  internal  tendon  of  the  eyelids,  wdiich  may 
be  seen  on  drawing  the  lids  outwai-d,  the  patient  sitting  erect,  and  the 
surgeon  standing  behind.     Tlie  point  of  the  instrument  is  pressed  di- 


PARTICULAR  CPERATIONS. 


425 


rectly  downward,  fig.  274,  until  it  enters  the  sac,  which  will  be  denoted 


Fig.  274. 


by  a  flow  of  tears  and  mucus.  The 
opening  should  be  slightly  enlarged  out- 
wardly as  the  knife  is  withdrawn.  A 
probe,  curved  a  little  forward  and  in- 
ward, is  then  inti'oduced,  and,  if  necea 
sary,  pushed  through  into  the  nostril 
when  a  tube,  style,  or  tent  is  inserted. 


Entropium  and  Ectropium. — The 
inverted  lid  can  often  be  restored  by 
cauterizing  the  outside  of  the  lid,  or  by 
incising  the  mucous  membrane.  Emer- 
sion is  often  cured  by  a  removal  or  divi- 
sion of  the  tarsus. 

LACHRjfMAL  F'STULA. 

Anchyloblepharon  and  Symblepharon. — The  first  of  these 
terms  is  applied  to  a  growing  together  of  the  eyelids,  whi  "h  may  be 
remedied  by  the  use  of  olive  oil,  or  any  bland  cerate ;  and  the  second, 
when  the  lids  adhere  to  the  eyeball.  They  are  sometimes  dissected 
apart,  but  the  operation  is  not  often  successful. 

Ptosis  and  Lagophthalmos. — The  former  case — elongation  or 
drooping  of  the  eyelids — may  generally  be  remedied  in  the  same  way 
as  entropium;  and  the  latter — a  shortening  of  the  eyelids — nay  be 
treated  as  ectropium. 

Blepharidoplastice  and  Rhinorrhape. — In  relation  to  these 
formidable  words,  I  can  only  inform  the  curious  reader  that  the  first  ap- 
plies to  the  formation  of  new  eyelids  and  eyelashes  from  the  adjacent 
integument;  and  the  second,  to  new  lids,  or  parts  of  lids,  from  the  in- 
tegument taken  from  the  back  of  the  nose.  New  eyelids  have  also 
been  formed  of  the  integument  of  the  temple. 

Rhinoplastice. — This  operation,  sometimes  called  taliacotian,  con 
sists  in  the  formation  of  an  artifio^al  nose  from  the  integument  of  the 
forehead  or  temple.     In  this  and  all  similar  cases,  the  particular  circum- 
stance of  each  case  must  determine  the  kind  of  operation  required. 

ScHLESEKTOMY — Keratoplastice. — Thesc  terms  have  been  lately 
applied  to  an  operation  for  the  formation  of  an  artificiaV  pupil.  Expe- 
rience dl^es  not  justify  it  except  in  cases  of  complete  blindness. 


420 


SURGERY. 


Fig.  275. 


HARD  LENTICULAR  CATARACT. 

Fiff.  276. 


Otoplastice.— One  of  Talmcozzi's  operations  for  forming  a  new 
e^r  out  of  the  scalp  of  the  oack  pjirt  of  the  head  is  so  called. 

Cheilo  and  Gznio-Plastice. — These  are  still  other  taliacotiaa 
operations,  either  performed  or  proposed,  to  restore  lost  parts  of  the 
lips  and  chin  by  taking  the  integument  adjacent. 

Couching. — This  is  one  of  the  operations  for  curing  blindness  caused 

by  cataract.  The  disease  con- 
sists in  an  opacity  of  the  crys- 
talline lens,  or  its  capsule,  or 
both.  The  eye  presents  very 
?:.  different  appearances  in  dif- 
M   ferent  forms  of  the  disease. 


^:^    Fig.  275  represents  a  hard 


cataract ;  it  has  a  radiated  ap- 
pearance, with  an  amber-col- 
ored center  and  gray  circum- 
ference. Fig.  276  shows  the 
appearance  of  the  eye  when 
the  lens  is  in  a  soft  pulpy  or 
creamy  state.  Liston  says, 
"the  darker  the  color,  the 
harder  the  cataract." 

Opacity  in  the  anterior  part 
of  the  capsule  is  usually  indi- 
cated by  a  whitish  spot  in  the 
center  of  the  pupil,  with  a 
dark  blue  circle  around  it ; 
and  when  the  opacity  is  in 
the  posterior  portion,  it  ap- 
pears concave,  striated,  and 
yellowish,  and  at  a  distance 
behind  the  iris,  fig.  277.  In 
the  majority  of  cases,  how- 
ever, the  affection  is  of  a  mix- 
ed character. 

For  a  day  or  two  before 
operating,  surgeons  usually 
keep  the  pupil  dilated  by  the 
frequent  application  of  some 
sti'onff    narcotic    to    the   lida 


SOFT  LENTICULAR  CATARACT. 

Fi«r.  277. 


CAPSULAR    CATARAPT 


PARTICULAR    OPERATIONS. 


427 


and  balls  of  the  eye,  as  extract  of  belladonna,  stramonium,  etc.  The 
head  of  the  patient  is  steadied  by  an  assistant,  who  also  holds  the  eye 
fast  with  the  speculum;  the  upper  lid  may  also  be  held  by  the  fingers 
of  the  assistant,  and  the  under  lid  by  the  operator,  who  is  obliged  to 
prevent  the  eye  from  rolling  with  one  hand,  while  the  other  handles  the 
instruments.  The  usual  position  of  the  patient  is  a  low  chair,  in  a  well- 
lighted  room,  and  that  of  t'ie  surgeon,  seated  on  a  high  chair  in  front, 
with  a  foot-stool  to  steady  his  elbow  on  his  knee.  The  couching  nee- 
dle is  introduced  through  the  sclerotic,  about  two  lines  from  the  cornea, 
and  a  little  below  the  horizontal  axis  of  the  eye,  and  its  point  carried 
slightly  backward  to  avoid  the  iris ;  when  the  point  of  the  needle  ia 
seen  in  front  of  the  lens — by  looking  through  the  pupil — the  capsule  is 
to  be  detached  from  the  lens  with  the  sharp  edges  of  the  needle,  and 
then  pushed  down  out  of  sight.  But  if  the  lens  itself,  or  its  posterior 
capsule,  then  appear  opaque,  the  edge  of  the  needle  is  to  be  moved 
round  its  margin  to  separate  the  lens  from  the  tunica  liyoloidea,  and 
then  the  lens  pushed  down  by  placing  the  flat  surface  of  the  needle  on 
top  of  it,  fig.  278,  below  the  pu- 
pil, and  slightly  backward  into 
the  vitreous  humor  ;  or  it  may 
be  drawn  down  by  thrusting 
the  needle  into  it.  If  the  lens 
rise  on  raising  the  needle,  it  is 
to  be  held  down  until  it  will 
remain  stationary,  when  the 
operation  is  finished  and  the 
needle  may  be  withdrawn. 
The  patient  should  be  kept  in 
a  dark  room,  and  the  eye  closed  and  covered  with  a  cold  wet  cloth  for 
several  weeks,  until  all  danger  of  inflammation  is  passed. 


I  ii.  273. 


COUClilXG. 


Extraction. — This  is  the  operation  for  removing  the  opaque  lens. 
The  upper  eyeUd  is  supported  by  the  retractor,  or  by  an  assistflni 
instead  of  a  speculum,  and  the  lower  one  by  the  fingers  of  the  sur- 
geon. Resting  his  little  finger  on  the  patient's  cheek,  the  point  of 
the  cornea-knife  is  passed  edge  downward  through  the  transparenfc 
cornea,  a  little  within  its  outer  margin  and  above  its  center,  and  passing 
straight  across,  parallel  to  the  iris,  emerges  at  the  opposite  margin. 
The  wedge-shaped  edge  of  the  knife  advances  in  two  directions  round 
the  cornea,  making  a  semicircular  section,  fig.  279.  On  removing  the 
knife,  the  lids  are  instantly  closed,  the  operator  giving  the  assistant  a 
signal  ft)r  the  purpose.     In  a  short  time  the  eye  is  again  opened,  fthe 


(28 


5URGERT 


Fi?  079 


3ornenl  flap  raised,  a  needle  inserted,  and  the  capsule  lacerated  with  it. 

Slight  pressure  is  then  made  upon  the  ball,  unless  the  lens  passes  out 

at  the  opening  without. 
After  examining  the  eye 
to  ascertain  if  the  iris 
is  prolapsed — in  which 
event  the  eye  has  to  be 
exposed  to  a  sti'ong  light> 
to  cause  contraction  and 
retraction,  or  the  iris 
pushed  back — the  cornea 
is  adjusted,  and  the  eye 
dressed  with  the  com- 
press and  bandage. 


EXTRACTIOX  OF  CATARACT. 


Absorption,  or  Solutio'. — This  is  another  and  the  easiest  meth- 
od of  disposing  of  an  opaque  lens,  but  it  frequently  has  to  be  repeated. 
It  is  best  adapted,  however,  to  congenital  and  soft  cataracts.  Surgeons 
have  an  anterior  and  posterior  operation  ;  but  the  latter  is  preferable. 
The  couching  needle  is  introduced  as  for  depression  or  coucliing,  the 
capsule  broken  up,  and  the  lens  cut  in  several  directions.  If  this  does 
not  soon  effect  its  absorption,  the  needle  is  again  introduced,  and  the 
lens  broken  into  minute  fi-a^ments. 


Teeth  Drawing. — The  turnkey  has  long  been  in  use  for  extracting 
teeth,  especially  the  back  teeth ;  but  forceps  are  becoming  more  and 
more  in  favor  in  all  cases.  When  the  turnkey  is  employed,  the  gum 
should  be  cut  cleanly  from  the  neck  of  the  tooth  with  the  point  of  a 
sharp  penknife,  the  hook  of  the  instrument  fastened  upon  the  tooth  as 
low  down  or  near  the  jaw-bone  as  possible,  and  the  fulcrum  resting  on, 
and  not  against  the  side  of  the  jaw.  This  manner  of  adjustment  will 
raise  the  tooth  as  nearly  perpendicular  as  possible,  and  to  that  extent 
diminish  the  danger  of  breaking  the  jaw-bone.  In  some  cases  the 
neck  or  fangs  of  the  tooth  are  firmly  adherent  to  the  jaw  when  a  great- 
er or  less  fracture  is  inevitable.  The  severe  bleeding  which  some- 
times follows  the  operatioii,  can  be  readily  checked  by  washing  the 
mouth  with  the  coldest  wat6r,  and  exposing  it  freely  to  the  cool,  open  air. 

When  ybrcrp.?  are  used,  of  which  several  sizes  and  shapes  are  man- 
ufactured to  suit  the  different  teeth,  figs.  280,  281,  and  282,  the  blades 
are  to  be  pressed  firmly  down  to  the  jaw,  and  while  the  tooth  is  raised 
by  a  steady  force,  slight  lateral  motions  are  to  be  made  to  loosen  the 
fangs  in  tb<^  sofket.     In  the  extraction  of  incisoi  teeth,  circular  motior 


PARTICULAR   OPERATIONS. 


429 


should  be  made.     The  cuspids  may  be  extracted  witli  the  incisor,  and 
the  bicuspids  >vith  the  molar  forceps.     In  extracting  fangs  or     spags," 

Fia:.  280. 


MOLAR   FORCEPS  OF  DR.   HILL. 
Fig.  281. 


COMMON    INCISOR    FORCKPS. 

Fig.  282. 


POINTED    FORCEPS    FOR    EXTRACTING    FANGS. 

the  gums  are  to  be  completely  detached,  and  the  sharp  points  of  the 
forceps  pressed  as  far  down  as  possible,  M^hen  the  fragment  is  to  be 
seized,  raised,  and  rotated  at  the  same  time. 

Pumping  the  Stomach. — The  introduction  of  the  common  stom- 
ach-pump requires  no  special  directions ;  but  in  emergencies,  as  in 
rases  of  poisoning,  the  stomach  can  be  emptied  by  introducing  the  elas- 
tic tube  of  the  common  injecting  syringe,  using  the  syringe  itself  as  the 
pump.  When  it  is  withdrawn,  the  outer  end  should  be  closed,  so  that 
whatever  liquid  it  might  contain  would  not  run  back  into  the  stomach. 

Catheterism. — This  term  applies  to  the  clearing  and  enlarging  of 
various  canals  in  the  body,  but  is  usually  understood  as  pertaining  sole- 
ly to  the  passage  of  the  catheter  through  the  urethra  into  the  bladder. 
Either  a  sti-aight  or  curved  tube  can  be  inserted  by  any  one  ftimiliar 
with  tlie  anatomy  of  the  parts. 


480  SURGE  R  Y. 


To  introduce  tho  male  catheter  most  conveniently,  the  patient  lies  on 
the  back  with  the  shoulders  somewhat  elevated  ;  the  catheter  is  held  at 
n  right  angle  to  the  body  until  its  point  reaches  the  arch  of  the  pubes, 
and  then  depressed  to  a  level  with  the  thighs,  when  the  point  of  the  in- 
strument will  slip  over  the  triangular  ligament  and  enter  the  bladder. 
The  female  catheter  is  easily  introduced,  as  the  thickened  edge  of  the 
urethra  can  readily  be  felt  about  an  inch  behind  the  symphisis  pubis,  at 
the  upper  edge  of  the  vagina. 

Conunon  catheters  for  the  urethra  are  made  of  silver  or  gum-elas- 
tic. When  the  latter  is  introduced,  a  wire  is  contained  within  the 
tube  to  prevent  its  bending  on  meeting  with  resistance  in  its  passage. 

A  catheter  is  sometimes  passed  into  the  Eustachian  tube  to  clean  or 
enlarge  it;  the  orifice  of  the  tube  is  about  a  quarter  of  an  inch  behind 
the  soft  palate,  and  is  large  enough  for  the  insertion  of  the  little  finger. 
The  instrument  is  passed  through  the  nostril  with  its  convexity  up- 
ward, until  the  patient  gags,  when,  by  turning  the  point  further  to- 
ward the  affected  side,  it  will  slip  into  the  tube,  or  the  point  may  be 
directed  into  it  by  the  finger  introduced  through  the  mouth. 

Inoculation. — This  operation  has  thus  far  been  confined  to  vacci- 
nation— the  introduction  of  the  kine-pox  virus  as  a  preventive  of  small- 
pox. The  cuticle  is  raised  with  the  point  of  a  sharp  lancet  or  needle, 
and  the  vaccine  lymph,  previously  moistened,  rubbed  on  the  abraded 
surface.  Three  or  four  punctures  are  usually  made  near  each  other, 
on  the  outside  of  the  arm  above  the  elbow. 

But  the  French  surgeons  are  threatening  us  with  another  kind  of  in- 
oculation, that  of  syphilis  itself!  It  is  announced  in  the  late  medical 
journals,  that  the  wonderful  discovery  has  been  made  that,  by  repeat- 
edly inoculating  the  system  with  this  virus  until  the  system  is  saturated 
so  that  it  will  take  no  more,  the  system  will  thenceforward  be  proof 
against  any  further  action  of  syphilitic  poison.  What  use  "the  pro- 
fession" in  Paris  or  New  York  intend  to  make  of  this  "discovery,"  is 
not  stated;  and  I  mention  the  subject  for  the  especial  purpose  of  rep- 
robating the  gross  immorality  as  well  as  arrant  quackery  of  the  whole 
affair. 

CEsopHAGOTOMY. — The  gullet  has  sometimes  been  opened  to  ex- 
tract foreign  bodies,  and  to  introduce  food  into  the  stomach.  An  inci- 
sion is  made  between  the  trachea  and  sterno-cleido  mastoid  muscle ; 
and  the  dissection  made  chiefly  with  the  fingers,  to  avoid  the  recurrent 
nerve,  the  fascia  being  cut  with  the  protection  of  a  director.  The  op- 
eration may  prolong,  but  seldom  saves  life. 


PARTICULAR   OPERATIONS.  13i 


Choking  is  generally  produced  by  some  substance  lodging  just  above 
the  cricoid  cartilage,  from  which  it  is  in  most  cases  soon  pushed  for- 
ward toward  the  stomach,  or  raised  a  little,  sticking  fost  in  the  pharynx, 
where  it  may  produce  suffocation  by  pressing  upon  the  lurynx  and  ex- 
citing spasm  of  the  glottis.  By  opening  wide  tlie  mouth,  the  article 
can  generally  be  loosened  with  the  finger,  a  fork,  teas^poon,  spoon-han- 
dle,,or  curved  forceps.  If  it  has  passed  below  reach  in  this  way,  it  may 
bo  pushed  into  the  stomach  with  H^rrobang,  a  piece  of  whalebone,  hav- 
ing a  rounded  end,  and  covered  with  silk ;  or  withdrawn  by  means  of 
an  air-pump. 

Laryngotomt. — This  operation  is  sometimes  necessary  to  remove 
foreign  bodies.  An  incision  is  made  through  the  skin  from  the  lower  side 
of  the  pomum  adami  to  the  lower  border  of  the  cricoid  cartilage.  The 
skin  is  then  separated,  and  the  cellular  membrane  ruptured  with  the 
handle  of  the  scalpel,  between  the  sterno-hyoid  muscles  down  to  the 
crico-thyroid  membrane,  v/hen  the  point  of  the  scalpel  h  r>assed  sud- 
de-tiiy  through  this  membrane. 

Tracheotomy. — The  trachea  or  windpipe  is  sometimes  opened  ia 
order  to  extract  foreign  substances.  The  place  selected  is  the  median 
line,  extending  from  near  the  upper  end  of  the  sternum  to  the  cricoid 
cartilage.     It  requires  a  skillful  anatomist. 

Paracentesis  Abdominis. — "Tapping,"  as  this  operation  is  usual- 
ly called,  is  performed  in  ascites,  or  dropsy  of  the  abdomen  ;  it  is  justi- 
fiable whenever  the  fluid  is  contained  in  a  cyst,  and  when  all  the  usual 
means  for  promoting  the  absorption  of  the  fluid  have  failed.  The  pa- 
tient sits  in  a  chair;  a  bandage  is  made  of  a  sheet  folded  about  half  a 
yard  wide ;  this  is  placed  around  the  abdomen,  with  a  hole  in  front 
through  which  to  operate,  and  crossed  behind  the  back,  where  the 
ends  are  lield  by  two  assistants,  who  are  to  tighten  it  as  the  fluid  es- 
capes. The  surgeon  then  makes  an  incision  in  the  Unea  alba,  tv/o  or 
three  inches  below  the  umbilicus,  fig.  283,  with  a  sharp  lancet  or  bis- 
toury, through  which  a  blunt  tube  or  canula  is  introduced  to  carry  oflf 
the  fluid.  If  faintness  occur,  the  flow  must  be  lessened  or  even  dis- 
continued for  a  time  and  if  excessive  fainting  supervene,  the  patient 
may  be  placed  in  a  horizontal  position,  and  the  completion  of  the  ope- 
ration deferred  for  several  hours,  or  even  a  day  or  two.  The  only 
dressing  required  is  the  adhesive  strap  and  bandage ;  the  patient  must 
keep  very  quiet  for  several  days,  and  then  revsume  habits  of  exercise 
very  gradually. 


482 


SURGERY 


Paracentesis  Vesica. — The  bladder  may    e  "tapped"  above  the 

Fig.  283. 


PARACENTESIS    ABDOMINIS. 

front  of  the  pubes,  or  punctured  through  the  rectum  in  males,  or  vagi- 
na in  femcles,  in  obstructions  which  admit  of  no  other  method  of  relief. 

Imperforate  Anus. — Children  are  sometimes  born  with  the  in- 
teiiument  closed  over  the  rectum,  which  can  be  observed  swelling  be- 
neath. A  simple  incision  will  remedy  the  difficulty.  When  the  rec- 
tum cannot  be  reached,  and  in  cases  of  its  closure  in  the  adult  in  con- 
sequence of  disease,  the  only  remedy  is  an  artificial  anus.  This  is 
usually  made  by  cutting  in  the  loins  to  the  descending  colon,  and  at- 
biching  the  bowel  by  two  ligatures  to  the  lips  of  the  wound;  an  inci- 
sion is  then  made  into  it,  and  the  lips  of  this  wound  more  closel}'  united 
with  those  of  the  first. 


Imperforate  Urethra. — When  this  is  a  congenital  malformation, 
a  round  trochar  is  to  be  inserted,  followed  by  a  cauula,  and  then  by  a 
catheter,  and  this  is  retained  until  the  orifice  \ieals. 

Lithgntripsy  and  Lithotomy. — Each  of  these  modes  are  resort- 
ed to  for  stone  in  the  bladder.  The  former  operation  consists  in 
cnishing  it  in  the  bladder  with  an  instrument  called  the  lUhontriptor, 
and  is  only  apj)]icQble  to  adults  when  the  stone  is  soft  and  small ;  and 
the  latter  consists  in  cutting  into  the  bladder  with  the  gorget  or  knife. 

The  operation  of  lithontripsy  is  more  frequently  applicable  to  the  fe- 
male, by  reason  of  the  larger  diameter  of  the  urethra;  and  for  the 
«ame  reason,  even  this  is  very  rarely  necessary. 


PARTICULAR    OPERATIONS. 


438 


For  the  operation  of  lithontripsy,  the   urethra  must  be  dilated   by 
Dougies  until  the  lithontriptor  will  pass.     This  instrument,  fig.  284,  w 

Fi-.  284. 


LITHO?,-TRIPTOR   INCLOSING  A  CALCULUS. 

then  oiled  and  passed  into  the  bladder,  while  closed,  as  a  common 
bougie.  When  it  comes  in  contact  with  the  stone,  the  movable  half 
is  pushed  in,  by  which  the  blades  are  opened  at  the  several  joints;  it 
is  then  rotated  from  side  to  side,  tightened  occasionally,  etc.,  so  as 
to  grasp  the  stone  ;  when  fixed  between  the  blades — which  fact  is 
known  by  the  inability  to  draw  the  sliding  part  back — the  arms  of  the 
screw  are  turned  gradually,  by  which  the  slide  is  withdrawn  and  the 
blades  brought  slowly  and  with  great  force  together.  After  the  stone 
has  given  way  and  the  instrument  closed,  it  is  to  be  reopened  and  man- 
aged in  the  same  wa}'  for  any  large  fragments  which  remain.  During 
the  operation  the  patient  is  placed  on  a  table,  with  the  hips  elevated 
and  the  bladder  full,  or  nearly  so  ;  or  it  may  be  filled  by  injection 
through  the  catheter.  After  the  ci'ushing  process  is  completed,  the 
lithontriptor  is  withdrawn,  the  patient  turned  ftice  downward,  and  di- 
rected to  urinate  as  rapidly  as  possible  ;  after  which  the  bladder  may  be 
repeatedly  injected  and  the  powdered  stone  washed  out. 

In  cuttino;  for  the  stone,  the  lateral  operation  is  now  generally  pre- 
ferred, and  always  adopted  by  some  of  the  most  eminent  living  sur- 
geons. But  as  no  one  will  attempt  it  without  special  education  in  the 
dissecting-room,  its  description,  which  is  somewhat  tedious,  need  not 
be  detailed  here. 


AmputatiOxN. — The  Water-Cure  method  of  treating  injuries,  tu- 
mors, ulcers,  and  inflamiiatiwns  is  destined  to  diminish  very  greatly  the 
11—37 


434 


SURGERY 


demaod  for  this  operation,  which,  however,  is  much  more  simple  t;han 
is  generally  supposed,  and  can  be  performed  by  almost  any  person  who 
combines  a  good  mechanical  tact  in  the  use  of  tools,  with  a  sufficient 
amount  of  anatomical  knowledge  to  enable  him  to  compress  he  main 
artery. 

The  operation  may  be  performed  with  nearly  equal  advantage  in  two 
ways,  one  of  which  is  called  the  circular,  and  the  other  ihefiap  ope- 
ration. The  latter,  however,  is  applicable  to  a  greater  number  of 
places. 

The  usual  instruments  employed,  in  addition  to  the  pocket-case,  are, 
the  tourniquet,  large  knife,  saw,  and  bone-forceps.  For  the  circular 
operation,  a  blunt,  round-pointed  knife  is  used ;  and  for  the  flap  opera- 
tion, two  sharp-pointed  ones  for  different  parts.  Of  course,  the 
thorough,  practical  surgeon  is  to  be  pi"eferred  in  all  cases  requiring 
amputation,  but  emergencies  do  sometimes  exist  in  w^hich  immediate 
amputation  is  the  only  chance  for  the  patient's  life ;  and  to  meet  this 
exigency,  the  following  explanations  are  given  : 

The  patient  is  seated  in  a  chair,  or  placed  on  a  bed  or  table ;  the 
pad  of  the  tourniquet  is  fixed  on  the  artery  at  a  convenient  distance 
above  the  place  of  operation.  In  the  circular  operation  upon  the  arm, 
one  assistant  supports  the  forearm,  and  another  grasps  the  ai'm  above 
with  both  hands,  and  pulls  back  the  integument  as  much  as  possible. 
The  surgeon  passes  his  hand  under  the  arm,  bringing  the  knife  corn- 
Fig.  285. 


CiaCULAR   AMPUTATION  OF  THE  ARM. 

oietely  over  it  on  his  own  side,  with  the  point  downward,  fig.  285,  and 
makes  the  firs',  incision  by  drawing  the  b'ade  backward  from  hilt  to 


PARTICULAR    OPERATIONS  4*55 


point,  rutting  through  the  skin  ana  superficial  fascia,  entirely  round  the 
limb.  The  skin  is  then  loosened  from  the  muscles  beneath,  by  sep- 
arating the  areolar  tissue  with  a  scalpel  or  bistoury ;  the  skin  is  next  re- 
tracted further  up,  and  then  another  incision  made  as  high  up  as  the 
skin  will  allow,  dividing  all  the  flesh  down  to  the  bone-  Some  sur- 
geons give  an  elliptical  direction  to  both  incisions,  leaving  the  muscles 
longer  before  and  behind  than  at  the  sides.  The  muscles  are  next 
separated  from  the  bone  an  inch  or  two  with  the  point  of  a  knife  or 
scalpel,  and  a  strip  of  muslin,  a  yard  long  and  three  inches  wide,  made 
into  a  "two-tailed  retractor,"  by  slitting  it  to  its  middle,  applied,  tho 
broader  end  being  placed  on  the  under  side,  the  two  tails  passing  up  on 
each  side  of  the  naked  bone,  and  crossing  them  at  the  top;  by  this  the 
flesh  is  pulled  upward  as  far  as  possible,  and  held  by  an  assistant. 
The  periosteum  is  then  separated  from  the  bone  by  a  circular  cut,  and 
then  the  bone  is  sawed  ofl",  the  splints,  if  any,  remain,  being  smoothed 
olf  by  the  bone-forceps  or  nippers.  The  retractor  is  then  removed,  and 
the  brachial  artery  tied.  If  the  artery  is  not  readily  found,  the  tour- 
niquet is  loosened,  when  a  jet  of  blood  discovers  it.  All  other  arteries 
which  bleed  on  loosening  the  tourniquet,  are  to  be  also  taken  up  and 
tied.  When  the  veins  cease  bleeding,  the  stump  is  to  be  washed  clean 
and  dressed  by  bringing  the  edges  of  the  flesh  together  in  an  exact  hor- 
izontal line  across  the  middle  of  the  stump,  and  there  fastened  by  strips 
of  adhesive  plaster,  three  fourths  of  an  inch  wide  and  eight  or  ten  inches 
in  length,  placing  the  first  over  the  center  of  the  seam,  and  the  others 
laterally  at  about  a  quarter  of  an  inch  distance.  Other  straps  may  be 
laid  obliquely  over  these,  and  narrow  straps  in  any  direction  necessary 
to  secure  every  part  of  the  wound  firmly  ;  and  a  strap  around  the  whole 
arm  to  secure  all  the  others  is  also  advisable.  The  stump  is  then  cov- 
ered with  lint,  retained  by  a  light,  easy  bandage  ;  and  the  dressings  are 
to  be  kept  constantly  w^et  with  cold  water,  if  there  is  the  least  tendency 
to  inflammation. 

When  animal  membrane  is  used  for  tying  the  arteries,  it  may  be  cut 
off  close  to  the  knot  and  left  to  itself;  but  if  linen  or  silk  is  employed, 
one  end  of  the  ligature  must  be  left  long  enough  to  hang  out  between 
the  straps.  The  dressing  does  not  usuall}'  require  removing  under  sev- 
eral days ;  and  when  they  are  removed  or  readjusted,  the  parts  must 
be  carefully  supported  by  an  assistant ;  the  ligature  must  be  taken 
away  whenever  it  can  be  done  by^  ^ntle  pulling  ;  but  its  removal  should 
not  be  attempted  within  one  week. 

When  it  is  necessary  to  amputa  ^  the  arm  high  up,  the  subclavian 
artery  should  be  compressed  where  it  passes  over  the  first  rib,  by  the 
thumb  of  an  assistant. 


436 


S  U  R  0  E  R  Y. 


In  the  fiap  operaiior^  for  the  forearm,  fig.  236  shows  the  proper  posi« 


Fig.  286. 


tion  of  the  arm.  The  pos- 
terior flap  is  made  first ; 
and  when  the  point  of  the 
knife  reaches  the  bone, 
the  hand  is  to  be  rotated  a 
little  inward,  and  the  point 
pushed  on  close  over  both 
bones,  taking  care  that  it 
does  not  pass  between 
them  ;  when  the  blade 
passes  over  the  ulna,  the 
hand  is  to  be  rotated  a  lit- 
tle outward,  to  bring  its 
point  further  down  under 
that  bone  ;  the  incision  is 
then  pursued  downward 
and  outward,  so  that  the 
edge  of  the  knife  may 
emerge  at  about  an  inch 
and  a  half  below,  and  at 
equal  distance  from,  the 
points  of  entrance  and 
emergence.  The  exter- 
nal flap  is  then  raised  a 
little,  the  knife  entered  at 
the  former  point,  pushed 
through  close  in  front  of  the  bones,  and  brought  obliquely  downward, 
thus  making  a  second  flap  to  corresp*.Tid  with  the  first.  The  remain- 
der of  the  operation  and  the  dressings  are  similar  to  those  of  the  former 
operation. 

Amputation  of  the  fingers,  though  occasionally  desirable  at  either  joint, 

is  most  frequently  per- 
formed at  ihe  base — the 
phalangeo-metacarpal  ar- 
ticulation, fig.  237.  An 
incision  is  made  upon  the 
knuckle  in  an  ell'ptical 
form  around  the  finger, 
extending  down  upon  the 
AMPUTATi 'N  or  THf:  FixtjER.  palmar  surface  of  the  fir»- 


FLAP  OPERATION. 


Fi?.  287. 


PARTICULAR   OPERATIONS.  487 


ger  about  an  inch,  to  make  a  flap  large  enough  to  cover  the  joint ;  after 
which  the  tendons  and  ligaments  are  cut  through,  and  the  joir.t  dislo- 
cated by  carryiig  the  knife  through  it. 

LiQATiNG  AND  CoMPRESSiNG  Ap^TERiES. — Tliese  Operations  will 
usually  be  performed  by  the  experienced  surgeon ;  but  emergencies 
will  frequently'-  exist  in  which  it  is  indispensable  to  cut  down  upon  and 
tie,  or  make  compression  on  a  large  artery,  in  order  to  arrest  a  dan- 
gerous flow  of  blood,  or  prevent  hemorrhage  while  removing  tumora 
or  other  morbid  parts.  Hjw  and  where  to  do  these  things,  ought, 
therefore,  to  be  matters  of  general  information.  In  ligating  arteries, 
the  main  points  to  be  observea  are,  to  make  an  oblique  iyicision  over  it, 
and  to  avoid  taking  up  the  nerve,  which  is  frequently  inclosed  in  the 
same  sheath  with  the  artery.  And  in  compressing  arteries,  a  hand 
kerchief  or  the  thumb  may  be  employed,  making  the  pad  or  pressure 
to  bear  directly  on  the  vessel.  When  the  thumb  is  employed,  the 
beating  of  the  artery  will  dii'ect  the  exact  point  for  the  pressure  to  be 
made,  which  is  to  be  increased  until  the  pulsation  ceases. 

The  subclavian  aileiy  may  be  compressed  by  the  thumb,  and  with 
difficulty  in  any  other  way,  where  it  passes  over  the  first  rib,  in  the 
space  between  the  first  rib  and  clavicle,  thus  controlling  the  circula- 
tion of  the  entire  arm.  The  brachial  artery  can  be  easily  compressed 
on  the  inner  side  of  the  arm,  about  midway  between  the  elbow  and 
axilla,  as  it  hes  near  the  surftce.  The  circulation  of  the  lower  limb 
may  be  efl*ectually  controlled  by  compressing  the  femoral  artery  at 
the  groin  just  above  Poupart's  ligament;  the  pulsation  of  the  artery 
can  be  felt  immediately  below  the  concavity  of  tlie  groin  ;  the  thumb  is 
here  the  most  effectual  instrument  for  compression,  although  a  piece  of 
cork,  or  the  handle  of  a  door-key,  wrapped  in  several  folds  of  linen, 
will  answer. 

The  large  arteries  .of  the  neck  seldom  require  compression,  except 
when  large  tumors  are  to  be  dissected  out.  The  common,  carotids  may 
be  considered  as  resting  on  the  transverse  processes  of  the  cervical  ver- 
tebrae, and  their  circulation  may  be  controlled  by  pressing  them  against 
those  processes. 

Note. — There  are  a  few  instruments  required  in  some  of  the  prece- 
ding operations  which  are  found  at  nearly  all  the  manufacturing  shops; 
but  an  ocular  view  may  enable  the  operator  to  have  either  of  them 
n:ade  to  order,  should  it  prove  necessary  or  more  convenient.  Fig. 
288  represents  the  double  hook  employed  in  tne  operation  for  sti-abis- 
mus.  Fig.  289  is  the  curette  or  director  used  in  the  same  operation. 
Fig  290  is  a  pair  q{  fine  Jiook  forcep?,     Fig.  291  is  a  pair  of  curved 


438 


SURGERY. 


scissors.  Fig.  292  represents  the  silver  tube  inserted  in  cases  of  fistula 
lachrymalis.  Fig.  293  is  the  style  sometimes  employed  in  the  treat- 
ment of  the  same  disease.  Fig.  294  is  the  ordinary  curved  couching- 
needle,  and  fig.  295  is  called  Hay's  couching-needle.  The  former  nee- 
dle is  sometimes  called  Scarpa's,  and  is  generally  preferred. 


Figs.  288.        289. 


290. 


29L 


Fli  295 


PART    VIII. 

MIDWIFERY. 
CHAPTER  I. 

HISTORY  OF  MIDWIFERY 

JirfCiEPTT  Midwifery. — All  history,  sacred  and  profane,  attests  that 
the  general  practice  of  midwifery  has  been  in  the  hands  of  females  un- 
til a  veiy  modern  date.  It  is  true  Hippocrates  theorizes  on  obstetrics, 
but  we  have  no  evidence  of  his  possessing  any  experimental  knowledge 
on  the  subject.  Historians  tell  us  that  in  Greece,  Rome,  Persia, 
Egypt,  Arabia,  and  Chaldea,  woman  was  woman's  physician.  The  Old 
Testament  informs  us  \hi\t  female  midwifery  was  an  honorable  calhng 
among  the  ancient  Hebrews.  "Since  the  beginning  of  history,"  says 
Mrs.  C.  M.  Dall,  "  the  lives  of  eighty-seven  women,  eminent  not  only 
for  obstetrical  skill,  but  capable  of  extended  practice,  have  been  writ- 
ten." 

So  far  as  the  world  has  had  experience  in  this  matter,  the  success  of 
female  accouchers  has  been  at  least  as  gi-eat  as  that  of  male  accouch- 
ers;  and  the  statistics  of  all  ages  show  that  the  attendance  of  woman 
has  been  accompanied  with  fewer  accidents  and  a  less  number  of  fatal 
cases  than  the  i^Tdcticc  of  man.  Since  it  has  been  as  fashionable  as  it 
is  foolish  to  drug  and  bleed  pregnant  females  occasionally,  on  the  ab- 
surd notion  that  there  are  a  great  many  natural  "diseases  of  pregnan- 
cy," the  success  of  our  mosi  eminent  professional  men-midwives  com 
pares  rather  unflivorably  with  that  of  many  professional  female  mid 
wives,  who  lived  in  happy  ignorance  of  the  whole  of  the  modern  drug 
and  bleeding  art. 

Modern  Midwifery. — Save  in  most  parts  of  Great  Britain  and  the 
United  States,  the  general  practice  of  midwifery  still  is  in  the  hands  of 
woman.  In  several  European  countries,  the  business  is  divided  be- 
tween male  and  female  practitioners ;  but  in  the  greater  number  of 


440  MIDWIFERy. 


countries  on  earth,  civilized  and  uncivilized,  woman  officiates  in  all  or- 
dinary cases.  Throughout  Russia,  at  this  day,  educated  female?  at- 
tend all  classes  of  society,  from  the  royal  family  to  the  meanest  serf. 
The  Chinese  employ  midwives  in  all  ordinary  cases,  obsteti-ical  sur- 
geons Deing  called  upon  only  when  instrumental  assistance  is  necessary. 
'J'he  American  Indians,  the  Otaheitians,  the  New  Zealanders,  and 
many  other  nations  and  tribes,  wlio  employ  female  midwives  or  none, 
are  celebrated  for  easy  births  and  exemption  from  accidents.  In  France, 
the  sage  femme,  wise  woman,  is  the  principal  accoucher.  In  Germa- 
ny, the  xrocdvromc,  skillful  woman,  officiates.  In  Denmark  her  title 
is  iordcrmoder,  earth-mother.  In  Sweden  and  Norway  she  is  called 
iord-gumma.  In  Spain  and  Portugal,  the  co-madre — literally,  with 
motlier — attends.  All  of  these  terms  are  equivalent  to  midwife  in  our 
language. 

Fkmale  Authors  and  Practitioners. — Soon  after  the  institution 
of  ti>e  first  medical  school  in  Greece,  the  exclusive  sj)irit  of  tlie  faculty 
obtained  the  enactment  of  a  statute  prohibiting  the  practice  of  this  art 
by  "  women  and  slaves."  The  tsrannical  act  spread  dismay  among  the 
women  of  Athens ;  and  so  tumultaously  did  they  rebel  against  the  out- 
rage upon  "woman  rights,"  tliat  a  new  act  was  soon  after  passed  al- 
lowing free-born  women  to  learn  midwifeiy.  No  other  attempt  was 
made  by  the  profession  to  wrest  this  practice  from  its  rightful  owners 
until  after  the  accession  of  Henry  IV. 

Among  those  who  have  attained  eminence  in  this  tlieir  peculiar  de- 
partment of  the  healing  art,  tlie  following  names  may  be  mentioned  in 
this  place:  Agnodike,  the  daughter  of  Hieroj)hilus  ;  she  practiced  suc- 
cessfully at  Athens  in  defiance  of  the  medical  clique.  Artemesia,  the 
queen  who  assisted  Xerxes  at  the  battle  of  Salamis.  Kli)indike.  of 
Greece,  daughter  of  Cimon,  and  sister  of  Miltiados.  Yroutata,  of  Sa- 
lermo,  who  practiced  in  the  latter  part  of  the  lliirteenth  century,  and 
wrote  several  books.  Mad.  Peirette,  wlio  was  sworn  into  the  office 
of  midwife,  in  Paris,  in  1408,  and  bv^came  famous  throughout  France. 
Mad.  Gancourt,  later  in  the  fifteenth  century,  became  equally  cele- 
brated. Mad.  Francoise,  the  midwife  of  Catherine  de  Medicis,  was 
t\n  approved  lecturer  on  obstetrics  near  the  middle  of  the  sixteenth 
century.  Olympia  Morata,  born  in  Ferrara  in  1G.2G,  wrote  the  lec 
tures  which  her  hu^^lmnd,  a  young  physician,  delivered  at  Heidelberg. 
Mad.  Perronne  had  the  reputation  of  contributing  all  the  obstetrical 
matter  which  was  published  in  the  works  of  the  eminent  French  sur- 
geon, .Tames  Guillemeau.  Louise  Bonrsin  Bourgeois,  born  in  1580, 
man-'^d  ?  surgeon,  was  appointed  to  attend  the  Queen  of  France,  and 


HISTORY    OF    MIDWIFERY.  441 


published  many  valuable  works.  Mad.  La  Marclie,  boni  in  1638,  was 
an  accomplished  literary  scholar,  as  well  as  extensive  obstetrical  writer 
and  practitioner.  Justine  Dieterich  Siegmunden,  born  in  Silesia  in  1650, 
was  one  of  the  most  accurate  anatomists  of  her  day,  an  extensive  practi- 
tioner of  midwifery,  and  the  authoress  of  several  obstetrical  works.  Mad. 
Breton,  in  the  eighteenth  ce>ntury,  invented  a  plan  for  the  artificial 
nourishment  of  babes.  Elizabeth  Blackwell,  born  in  England  in  1712, 
was  the  authoress  of  the  first  illustrated  work  on  medical  botany  ever 
published.  Mad.  Ducondray,  born  at  Paris  in  1712,  was  the  first  per- 
son who  lectured  with  a  manikin,  which  she  invented  herself.  Mo- 
randi,  born  at  Bologna  in  1716,  was  among  the  first  to  invent  and  per- 
fect wax  preparations.  Mademoiselle  Biheron,  born  at  Paris  in  1730, 
made  still  greater  improvements  in  wax  figures  illustrative  of  obstet- 
rical knowledge. 

Saridi  Stone,  of  Eiigliind,  was  the  fmthoress  of  a" work  published  in 
1737,  called  the  "Complete  Practice."  Elizabeth  Nihell,  of  London, 
was  distinguished  for  successfully  opposing  a  distinguished  physician  on 
one  hand,  and  a  notorious  quack  on  the  other.  In  l'?60  she  wrote  a 
treatise  on  midwifery,  in  which  she  exposed  the  use  of  instruments, 
which  the  male  accouchers  were  becoming  too  fond  of  employing;  ad- 
vocated the  employment  of  women,  and  strongly  protested  against  the 
interference  of  men.  She  declared  that  a  curse  followed  their  inter- 
meddling, in  evidence  of  which  she  adduced  the  increasing  number  of 
difficult  and  fatal  labors.  Mad.  Refilatin,  born  in  1720,  was  the  author  of 
a  work  on  "  Delayed  Accouchments."  Margaret  Stevens  was  the  author- 
ess of  the  "Domestic  Midwife,"  published  in  London  in  1795.  Mad.Lu 
nel  published  a  work  in  Paris  in  1750.  Mad.  La  Chapelle,  who  officiated 
in  over  twenty-two  thousand  cases  at  the  Maternite  Hospital  in  Paris, 
ranks  among  th-e  standard  authorities  on  midwifery.  Mad.  Bovin,  anoth- 
er standard  authoress  of  several  works,  attended  over  twenty  thousand 
cases,  and  performed  nearly  all  the  manual  and  instrumental  operations 
known  to  the  art  as  successfully  as  any  male  accoucher  has  ever  done. 
Mad.Lesebourswas  the  authoress  ofawork  published  in  1770.  Anirish 
midwife,  named  Dunally,  performed  the  C cesarean  operation  success- 
fully with  a  common  razor.  Mad.  Rondet,  born  in  1800,  perfected  a 
tube  for  the  restoration  of  children  born  asphyxiated.  Mad.  Dian  was 
practicing  reputably  in  1821.  Mad.  Wittembaciv  was  consulted  in  re- 
lation to  obstetrics  by  the  most  experienced  physicians. 

In  the  United  States  the  following  names  occur  in  this  connection  : 
Old  Mrs.  Wiat,  who  died  at  Dorchester,  Mass.,  in  1705,  aged  ninetj'- 
four  years,  assisted  as  midv/  fe  in  more  than  eleven  hundred  cases. 
Mrs.  Whittemore.  who  diet    ir    Marlboro',   Vermont,  at  the  age  of 


442  MIDWIFERY, 


eighty-seven  often  traveled  through  the  woods  on  snow-shoes  to  at- 
tend her  patients,  and  of  more  than  two  thousand  cases  of  births,  she 
never  lost  a  patient.  Mrs.  Elizabeth  Phillips,  who  was  born  at  West- 
minster, England,  and  commissioned  to  act  as  midwife  by  the  Lord 
Bishop  of  London  in  1718,  removed  to  Charlestown,  Mass.,  the  follow- 
ing year,  where  her  gravestone  now  records  the  honorable  story  that 
she  assisted  in  successfully  bringing  into  the  world  above  three  thou- 
sand children.  Mrs.  Jane^  Alexander,  whc  iied  at  Boston  in  1845, 
aged  sixty-one  years,  studied  mid^^if6»•y  witii  Dr.  James  Hamilton,  of 
Edinburgh,  and  pi-acticed  in  this  countiy  twenty-five  years  without  losing 
a  patient.  Mrs.  Stebbins,  who  died  at  Westfield,  Mass.,  in  1844,  at 
the  age  of  seventy-five,  was  an  extensive  and  successful  practitioner  for 
many  years.  Similar  facts  could  be  greatly  multiplied,  but  I  have  al- 
ready enough  for  my  purpose. 

Man-Midwifery. — According  to  the  best  authorities  we  can  find, 
man-midwifery,  as  a  regular  part  of  the  physician's  duties,  dates  back 
precisely  one  hundred  and  eighty-eight  years,  and  then  it  originated 
with  a  court  prostitute  of  Louis  XIV.,  the  Duchess  de  Villiers,  who, 
under  arrangements  of  the  utmost  secrecy,  submitted  to  be  attended  by 
Julian  Clement,  an  eminent  surgeon.  Clement  was  soon  after  ap- 
pointed to  the  new  and  lucrative  office  of  midwife  to  the  Princess  of 
France.  Until  that  event  the  ordinary  practice  was  entirely  in  the 
hands  of  female  midwives,  surgeons  being  called  upon  only  as  surgeons 
in  cases  of  unnatural  labors. 

In  the  most  uncivilized  and  unenlightened  portions  of  the  globe,  a 
male  midwife  has  never  been  heard  of.  A  male  accoucher  was  not 
known  among  the  "  Puritans"  until  this  country  Imd  been  settled  more 
than  a  century.  In  1723,  Dr.  John  Maubray,  the  first  male  lecturer 
iu  England  on  this  subject,  wrote  a  book  against  the  abuse  of  instru- 
ments, which  the  male  accouchers  were  becoming  too  fond  of  employ- 
ing. In  fact,  at  that  time  the  use  of  instruments  was  considered  such 
an  improvement  on  nature  that,  in  the  language  of  Dr.  Gregory  {Man- 
midwifery  Exposed),  "  Almost  eveiy  doctor,  old  or  young,  was  for  try- 
ing his  hand  at  it."  So  notorious,  indeed,  was  the  rage  for  instrument- 
al operations,  that  Sterne,  in  1757,  satirized  it  in  "The  Life  and  Times 
of  Tristram  Shandy,  Gent." 

Dr.  Shippen,  of  Philadelphia,  was  the  first  lecturer  on  midwifery  in 
the  United  States — 176-2.  Dr.  Alwood,  of  this  city,  in  the  same  year, 
was  the  first  to  advertise  himself  as  a  man-midwife.  And  no  longer 
ago  than  1820,  a  Boston  physician  jjublished  and  circulated  a  pamphlet 
advocating  t^ie  exclusion  o^  females  fi-om  the  practice,  and  the  substitu- 


REPRODUCTION.  443 

tion  of  males.  At  the  present  time,  nearly  every  allopathic  medical 
journal  in  the  world  is  vehemontly  opposed  to  relinquishing  this  prac- 
tice into  the  hands  of  females,  while  every  progressive  and  reform  pe- 
riodical I  am  acquainted  with  as  earnestly  advocates  the  restoration. 

Who  Should  be  Midwives  ? — I  confess  to  be  of  that  number  who 
advocate  a  restoration  of  the  practice  o^  midwifery  to  educated  fe- 
males ;  but  I  am  very  far  from  desiring  tv.  see  it  taken  from  the  hands 
of  educated  physicians  and  entrusted  to  ignorant  nurses.  I  hold,  how- 
ever, that  all  females  should  be  sufficiently  intelligent  on  this  subject 
to  manage  an  ordinary  labor,  and  certainly  the  education  required  for 
this  purpose  is  exceedingly  simple — so  much  so  that  the  majority  of 
females  could  and  would  acquire  it  without  any  teacher  whatever,  if 
they  were  entirely  left  to  themselves,  and  thereby  compelled  to  be- 
come self-instructed.  It  is  very  true,  moreover,  that  the  multitudi- 
nous disorders  and  deformities  existing  in  artificial  society,  do  now,  and 
will  for  a  long  time  to  come,  render  surgical  assistance  necessary  in 
certain  cases  ;  and  for  this  purpose  the  practical  surgeon-accoucher 
should  be  retained  for  accidents,  complications,  and  emergencies.  His 
services  would  be  rarely  called  in  requisition  if  we  had  properly-edu- 
cated females  to  take  the  entire  management  of  the  ordinary  practice  ; 
and  surely  no  one  will  pretend  that  young  men  can  be  taught  the  sim- 
ple yet  delicate  duties  of  a  companion  and  attendant  during  childbirth, 
more  readily  than  young  women  can,  or  be  more  efficient  in  the  dis- 
charge of  the  responsible  duties  devolving.  The  reason  young  women 
are  not  so  educated,  or  are  but  imperfectly  educated,  is  because  the 
'immense  influence  of  an  interested  profession  is  arrayed  against  them. 


CHAPTER  II. 

REPRODUCTION. 


Theories  of  Reproduction. — No  subject  has  engi'ossed  a  greater 
share  of  the  attention  of  philosophers  and  physiologists  in  all  ages  of  the 
world  than  the  mysterious  function  by  which  the  great  command,  "  in- 
crease and  multiply,"  is  fulfilled.  All  the  theories  which  ingenious 
minds  have  fabricated  may  be  resolved  into  three,  and  perhaps  two ; 
although  no  less  than  two  hundred  and  sixty-thre.e  modifications  of  those 
theories  have  been  proposei.     Without  wasting  any  time  upon  thes« 


4ii  MIDWIFERY 


fanciful  speculations,  it  is  enough  for  all  practical  purposes,  to  under- 
stand that  sexual  association  is  necessary  to  the  propagation  of  our 
race;  and  that  the  female  furnishes  the  ovum  or  germ  of  the  future 
being,  while  the  male  communicates  the  vivifying  principle.  Both, 
however,  equally  concur  in  supplying  the  actual  elements  of  its  organ- 
ization originally ;  but  the  mother  has  the  greater  modifying  power 
over  the  development  of  those  elements,  on  account  of  the  constantly 
commingling  of  the  circulating  lluids  of  mother  and  child  until  birth, 
and  the  nourishment  of  the  child  being  derived  directly  from  the  moth- 
er during  the  period  of  early  infancy. 

Transmission  of  Organization. — Nothing  is  better  established 
tlian  the  fact  that  the  character  and  quality  of  the  organization  of  the 
child  are  dependent  on  that  of  both  parents;  and  this  fact  is  of  im- 
mence  importance  in  its  bearings  on  the  well-being  of  the  family  of 
mankind.  Though  this  principle  is  pretty  well  understood  in  the  man- 
agement of  cattle  and  in  improving  the  breed  of  horses,  it  is  very  gen- 
erally overlooked  in  theory  or  disregarded  in  practice  as  relates  to  the 
human  being  ;  and  it  is  to  me  a  matter  of  astonishment  that  the  stand- 
ard works  on  physiology  and  obstetrics  in  our  medical  schools  never 
elucidate  the  subject,  and  seldom  allude  to  it.  But  surely  all  who  con- 
template the  matrimonial  relation,  as  well  as  all  who  are  alread}'^  in  that 
relation,  ought  to  know  that  precisely  according  to  the  development, 
purity,  and  vigor — in  a  word,  health — of  their  own  bodily  and  mental 
constitution,  will  be  the  physiological  integrity  and  mental  character  of 
theu-  offspring.  It  should  be  universally  known,  too,  that  the  passion 
which  impels  to  j)rocreation,  lying  at  the  very  foundation  of  existence, 
is  of  necessity  one  of  the  most  powerful  of  the  propensities  ;  and  that, 
while  its  rational  and  legitimate  exercise  is  conducive  to  health,  moral 
purity,  and  intellectual  vigor,  its  excessive  indulgence  or  abuse  is  as 
conducive  to  physiological  enervation  and  moral  degradation. 

It  is  the  common  consent  of  the  medical  world  that  libertines,  drunk- 
ards, and  gluttons,  cannot  have  healthy  children  ;  but  we  ought  to  be 
able  to  trace  the  sources  of  infirmity  beyond  their  grosser  manifesta- 
tions. Neither  the  father  whose  nerves  are  shattered  by  tobacco, 
whose  digestion  is  disordered  by  improper  food,  whose  constitution  is 
impaired  by  drug  medicines,  or  whose  blood  is  often  inflammatory 
with  the  violence  of  ungoverned  passion  ;  nor  the  mother  whose  mus- 
cular system  is  enfeebled,  whose  nerves  are  debilitated,  or  whose  ab- 
dominal organs  are  contracted  and  rigid,  and  whose  brain  is  constantly 
h-ritated  by  indolence,  novel  reading,  constipating  food,  strong  coffee, 
green  tea.  or  the  ^vequent  indulgence  of  the  p'lssionate  or  fretful  n\ood, 


KEPEODUCTiON.  445 


can  do  justice  to  the  rising  generation.  If  in  any  of  these  ways  they 
"eat  sour  grapes,"  the  children's  teeth  will  certainly  be  "set  on  edge." 
In  this  way,  too,  do  the  sins  of  the  fathers  and  mothers  curse  their  own 
offspring  through  many  generations. 

The  extremes  of  excessive  toil  and  absolute  indolence  alike  dispose 
to  a  vitiated  organization;  and  we  see  the  lamentable  evidence-*  equally 
among  the  wretched  millions  who  toil  incessantly  for  less  than  a  sutil- 
ciency  of  food  and  raiment,  and  the  profligate  idlers  of  a  more  luxuri- 
ous but  scarcely  better  fortune.  Nature  never  intended  that  constant 
labor  should  agree  with  the  constitutions  of  a  part  of  mankind,  and  con- 
stant idleness  or  dissipation  be  compatible  with  the  rest.  Those  whose 
muscles  are  perpetually  worked  down  to  the  point  of  absolute  ex- 
haustion, require  all  the  rest  and  sleep  they  can  get  to  replenish  the 
muscular  system;  and  the  brains  being  but  little  exei'cised,  will  nat- 
urally degenerate,  and  they  will  propagate  a  race  comparatively  idiot- 
ic. Those  who  exert  the  brain  intemperately,  and  sufifer  the  bodily 
functions  to  decline,  will  subject  their  offspring  to  feeble  constitutions 
and  unbalanced  minds;  and  those  whose  life  is  a  dull  round  of  indolent 
repose,  or  dissipation,  will  entail  the  bodily  and  mental  qualities  of 
grossness,  vulgarity,  debauchery,  and  selfishness. 

A  very  common  source  of  debility  on  the  part  of  parents,  and  hence 
imperfect  organization  on  the  part  of  offspring,  is  the  abuse  of  ama- 
tiveness.  No  false  delicacy  can  excuse  those  who  assume  to  be  teach- 
ers, for  refusing  to  speak  plainly  on  a  matter  which  so  much  concerns 
human  health  and  happiness;  and  I  cannot  better  acquit  myself  in  this 
duty  than  by  making  the  following  quotation  from  a  recent  work  {Or- 
ganic Laics),  by  J.  Bradford  Sax  : 

"  The  various  organs  and  f  iculties  of  the  parents  are  transmitted  to 
the  child  with  all  their  peculiarities  and  conditions.  The  perfection 
with  which  they  are  transmitted  depends  upon  their  degree  of  activity 
at  the  time  of  parentage ;  the  more  active  they  are  at  the  time  the 
more  perfectly  will  they  be  inherited.  Hence,  in  order  to  secure  per- 
fect offspring,  it  was  provided  that  during  the  act  of  parentage  all  the 
organs  and  faculties  of  the  body  and  mind  in  both  parents,  but  espe- 
cially in  the  father,  should  be  stimulated  to  the  highest  possible  degree 
of  activity.  Of  course  a  corresponding  reaction  must  afterward  take 
place. 

"Now  it  is  impossible  that  such  violent  or  intense  vital  stimulations 
and  reactions  should  occur  without  an  immense  expenditure  of  nervous 
or  vital  energy  on  the  fund  of  life.  In  point  of  fact,  no  act  or  function 
is  so  exhausting  to  the  whole  system  as  this.  If  indulged  in  to  ex- 
cess, no  practice  can  possibly  be  so  debilitating,  depraving,  and  de- 


446  MIDWIFERY. 


Btructive  to  all  the  organs  and  faculties.  Probably  more  of  the  nervous 
fluid  or  influence  is  expended  in  a  single  sexual  crisis  than  would  suf- 
fice to  carry  on  all  the  ordinary  vital  operations,  perhaps  for  days.  If 
it  is  indulged  in  daily,  or  even  weekly,  the  deluded  subject  need  not 
hope  for  heijlth  or  happiness." 

In  a  recent  and  very  exi  •s'Uent  work  {Popular  Education)  bv  Ira 
Mayhew,  A.M.,  late  Superintendent  of  Public  Instruction  in  Michigan, 
the  author  remarks:  "Physiologists  in  general  coincide  in  the  belief 
that  a  vigorous  and  healthy  physical  and  mental  constitution  in  the  pa- 
rents, communicates  existence  in  the  most  perfect  state  to  their  off- 
spring ;  while  impaired  constitutions,  from  whatever  cause,  are  trans- 
mitted to  posterity.  In  this  sense,  all  who  are  competent  to  judge  are 
ngi'eed  that  the  Giver  of  life  is  a  jealous  God,  visiting  the  iniquity  of  the 
fathers  upon  the  children  unto  the  third  and  fourth  generation  of  thera 
that  hate  Him  or  violate  His  laws.  Sti'ictly  speaking,  it  is  not  disease 
which  is  transmitted,  but  organs  of  such  imperfect  structure  that  they 
are  unable  to  perform  their  functions  properly,  and  so  weak  as  to  be 
easily  put  into  a  morbid  state  or  abnormal  condition  by  causes  unim- 
paired organs  are  unable  to  resist." 

The  Marriageable  Age. — Ample  statistical  data  have  settled  the 
question  that  the  first  children  of  those  who  marry  very  young  are 
more  animal  and  less  moral  and  intellectual  than  those  born  nearer  the 
middle  period  of  the  life  of  the  parents.  Extensive  observation  has 
also  established  the  position,  that  the  great  majorit}'  of  men  and  women, 
morally  and  intellectually  eminent,  have  been  among  the  younger  chil- 
dren of  the  family.  The  elevation  and  improvement  of  the  race,  there- 
fore, seems  to  be  adversely  affected  by  early  maiTiages.  The  sound- 
est physiologists  and  phrenologists  regard  twenty-two  to  twenty-five  for 
the  female,  and  twenty-five  to  tliu'ty  for  the  male,  as  the  most  appro- 
priate ages  for  assuming  the  serious  duties  as  well  as  participating  in 
tlie  pleasures  of  m.atrimonial  life. 

Physiological  Law  of  Marriage. — Physiologists  are  divided  on 
the  question,  whether  organizations  similar  or  unlike  are  most  condu- 
cive to  vigorous  oflTspring.  Phrenologists  generally  maintain  that  tem- 
peraments decidedly  different,  provided  those  differences  are  not  ex- 
treme, make  the  most  fortunate  alliances  for  the  offspring;  and  the 
same  principle  is  held  in  relation  to  the  mental  organs.  This  proposi- 
tion is  strongly  corroborated  by  the  favorable  results  of  cross-breeding 
in  the  l()wer  animals,  and  even  from  the  cross-marriages  of  the  people 
of  different  nations,  sc  far  as  observations  have  been  recorded.     I  ap 


PHYSIOLOGY   OF   THE   FCETUS.  447 

pi'phend,  however,  that  this  law,  if  it  be  a  law,  derives  its  principal  im- 
portance from  the  erroneous  habits  and  customs  of  society.  People 
who  "live,  move,  and  have  their  being"  under  one  dull,  monotonous 
routine  of  surrounding  circumstances,  will  become  mentally  stupid,  and 
physiologically  indolent  and  sensual,  for  want  of  suitable  external  cir- 
cumstances to  call  out  the  mind  and  exercise  the  body;  and  here  cross- 
breeding, or  the  union  of  different  temperaments,  tastes,  habits,  fash- 
ions, and  differently-developed  faculties,  will  tend  to  excite  and  culti- 
vate the  powers  of  both  parties.  But  when  both  parties  are  health- 
fully developed  in  body  and  mind,  actively  yet  not  drudgingly  engaged 
in  some  occupation  which  gives  free  exercise  to  all  the  functioi^  and 
faculties,  the  voluntary  habits  being  at  the  same  time  physiologically 
correct,  there  is  not,  certainly,  an  equal  reason,  if,  indeed,  there  is  any, 
to  seek  for  aught  save  the  most  congenial  tempers. 


CHAPTER  III. 

PHYSIOLOGY  OF  THE  FCETUS. 


FffiTAL  Development. — About  two  weeks  after  impregnation,  the 
new  organization  becomes  about  as  large  as  a  pea,  and  its  two  envelopes, 
or  membranous  coverings,  called  chorion  and  amnion,  with  a  gelatinous 
substance  inclosed  between  them,  are  distinctly  visible.  A  thin  mem- 
brane is  also  formed  over  the  whole  internal  surface  of  the  uterus,  call- 
ed the  decidua.  Soon  after  a  small  white  thread-like  substance  ap- 
pears, which  is  the  commencement  of  the  brain  and  spinal  marrow ; 
before  the  twentieth  day  the  eyes  are  visible  ;  and  before  the  first 
month  is  completed  a  cartilaginous  or  grisly  substance  indicates  the  fu- 
ture bones. 

In  the  second  month  the  cartilage  begins  to  harden  into  bone,  the  ru- 
diments of  the  teeth  are  visible,  the  general  form  is  developed,  and  it 
is  about  an  inch  in  length.  During  the  third  month  the  heart  is  de- 
veloped, and,  although  without  blood,  has  a  slight  degree  of  motion. 
At  the  end  of  three  months,  the  eyelids  are  distinct,  the  lips  perfect, 
the  fingers  and  toes  apparent,  the  heart  beats  forcibly,  and  all  parts  aro 
well  defined,  the  weight  being  tsvo  or  three  ounces,  and  the  length 
four  or  five  inches.  In  the  fourth  month  the  muscles  become  distinct- 
the  brain  and  spinal  marrow  firmer,  the  abdomen  covered  with  integu- 
ment; a  large  portion  z^  the  bony  structure  is  ossified,  tho  rudiments 


448 


MIDWIFERY. 


Fig.  296. 


of  the  second  set  of  teeth  are  seen  under  the  first,  and  tire  substanca 
called  meconium,  begins  to  collect  in  the  bowels. 

Near  the  middle  of  the  fourth  month,  the  uterus  rises  above  the  pel- 
vis into  the  cavity  of  the  abdomen,  when  the  mother  becomes  remark- 
ably sensible  of  the  mohons  of  the  foetus.  This  period  has  been  called 
quickening,  upon  the  erroneous  supposition  that  the  foetus  then  first  be- 
came endowed  with  life;  but  it  is  truly  alive  from  the  moment  of  con- 
ception. Sickness  at  the  stomach,  tendency  to  faintness,  etc.,  denote 
The  disturbance  occasioned  by  the  sudden  change  of  position. 

From  four  to  nine  months  the  general  development  is  more  rapid. 
[n  the  fifth  month  the  situation   of  the  nails  can  be  discerned,  the 

weight  is  about  one  pound,  (md 
the  length  about  nine  inche.?.  In 
the  sixth  month  the  head  be- 
comes downy,  and  the  nails  niark- 
ed  :  the  weight  increases  to  one 
and  a  half  or  two  pounds,  and  the 
length  to  twelve  inches.  During 
the  seventh  mouth  the  hair  is  per- 
fected, the  nails  fully  formed,  the 
bones  are  comparatively  firm,  the 
meconium  collects  lower  down  in 
the  large  intestines;  weight  about 
thi'ee  pounds  ;  length  about  four- 
teen inches.  Many  children  are 
capable  of  being  raised  if  prema- 
turely born  at  this  period,  and  even 
in  some  cases  if  born  a  month  or 
two  earlier.  During  the  eighth 
and  ninth  months,  no  new  phe- 
nomena present,  but  every  part 
acquires  a  firmer  consistence,  and 
all  the  functions  become  mor*..» 
active. 

FffiTAL  Circulation. — Until 
quite  recently  the  opinion  pre- 
vailed that  the  blood  of  the  mother 
circulated  direc.ly  through  the 
vessels  of  the  foetus ;  but  it  is  now 
known  that  the  foetus  has  a  sort 
of  independent  exi3teDce,although 


\J    \J 


roTAX    riRCUI.ATION 


PHYSIOLOGY    OF    THE  F(ETUS.  449 


its  nutrient  materials  are  of  course  derived  from  the  mother.  Tho 
mother  secretes  the  substances  of  nutrition,  which,  by  coming  in  con- 
tact with  the  foetus,  are  absorbed  ;  and,  after  being  mo^-fied  in  their 
passage  through  the  placenta,  are  digested  and  assimilated.  Fig.  296 
is  a  representation  of  the  foptal  circulation. 

1.  The  umbilical  cord,  consisting  of  the  umbilical  vein  and  two  umbilical  arteries;  pro- 
ceeding from  the  placenta  (2.)  3  Umbilical  vein,  dividing  into  three  branches ;  two  (1.  4>, 
to  be  distributed  to  the  liver;  and  one  (5),  the  ductus  venosus,  whicu  enters  the  in- 
ferior vena  cava  (6).  7.  Portal  vein,  returning  the  blood  from  the  intestines,  and  uniting 
with  the  right  hepatic  branch.  8.  Right  auricle;  the  course  of  the  blo-^ft  is  denoted  by 
the  arrow,  proceeding  from  8  to  9,  the  left  auricle  ]0.  Left  ventricle;  the  blood  follow- 
ing the  arrow  to  the  arch  of  the  aorta  (11),  to  be  v'-'stributed  through  the  branches  given 
otf  by  the  arch  to  the  head  and  upper  extremities.  The  arrows,  12  and  13,  represent  the 
return  of  the  blood  from  the  head  and  upper  extremities  through  the  jugular  and  subcla- 
vian veins,  to  the  superior  vena  cava  (14),  to  the  right  auricle  (8),  and  in  the  course  of  the 
arrow  through  the  right  ventricle  (1.5),  to  the  pulmonary  artery  {16).  17.  Ductus  arterio- 
sus, which  appears  to  be  a  proper  continuation  of  the  pulmonary  artery  ;  the  offsets  at 
each  side  are  the  right  and  leit  pulmonary  artery  cut  oft";  these  are  of  extremely  small 
size  as  compared  with  the  ductus  arteriosu.?.  The  ductus  arteriosus  loins  the  descend- 
ing aorta  (18,  18),  which  divides  into  the  common  iliacs,  and  these  into  tiie  internal  iliacs, 
which  become  the  hypogastric  arteries  (19),  and  return  the  blood  along  tht;  umbilical 
cord  to  the  placenta ;  while  the  other  divisions,  the  external  iliacs  (20),  are  contlnuei 
into  the  lower  extremities.  The  arrows  at  the  terminations  of  these  vessels  mark  the 
return  of  the  venous  blood  by  the  veins  to  the  inferior  cava. 

The  pure  blood  is  brought  from  the  placenta  by  the  umbilical  vein; 
this  vein  passes  through  the  umbilicus,  and  enters  the  liver,  where  it 
divides  into  several  branches,  two  or  thuee  of  which  are  distributed  to 
the  left  lobe  of  the  liver;  one  branch  communicates  with  the  portal 
vein  in  the  transverse  fissure,  supplying  the  right  lobe  ;  and  a  large 
branch,  the  ductus  venosus,  which,  passing  backward,  joins  the  inferior 
cava.  In  the  inferior  cava  the  pure  blood  is  mixed  with  that  which  is 
returning  from  the  abdominal  viscera  and  lower  extremities,  and  is  car- 
ried along  through  the  right  auricle,  guided  by  the  Eustachian  valve, 
and  through  the  foramen  ovale,  into  the  left  auricle.  From  tlie  left 
auricle  it  passes  into  the  left  ventricle,  thence  into  the  aort.),  and,  by 
means  of  the  carotid  and  subclavian  arteries,  is  distributed  to  the  head 
and  upper  extremities.  The  impure  blood  is  returned  from  the  head 
and  upper  ext)-emities  by  the  superior  vena  cava  to  the  right  auricle  ; 
from  this  Jt  is  propelled  into  the  right  ventricle,  and  thence  into  the 
pulmonary  artery.  As  the  lungs  are  solid  and  impervious,  only  a 
small  quantity  can  pass  into  them,  and  hence  the  grenter  portion  pusses 
tliroui:;h  the  ductus  arteriosus  into  the  commencement  of  the  descend- 
ing aorta,  where  it  is  mingled  with  that  portion  of  the  pure  blood  which 
IS  not  sent  throngli  the  carotid  and  subclavian  arteries.  Passing  along 
the  aorta,  a  small  quantity  of  this  mixed  blood  is  distributed  by  the  ex- 
ternal iliac  arteries  to  the  lower  extremities;  the  greater  part  is  con- 


i50  MIDWIFERi^ 


veyed  by  the  internal  iliac,  hypogastric,  and  umbilical  arteries  to  the 
])lacenta ;  the  hypogastric  arteries  proceeding  from  the  internal  iliacs, 
and  passing  by  the  side  of  the  fundus  of  the  bladder,  and  upward  alonp 
the  anterior  wall  of  the  abdomen  to  the  umbilicus,  where  they  become 
the  umbilical  arteries. 

"From  a  careful  consideration  of  this  circulation,"  says  Dr.  V/ilson 
(Human  Analoiny),  "  we  perceive,  1st.  That  the  pure  blood  from  the 
placenta  is  disti'ibuted  in  considerable  quantities  to  the  liver  before  en 
tering  the  general  circulation.     Hence  arises  the  abundant  nutrition  of 
that  organ,  and  its  enormous  size  in  comparison  with  other  viscera. 

"2dly.  That  the  right  auricle  is  the  scene  of  meeting  of  a  double 
current,  the  one  coming  from  the  inferior  cava,  the  other  from  the  su- 
perior, and  that  they  must  cross  each  other  in  their  respective  course. 
How  this  crossing  is  effected,  the  theorist  will  wonder ;  not  so  the 
practical  anatomist ;  for  a  cursory  examination  of  the  foetal  heart  will 
show.  1.  That  the  direction  of  entrance  of  the  two  vessels  is  so  oppo- 
site, that  they  may  discharge  their  currents  through  the  same  cavity 
without  admixture.  2.  That  the  inferior  cava  opens  almost  directly  into 
the  left  auricle.  3.  That  by  the  aid  of  the  Eustachian  valve,  the  cur- 
rent in  the  inferior  cava  will  be  almost  entirely  excluded  from  the 
right  ventricle. 

"3dly.  That  the  blood  which  circulates  through  the  arch  of  the  aorta 
comes  directly  from  the  placenta;  and,  although  mixed  w^ith  the  im- 
pure blood  of  the  inferior  cava,  yet  is  propelled  in  so  great  abund- 
ance to  the  head  and  upper  extremities,  as  to  provide  for  the  increased 
nutrition  of  those  important  parts,  and  prepare  them,  by  their  greater 
size  and  development,  for  the  functions  which  they  are  required  to  per- 
form at  the  instant  of  birth. 

"  4thly.  That  the  blood  circulating  in  the  descending  aorta  is  veiy 
impure,  being  obtained  principally  from  the  returning  current  in  the 
superior  cava,  a  small  quantity  only  being  derived  from  the  left  ventri- 
c\c  et  it  is  from  this  impure  blood  that  the  nutrition  of  the  lower 
eX^  ,  jties  is  provided.  Hence  we  are  not  surprised  at  their  insig- 
nificant development  at  birth;  w^hile  we  adm.ire  the  providence  of  na 
ture  that  directs  the  nuti-ient  current,  in  abundance,  to  the  organs  of 
sense,  prehension,  and  deglutition:  organs  so  necessary,  even  at  the 
instant  of  birth,  to  the  safety  and  welfare  of  the  creature." 

ThQ  foramen  ovale  becomes  gradually  closed  by  a  membranous  layer 
which  separates  the  two  auricles.  As  soon  as  the  lungs  are  inflated  by 
inspiration,  the  blood  of  the  pulmonary  artery  rushes  through  its  right 
and  left  branches  ioto  the  lungs,  to  be  retui'ned  by  the  pulmonary  veins 
to  the  left  auricle. 


PHYSIOLOGY    OF   THE   FCETUS. 


451 


The  Thymus  Gland. — This  structure  is  situated  on  each  side  of 
the  trachea  in  the  neck,  resting  against  the  pericardium,  and  extend- 
ing from  the  fourth  rib  upward  to  the  thyroid  gland.  It  becomes  per- 
ceptible between  the  second  and  third  months  of  embryotic  existence, 
and  continues  to  increase  in  size  until  the  seventh  month  ;  during  the 
ninth  month  it  suddenly  enlarges  again,  weighing  then  nearly  an  ounce. 
After  birth  it  enlarges  during  the  first  year,  and  then  gradually  dimin- 
ishes, almost  disappearing  at  puberty.  It  is  composed  of  numerous  lo- 
bules, containing  secretory  cells,  and  its  office  appears  to  be  to  prepare 
nutrient  material  until  the  digestive  function  is  fully  developed. 


The  Placenta. — This  is  a  spongy,  vascular  mass,  found  at  the 
surface  of  the  chorion,  and  ad-  Fig.  297. 

herent  to  the  uterus,  which  ex- 
ists in  some  form  in  all  mam- 
malia. It  possesses  little  or  no 
sensibility,  hence  it  has  little  or 
no  nervous  structure.  It  is  to 
the  foetus  what  the  lungs  are  to 
the  adult,  serving  for  the  aera- 
tion of  the  blood  of  the  former 
until  respiration  brings  the  blood 
in  contact  with  atmospheric  air 
in  the  lungs.  Fig.  297  repre- 
sents the  placenta  with  the  um- 
bilical cord  attached.  The  di- 
ameter of  the  placenta  is  usually 
about  six  inches,  and  its  thick- 
ness an  inch  and  a  half.  placenta  and  cord. 

Physiologists  do  not  agree  whether  the  vessels  of  the  placenta  term- 
inate in  or  communicate  w^ith  those  on  the  uterus ;  or  whether,  in  its 
utei«ne  portions,  there  are  intermediate  cells  in  which  the  arteries 
terniiijate,  and  from  which  the  veins  commence.  Nor  do  they 
agree  whether  any  portion  of  the  blood  of  the  foetus  actually  circu- 
lates through  the  heart,  lungs,  etc.,  of  the  mother.  From  all  the  in- 
vestigations which  have  been  made,  my  own  conclusion  is,  that  the 
placenta  serves,  in  part,  to  purify  the  blood ;  and  that  the  blood  of  both 
mother  and  fostus  mingles,  to  some  extent,  in  the  placenta,  in  conse- 
quence of  the  placental  vessels  extending  into  the  uterine  sinuses ;  and 
that,  further,  while  the  blood  of  mother  and  foetus  act  and  react  upon 
each  other  in  the  substance  of  the  placenta,  in  a  manner  analagous  to 
tbe  action  between  water  and  blocd,  in  the  bronchial  vessels  of  aquati« 


452  MIDWIFERY. 


animals,  some  portion  of  the  blood  of  the  foetus  does  actually  go  ih^ 
round  of  the  mother's  circulation. 

The  Umbilical  Cord. — The  funis,  cord,  or  navel-string  forms  the 
connection  between  the  }3lacenta  and  child.  It  is  composed  of  two  ar- 
teries and  a  vein,  and,  like  the  placeuta,  is  insensible.  The  arteries 
•;vind  spirally  around  the  vein  from  right  to  left,  forming  in  their  course 
.1  number  of  loops  or  knots.  The  length  of  the  cord  varies  gi-eatly ; 
its  average  is  eighteen  or  twenty  inches.  The  pulsation  of  the  cord, 
which  is  usually  strong  and  distinct,  ceases  in  ten.  fifteen,  or  twenty 
minutes  after  birth,  and  the  portion  attached  to  the  child  shrinks  and 
falls  off  in  five  or  six  days. 

The  Liquor  Am.mi. — This  terra  is  applied  to  the  fluid  which  col- 
lects in  the  cavity  of  the  amnion  ;  it  is  secreted  by  the  internal  surface 
of  this  membrane,  and  its  quantity  varies  from  a  pint  to  several  quarts  ; 
the  average  is  fi'om  one  to  two  pounds.  It  serves  as  nutriment  to  rlie 
fcEtus  :  to  allow  it  free  motion  ;  to  diminish  the  force  of  blows,  shocks,  and 
sudden  movements,  and  also  assists  in  dilating  the  os  uteri  during  labor. 


CHAPTER  IV. 

OBSTETRICAL   ANATOMY 

Bones  of  the  Pelvis. — The  055a  innominata  form  the  pelvis  lat- 
erally and  in  front,  each  of  which  is  divided  into  the  ischiuin,  or  sit- 
ting-bone ;  ilium,  or  hip  or  haunch-bone  ;  and  2^uhis,  or  share-bone,  Ji3 
heretofore  explained :  and  the  sacrum  and  coccyx  behind.  The  brim 
of  the  pelvis  is  defined  by  the  ilio-pectineal  line.  Ail  below  this  Ime  is 
called  the  true  or  lower  pelvis ;  while  the  false  or  upper  pelvis,  which 
is  really  the  lower  part  of  the  abdcminal  cavity,  is  immediately  above. 
The  brim  of  the  pelvis  is  of  an  oval  form,  except  where  it  is  broken  by 
the  projecting  part,  or  promontory,  of  the  sacrum  posteriorly. 

Cavity  of  the  Pelvis.— This  is  bounded  by  the  sacrum  behind, 
the  ischium  laterally,  and  the  pubis  in  front.  It  is  of  unequal  depth, 
measuring  five  to  six  inches  jjosteriorly,  three  inches  and  three  fourths 
fi'oiu  the  brin:  to  the  tuber  ischii.  and  from  tu  ■  inches  to  two  and  a 


OBSTETRICAL    ANATOMY. 


453 


ralf  anteriorly  at  the  symphisis  pubis.  The  bones  of  the  peh'ic  cavity 
•xre  smooth  on  their  inner  surface,  and  present  a  series  of  inclined 
«lanes,  tending  at  first  downward  and  slightly  backward,  then  down- 
ward and  forward.  The  brim  or  upper  margin  of  the  cavity,  which  is 
*ts  narrowest  part,  is  called  the  sujierior  strait ;  and  the  lower  or  outlet, 
*-he  inferior  strait.  This  outlet  is  of  an  oval  shape,  but  irregular;  its 
^teral  boundaries  are  immovable,  but  its  antero-posterior  diameter  can 
16  extended  on  account  of  the  mobility  of  the  coccyx. 

Diameters  of  the  Pelvis. — The  three  principal  diameters  are 

Fig.  298. 


•^ 


:^ 


DIAMETERS    OF    THE    PELVIS. 

represented  by  the  lines  in  fig.  298.  They  are  the  antero-postenor 
(1),  from  the  prominence  of  the  sacrum  to  the  inner  and  upper  edge 
of  the  symphisis  pubis ;  the  transverse  (2),  across  the  widest  part  of 
the  brim,  at  right  angles  to  tha  antero-posterior ;  and  the  oblique  (3), 
from  the  sacro-iliac  junction  of  one  side  to  the  opposite  side  of  the 
brim,  just  above  the  acetabulum.  The  average  admeasurements  of 
these  diameters  are :  antero-posterior,  four  inches  ;  transverse,  five 
inches ;  and  oblique,  four  ar?^  three  fourths.  Half  an  inch  either  v/ay 
may  be  allowed  for  variations.  The  circumference  varies  from  thir- 
teen to  fifteen  inches. 

The  only  practical  importance  of  these  admeasurements  is  in  cases 
of  deformities,  disease,  or  raal-presentations.  In  ordinary  cases  nature 
will  accomplish  her  woric  just  as  well  without  our  knowledge  of  ob- 
stetrical anatomy  as  with  it. 


Deformities  of  the  Pelvif. — The  bones  of  the  pelvis  may  be 


464 


MIDWIFERY 


c'istorted  in  a  variety  of  ways,  and  to  an  extent  which  renders  labor 
tedious  and  protracted,  or  entirely  impossible.  These  cases,  however, 
are  exti-eraely  rare,  and  it  not  unfrequently  happens  that  the  aggregate 

Fig.  299. 


OBLIQUE    DISTORTION 

of  the  diameters  is  not  materially  affected.  Fig.  299  is  a  representa- 
tion of  one  of  the  most  common  deformities.  The  usual  causes  are 
rickets  in  infancy,  and  violliiies  ossium,  or  softening  of  the  bony  stiTic- 
ture,  in  adults.  The  brim  of  the  pelvis,  or  superior  strait,  is  most 
frequently  affected  by  deformities,  so  that  if  the  child's  head  can  enter 
the  cavity,  the  delivery  will  almost  always  be  accomplished  naturally, 
although  the  labor  may  be  greatly  prolonged. 

The  extreme  distortion  in  the  antero-posterior  diameter  of  the  brim 

Fig.  300. 


AUTERO-POSTERIOR   DISTORTIOIf. 


PEEGNANCY.  455 


of  the  pelvis,  is  seen  in  fig.  300.  This  is  one  of  the  conditions  wlVich 
render  natural  labor  impossible,  although  slight  deformities  in  this  re- 
spect are  usually  overcome  by  the  natural  efforts. 


CHAPTER  V. 

PREGNANCY. 


Signs  of  Pregnancy. — The  cessation  of  menstruation  at  the  usual 
period  of  its  occurrence  is  among  the  first  indications,  though  not  in 
itself  conclusive  of  pregnancy.  Most  women  experience  some  degree 
of  nausea,  and  sometimes  vomiting  on  rising,  called  morning  sickness ; 
this  usually  begins  in  the  fifth  or  sixth  week,  and  continues  to  the  end 
of  the  third  month.  Salivation  sometimes,  though  not  often,  attends. 
The  breasts  manifest  an  uneasy  sensation  of  fullness  about  two  months 
after  conception  ;  throbbing  and  tingling  pains  succeed,  and  they  soon 
increase  in  size  and  firmness,  become  knotty,  and  the  areola  around 
the  nipples  darkens ;  these  are  the  most  unequivocal  of  all  the  signs 
of  pregnancy.  The  enlargement  of  the  abdomen  is  gradual  fi'om  tlie 
first,  although  in  some  cases  it  becomes  a  little  flatter  for  a  month  or 
two.  Quickening  occurs  usually  during  the  fourth  month,  after  which 
the  motions  of  the  fcetus  are  decisive. 

Duration  of  Pregnancy. — The  natural  duration  of  pregnancy 
has  usually  been  reckoned  at  nine  calendar  or  ten  lunar  months,  or  two 
hundred  and  eighty  days.  A  majority,  probably,  are  born  in  the  for- 
tieth week ;  nearly  as  many  in  either  the  thirty-ninth  or  forty-first ; 
many  births  take  place  in  the  thirty- eighth,  foity-second,  and  forty 
third  weeks ;  and  they  are  not  very  unfrequent  in  the  thirty-seventh, 
forty-fourth,  and  forty-fifth  weeks.  The  ordinary  period  seems  there- 
fore to  range  from  two  hundred  and  fifty-two  to  three  hundred  and 
sixteen  days.  The  commencement  of  pregnancy  is  generally  dated 
two  weeks  subsequent  to  the  last  appearance  of  menstruation ;  yet 
this  calculation  is  liable  to  an  error  of  between  two  and  three  weeks. 

Extra-Uterine  Pregnancy. — In  some  extraordinary  instances, 
the  precise  causes  of  which  we  can  never  understand,  the  ovum  is 
impregnated,  and  remains  in  the  ovary,  fallopian  tube,  or  the  inter- 


^456  MIBWIFERY 


space  in  the  avails  of  the  uterus.  In  all  these  cases  the  general  signs 
of  pregnancy  are  more  or  less  apparent,  wliile  the  enlargement  of  the 
abdomen  is  confined  to  one  side,  and  develops  very  much  like  an  ordi- 
nary tumor,  with  a^sense  of  weight,  uneasiness,  heat,  and  pain.  Sooner 
or  later  the  "vst  which  incloses  the  fittal  mass  ruptures,  the  child  dies, 
and  the  surrounding  parts  either  accommodate  themselves  to  their  pe- 
culiar circumstances  as  well  as  may  be,  and  allow  the  organic  remains 
to  occupy  th«  part  for  an  indefinite  period,  or  make  an  effort  to  remote 
the  foetus  by  the  formation  of  an  abscess  opening  externally,  or  a  fistu- 
lous communication  to  the  vagina  or  rectum,  through  which  the  osseous 
parts  of  the  mass  are  discharged. 

The  practitioner  must  here  restrict  his  or  her  duty  to  keeping  the 
patient  quiet,  attending  to  the  general  health,  especially  keeping  the 
stomach  and  bowels  easy,  and  sootliing  all  local  inflammation,  always 
recollecting  that  nature  best  accomplishes  what  she  undertakes  in  her 
own  way. 

SuPERFCETATioN. — The  occuiTence  of  a  second  conception  before 
the  termination  of  the  first,  has  been  regarded  as  impossible  by  many 
Authors ;  y?t  there  are  some  well-authenticated  cases  on  record. 
Sometimes  both  fcetuses  are  fully  developed,  and  the  second  born  sev- 
eral months  after  the  first :  in  other  cases,  one  foetus  is  expelled  in  a 
half-formed  or  blighted  condition.  Practically  we  are  to  regard  the 
latter  variety  as  a  case  of  abortion. 

PathglooY  of  the  Fcetus. — Nearly  ail  the  maladies  to  which  the 
child  is  subiect  may  aftcct  the  foetus:  and  when  we  consider  how  un- 
healthfully  the  majority'  of  females  live  while  in  the  pregnant  state,  and 
how  readilv  rhe  organic  instincts,  true  to  the  all-pervading  law  of  self- 
preservation,  throw  the  morbid  conditions  of  the  mother  upon  the  new 
being  within,  it  seems  almost  wonderful  that  so  great  a  majority  can 
live  until  tiic  time  for  being  born  arrives.  But  the  foetus  does  often 
die  in  the  uterus,  and  it  is  sometimes  important  to  ascertain  the  fact. 
The  signs  are  :  a  cessation  of  its  motions;  flaccidity  or  falling  in  of  the 
abdomen ;  recession  of  the  umbilicus ;  a  sensation  of  coldness,  and  of 
a  dense  weight  in  the  abdomen ;  the  breasts  suddenly  becoming  flac- 
cid ;  to  which  may  be  added  a  loose  feeling  of  the  uterine  tumor,  fail- 
ing health,  sunken  countenance,  dark  areola  round  the  eyes,  foetid 
breath,  frequent  chills,  etc.  Here,  as  usual,  we  are  to  '*  trust  to  na- 
ture." At  an  uncertain  time  the  uterus  will  expel  its  contents,  and  the 
treatment  required  is  the  same,  in  all  essential  paiticulars,  as  for  or- 
dinary aboitious. 


P  R  £  G  N  A  :\  C  Y  467 


Hygienic  Management  during  Prkgnancy. — Those  females 
who  would  escape  the  usual  and  dangerous  maladies  which  frequently 
accompany  pregnancy,  and  avoid  in  a  great  degree  the  ordinary  pains 
of  childbirth;  and,  above  all,  those  who  would  be  mothers  of  hcaWiy 
children — healthy  in  body  and  mind,  in  constitution  and  in  disposition — 
must  observe  attentively  and  obey  inviolably  a  few  simple  hygienic  pre- 
cepts. 1.  All  high-seasoned,  high-salted,  and  complicated  dishes  must 
be  abstained  from.  The  whole  course  of  diet  must  be  plain  and  sim- 
ple, and  coarse  enough  to  keep  the  bowels  always  free.  Animal  food, 
if  used,  should  not  be  taken  more  than  once  a  day.  2.  All  drugs  must 
be  eschewed,  especially  every  thing  of  the  narcotic  kind,  as  opium  and 
its  preparations,  which  have  a  direct  tendency  to  stupefj'  and  enfeeble 
tlie  future  being.  3.  Some  form  of  bath  must  be  taken  daily;  a  towel 
wa^a  will  answer,  and  it  need  not  be  very  cold  ;  about  70"  will  do  very 
well ;  and  if  the  patient  is  very  sensitive  or  feeble,  it  may  be  taken  in 
a  warm  room.  Pregnant  women  usually  hear  cold  water  remarkably 
well.  4.  The  hip-bath  should  be  frequently  employed,  especially  near 
the  period  of  delivery.  For  a  month  or  two  preceding  the  expected 
time  it  should  be  employed  daily ;  this  may  not  be  so  cold  as  to  be  par- 
ticularly disagi-eeable ;  65°  to  70°  in  temperature,  and  five  to  ten  min- 
utes in  time,  is  a  good  general  rule.  5.  The  patient  must  keep  on  her 
feet  a  good  part  of  the  time  during  the  whole  term.  She  may  walk 
frequently  in  the  open  air,  or  do  house-work,  or  exercise  in  any  easy 
manner  in  the  erect  attitude.  Nothing  is  more  likely  to  induce  a  wrong 
position  of  the  child  in  the  womb,  or  a  painful,  lingering  labor,  than 
pressing  and  cramping  the  abdomen  by  sedentary  habits.  Females 
who  are  compelled  to  work  with  the  needle,  or  sitting  at  a  work-table, 
should  be  particularly  careful  at  all  times  to  maintain  an  upright  pos- 
ture. Adhesions  of  the  afterbirth,  flooding,  tumors,  and  inflammations 
of  the  parts  are  frequently  owing  to  the  compression  produced  by  a 
misposition  of  the  body.  6.  Excessive  labor  and  violent  exertions,  also 
strong  mental  passions,  or  depressing  emotions,  are  to  be  avoided  as  far 
as  possible. 

Accidents  of  Pregnancy. — Medical  books  give  us  a  formidable 
catalogue  of  "  diseases  of  pregnancy  ;"  but  1  think  the  j)hrase  is  another 
of  those  misnomers  which  are  so  plentiful  in  the  books,  and  so  well  cal- 
culated to  mislead.  Diseases  during  pregnancy  are  common  enough; 
but  so  for  from  being  naturally  r/that  condition,  they  are  merely  the 
evidences  of  the  unnatural  habits  or  circumstances  of  the  individual. 

The  familiar  fact  that  those  diseases  which  rapidly  exhaust  the  vitality 
of  the  body,  as  consurai>tion,  are  suspended  during  pregnancy,  to  re- 
11—39 


M  I  D  W  I  F  E  R  Y.  458 


appear  with  all  their  formidable  and  fatal  array  rf  symptoms  soon  after 
the  completion  of  the  rei^roductive  function,  sufficiently  attests  the  prin- 
ciple that  nature  is  true  to  her  own  purposes,  and  ihat  all  diseases  dur- 
ing pregnancy  are  entirely  fortuitous. 

Abortion,  which  is  the  expulsion  of  the  foetus  before  the  sixth  month, 
and  premature  labor,  its  expulsion  between  the  sixth  month  and  matu- 
rity, are  the  most  painful  disorders  or  accidents  attending  pregnancy. 
The  danger  is  usually  in  proportion  to  the  hemorrhage.  The  common 
causes  ai-e  general  or  local  debility — "  inward  weakness" — violent  men- 
tal perturbation,  and  bodily  shocks  or  injuries.  Leucorrhoea  is  the 
cause  of  the  greatest  number  of  miscarriages.  Excessive  sexual  in- 
dulgence is  also  a  frequent  cause. 

The  symptoms  of  miscarriage  are,  an  unusual  sense  of  languor,  un- 
easiness, and  weariness,  with  aching  or  pain  in  the  back,  followed  after 
a  few  hours  or  days  by  a  slight  discharge  of  mucus  or  blood  from  the 
vagina,  and  bearing-down  pains ;  these  are  at  first  felt  in  the  back,  ex- 
tending around  the  loins  to  the  abdomen,  and  down  the  thighs,  recur- 
ring at  regular  intervals,  and  increasing  in  strength  and  frequency ;  in 
most  cases  the  pain  is  as  great  as  in  labors  at  the  full  term.  In  some 
cases  the  ovum  is  expelled  with  but  little  pain,  and  sometimes  the  fuetus 
is  expelled  and  the  membranous  shell  of  the  ovum  retained  for  many 
days,  and  perhaps  finally  passed  off  in  a  dissolved  state  with  the  lochia. 
Hemorrhage  seldom  continues  after  the  expulsion  of  all  parts  of  the 
ovum,  but  until  then  it  is  to  be  apprehended.  As  a  general  rule,  the 
flooding  is  less  the  nearer  gestation  approaches  maturity. 

Our  first  treatment  should  be  preventive ;  but  if  the  case  has  pro- 
gressed too  far,  the  flooding  requires  our  principal  attention.  Allopath 
ic  authors  deal  largely  in  opium,  ergot,  sugar  of  lead,  and  the  forcible 
extraction  of  the  ovum  with  instruments,  and  even  bleeding  from  the 
arm.  These  drugs  and  destructives  are  never  necessary,  but  always  in- 
jurious ;  in  fact,  they  often  injure  the  constitution  much  worse  than  the 
abortion  does. 

The  patient  should  recline  in  an  easy,  leoumbent  posture,  the  wet 
bandage  be  applied  around  the  abdomen,  and  changed  several  times  a 
day,  and  two  or  three  vaginal  injections  of  cold  water  employed  daily. 
When  the  flooding  is  excessive,  and  in  cases  of  internal  hemorrhage, 
denoted  by  headache,  gi-eat  lassitude,  shiverings,  frequent  and  feeble 
pulse,  and  the  patient  becoming  pale,  exhausted,  and  faint,  with  a 
dark  shade  under  the  eyes,  the  tav.ipion  miiy  be  employed  with  advant- 
age, or  a  silk  handkerchief,  wet  in  the  coldest  water,  or  inclosing  a 
cylindrical  piece  of  ice  or  snow,  may  be  introduced  into  the  vagina  as 
far  as  convenient ;  it  may  remain  for  six  ar  eight  hours,  and  then  be  ia- 


PREGNANCr.'  459 


troduced  again  if  necessary.  Enemata  of  the  coldest  water  are  also 
valuable  auxiliaries  in  severe  cases.  lu  all  cases  it  is  important  to 
have  the  room  well  ventilated,  and  the  patient  placed  on  a  cool  and 
rather  hard  bed  or  mattrass.  The  inexperienced  attendant  should  not 
be  unduly  alarmed  at  the  faintaess  which  takes  place  after  severe  or 
protracted  flooding,  for  it  generally  happens  that  this  condition  favors 
the  formation  of  a  clot  or  coagulum,  which  obstructs  the  bleeding  ves- 
sels and  effectually  arrests  the  hemoirhage.  It  is  not  uncommon  for 
patients  to  remain  an  hour  or  two  in  a  state  o^  dcliquium  animi. 

Morning  sickness,  when  very  troublesome,  is  best  alleviated  by  a 
light,  dry  evening  and  morning  meal,  as  Graham  crackers,  toasted 
bread,  etc. 

Toothache  may  be  relie.'ed  by  eating  very  sparingly  for  a  day  or  two, 
and  careful  attention  to  the  bowels. 

Cramps,  for  which  the  old-school  practice  ia,  bleeding  and  laudamim, 
may  be  quieted  by  rubbing  the  lower  limbs  with  a  cold  wet  cloth,  fol- 
lowed by  dry  friction. 

Constipation  is  more  apt  to  occur  in  tlie  early  than  the  later  months 
of  pregnancy.     It  requires  coarser  food  and  water-injections. 

Piles,  which  have  previously  affected  the  patient,  are  liable  to  reap- 
pear or  become  aggravated.  Frequent  sitz-baths  should  be  employed, 
with  a  small,  cold  injection  immediately  before  each  stool. 

Pruritus,  or  itching  of  the  genital  organs,  may  be  relieved  in  the 
same  way  ;  if  excessive,  warm  water  is  more  soothing  than  cold. 

Heartburn,  sick  headache,  sleeplessness,  nud  salivation,  are  among 
the  unpleasant  incidents  that  are  occasionally  presented.  They  are  to 
be  treated  in  the  same  way  as  morning  sickness.  Frequent  sips  of 
cold  water  are  very  soothing  in  most  of  t'hese  cases ;  and  when  the 
sick  headache  is  attended  with  prolonged  nausea  and  retching,  warm 
water  should  be  drank  freely  until  the  stomach  feels  easy,  or  vomiting 
occurs. 

Cravings  or  longings  for  improper  food  should  not  be  gratified. 
There  is  vastly  more  danger  of  "  marking  the  child,"  by  improper  in- 
dulgences on  the  part  of  the  mother,  than  by  proper  self-denial.  If 
the  mother  takes  proper  care  of  her  general  health,  and  kee))s  all  un- 
healthy articles  out  of  her  stomach,  the  trouble  from  this  source  will  bo 
of  little  consequence. 

Pains  in  the  breasts  are  sometimes  severe.  They  may  always  and 
safely  be  relieved  by  cold  wet  cloths,  covered  with  dry ;  exce{)t  when 
of  a  spasmodic  or  neuralgic  character,  in  which  case  warm  fomentations 
are  appropriate. 

Excessive  vomiting  sometimes  occurs,  and  may  be  so  severe  as  to  en 


460  xM  I  D  W  I  F  E  R  r 


danger  abortion.      Fasting,  and  cold  water-drinking,  are    the    special 
remedies. 

Pain  in  the  side — usually  the  right — often  occurs  after  the  middle 
period  of  pregnancy  ;  it  is  rarely  severe,  but  generally  constant.  Bleed- 
ing, leeching,  cup{)ing,  and  blistering  have  been  perseveringly  pre- 
scribed for  it  by  '•  old-school"  doctors,  but  without  the  slightest  benefit 
in  the  great  majorit}'  of  cases.  The  w^et  bandage  and  hip-bath  are  the 
better  remedies. 

Difficulty  of  breathing  frequently  affects  the  patient  more  or  less  to- 
ward the  completion  of  the  term;  in  some  cases  it  is  attended  with  se- 
vere cough.  Indolence  or  over-exertion  are  alike  to  be  regarded  in  the 
treatment.  Great  fatigue  of  body  or  mind  Should  be  avoided.  Lifting 
heavy  articles,  running  up  stairs,  walking  too  fast,  are  among  the  ex- 
cesses against  which  the  patient  should  be  cautioned. 

When  hemorrhage  occurs,  it  is  to  be  regarded  as  a  premonition  of 
abortion,  and  treated  accordingl3% 

Diarrhea  is  among  the  unusual  occurrences.  The  ti-eatraent  is,  hip- 
baths, the  abdominal  bandage,  cold  injections,  and  a  strict  dietary. 

Difficult  urination  sometimes  proves  veiy  annoying.  AVhen  it 
amounts  to  actual  retention,  the  catheter  may  have  to  be  employed; 
this,  however,  is  extremely  seldom.  Cold  hip-baths  and  bandages  are 
usually  sufficient.  Foot-baths  are  also  useful ;  and  in  severe  cases  the 
warm  hip-bath,  immediately  followed  by  the  cold,  will  often  relieve. 

Varicose  veins^  with  a  swelling  and  knotty  appearance  of  the  lower 
extremities,  sometimes  result  from  the  obstructed  circulation  occasioned 
by  the  pressure  of  the  uterine  tumor  on  the  adjacent  blood-vessels. 
Attention  to  the  general  health,  and  a  judicious  regulation  of  the  amount 
of  exercise — neither  too  much  nor  too  little — are  all  the  therapeutic  in- 
dications in  this  case. 

Hysteria  is  named  among  the  "diseases  of  pregnancy"  by  authors. 
I  have  never  known  it  to  occur  in  females  whose  hygienic  habits  were 
reasonably  correct ;  and  the  affection  is  probably  always  attributable  to 
noveJ  reading,  exciting  company  or  parties,  stimulating  drinks,  irritating 
food,  cathartic  and  opiate  medicines,  etc.  The  treatment  is  wholly 
negative — an  avoidance  of  these  causes. 

Convulsions  are  less  frequent  occurrences  than  hysterical  parox- 
jsms,  but  are  produced  by  the  same  general  causes,  and  can  be  pre- 
vented or  cured  by  their  avoidance  or  removal. 


PARTURITION.  461 


CHAPTER  VI. 

PARTURITION. 

Rationale  of  Labor. — Many  ingenious,  if  not  profound  specula- 
tions, have  been  written  by  medical  philosophers,  to  explain  wliy  the 
foetus  and  its  appendages  are  expelled  from  the  womb  at  about  the  end 
often  lunar  months,  or  two  hundred  and  eighty  days.  As  well  might 
they  have  expended  their  learning  in  endeavoring  to  divine  why  man 
arrives  at  a  given  stature,  and  then  ceases  to  grow ;  or  Nvhy  the  earth 
performs  its  circuit  around  the  sun  in  three  hundi-ed  and  sixty-five  days, 
instead  of  a  longer  or  shorter  period.  We  are  sufficiently  wise  for 
"our  being's  end  and  aim,"  if  we  know  the  fact  that  il  is  so.  But  the 
physiology  of  parturition,  which  it  behooves  us  to  understand,  is  easily 
explained. 

As  the  ripened  fruit  drops  from  its  parent  stem,  so  the  foetus,  when 
sufficiently  developed  for  independent  existence,  is  separated  from  its 
parental  connection.  A  slight  discharge  of  mucus,  often  more  or  less 
tinged  with  blood,  called  labor-shoiu,  and  which  serves  to  lubricate  and 
prepare  the  parts  for  the  requisite  distention,  is  the  first  decisive  indi- 
cation of  approaching  labor.  Wandering  pains  about  the  back,  around 
the  abdomen,  and  down  the  tliighs,  gradually  becoming  fixed  and  reg- 
ular, with  intervals  of  perfect  ease,  denote  the  preparation  going  on  in 
the  uterine  region.  Each  labor  ^^pahi"  is  produced  by  a  distinct,  pe- 
riodical contraction  of  the  longitudinal  and  circular  fibres  of  the  uterus, 
which  diminish  its  diameter  and  dilate  its  mouth.  These  contractions, 
and  consequent  pains,  are  renevred  at  certain  intervals  until  the  dilata- 
tion is  sufficient  to  permit  the  passage  of  the  child  without  injur}' to  the 
soft  parts.  The  pain  experienced  by  the  patient  bears  no  very  near 
relation  to  the  force  of  the  conti'action  of  the  uterus,  but  is  rather 
measured  by  the  healthful  condition  or  morbid  sensibility  of  the  parts. 
Those  who  live  healthfully,  suffer  but  little  ;  while  nany  of  opposite 
habits,  endure  the  most  excruciating  agonies. 

In  the  early  stage  of  labor,  the  pains  are  called  cutting  or  grinding ; 
they  are  of  an  acute  and  stinging  character,  and  are  occasioned  by  the 
stretching  of  the  fibres  of  the  os  uteri.  In  the  second  stage,  the  con- 
traction of  the  uterus  is  aided  by  the  contraction  of  the  abdominal  mus- 
cles--somo  writers  say  the  volunta'y  effovti  of  the  patient;  but  this 


462  M  U  W  I F  E  R  Y. 


action  takes  place  whether  the  patient  wills  it  or  not — when  the  pa- 
tient is  obliged  to  co-operate  with  the  expulsive  eftbrt,  by  holding  her 
breath,  and  then  the  pains  are  called /orcfng,  or  hearing-down.  The 
forcing  or  expulsive  pains  gradually  increase  in  severity,  but  the  pa- 
tient usually  bears  them  better  as  the  labor  approaches  its  termination. 
Says  Dr.  Churchill  {System  of  Midwifery):  "The  amount  of  suffer- 
ing depends  a  good  dpal  upon  the  temperament  of  the  patient,  and 
ui)oii  the  habits  of  life  among  savages  it  appears  slight,  but  it  is  ex- 
cessive in  civilized  life."  There  is  an  important  lesson  implied  in  the 
above  quotation.  Happy  will  it  be  for  those  mothers  who  can  appre- 
ciate and  apply  it. 

The  remarkable  peculiarities  of  labor  pains  are,  their  periodicity; 
the  intervals  of  perfect  ease,  during  wliich  the  patient  is  often  inclined 
to  sleep;  each  uterine  contraction  gradually  increasing  to  its  maximum 
of  force,  and  then  suddenly  subsiding  the  intervals  of  rest  diminish- 
ing, and  the  length  of  the  pain  increasing  as  the  labor  advances.  The 
membranes  are  sometimes  ruptured,  and  the  water  of  the  amnion  dis- 
charged at  the  commencement,  and  sometimes  not  till  very  near  the 
conclusion  of  labor ;  and  not  unfrequently  the  water  escapes  on  the 
first  occurrence  of  the  premonitory  pains.  Sometimes  the  membrane 
does  not  ru})ture  at  all,  and  the  child  is  expelled  entirely  inclosed — ia 
common  parlance,  "  born  with  a  vail." 

The  Pains  of  Childbirth. — An  erroneous  interpretation  of  Scrip- 
ture has  caused  the  opinion  to  prevail  extensively  in  the  civilized  world, 
that  great  suffering  is  the  ordained  law  of  woman  in  childbirth ;  and 
this  error  has  had  a  paralyzing  effect  on  the  popular  mind,  and  caused 
the  sufferers  to  submit  reverently  to  their  fate,  instead  of  seeking  the 
true  light  of  physiology  on  the  subject.  If  Eve  was  sentenced  to 
bring  forth  in  sorrow,  it  was  because  of  her  personal  transgression. 
Show  me  a  woman  on  earth  who  agonizes  through  the  period  of  part- 
urition, and  I  will  prove  her  to  have  transgressed  the  laws  of  health  ia 
her  own  person ;  and  conversely,  find  me  a  inother  who  lives  physio- 
V)gically,  and  I  will  show  you  one  with  whom  the  act  jf  childbirth  has 
leither  agony  nor  terror. 

The  philosophy  of  this  mutter  is  admirably  expressed  in  a  httle  work 
(The  Curse  Removed),  by  Dr.  T.  L.  Nichols:  "The  women  of  nature 
have  no  such  word  as  '  confinement' — a  word  so  apjn-opriate  in  civiliza- 
tion. The  great  truth  to  be  learned  by  every  body  is,  that  gestation 
and  parturition  are  natural  processes.  It  is  as  natural  for  a  woman  to 
bring  forth  children,  as  for  a  shnil)  to  produce  flowers  and  fruit;  and 
her  organs  are  as  naturally  adapted  for  the  purpose.     In  a  state  of 


PARTURITION.  4G3 


health  no  natural  process  is  painful.  Pain  is,  in  all  cases,  the  sign  of 
d.sease.  It  has  no  other  use  or  signification.  With  a  sore  throat,  it  is 
painful  to  swallow;  with  a  diseased  stomach,  digestion  is  painful;  so  is 
childbirth  painful  to  a  diseased  nervous  system,  but  never  to  an  entirely 
healthy  one. 

"It  is  not  credible  that  any  natural  function  should  be  attended  with 
pain  in  a  healthy  state  of  the  system.  All  nature  protests  against  the 
idea — all  experience  is  opposed  to  it.  Causes  and  effects  are  too  well 
adapted  to  each  other — ends  and  means  too  admirably  fitted.  This 
world  is  the  work  of  infinite  power  and  benevolence ;  all  the  human 
system  is  the  masterpiece  of  all  this  fair  creation.  It  is  not  to  be  sup- 
posed that  the  most  imjjortant  of  all  the  functions  of  the  most  perfect 
of  created  beings,  of  whom  we  have  any  knowledge,  should  be  sub- 
ject to  inevitable  pain  and  peril  in  its  performance.  Such  a  belief 
is  an  insult  to  Providence.  When  God  looked  upon  His  creation,  and 
pronounced  it  good,  He  could  not  have  overlooked  the  most  important 
function  of  His  last  and  most  perfect  work  ;  and  there  can  be  no 
question  that  in  the  original  creation  of  woman,  she  was  fitted  to  obey 
the  command,  'Increase  and  multiply,  and  re[)lenish  the  earth,'  with- 
out peril  or  pain.  The  very  idea  of  the  curse  inflicted  upon  her  car- 
ries with  it  the  belief,  that  she  was  originally  created  perfect  in  this 
particular. 

"  What,  then,  has  made  the  change  ?  Why  is  woman  subjected  to 
all  her  pains,  sufferings,  outrages,  and  perils,  in  the  pei-formance  of  the 
great  function  of  her  life?  It  is  because  the  forbidden  fruit  of  ener- 
vating luxuries  and  excesses  is  continually  eaten.  And  just  in  propor- 
tion as  woman  transgresses  the  laws  of  nature,  which  are  the  real  and 
unquestionable  commands  of  God,  just  so  far  are  they  subject  to  the 
curse. 

"  Man  has  it  in  his  power  to  incur  all  direct  curses  by  transgression, 
or  to  avoid  all  curses  and  invoke  all  blessings  by  obedience  to  the  divine 
law.  Industry  makes  of  the  barren  earth  another  Eden.  Temper- 
ance and  cleanliness  give  health,  and  health  brings  happiness  in  all  the 
duties  of  life.  So  it  is  with  woman.  Indolence,  self-indulgence,  vo- 
luptuousness, and  all  the  sins  against  the  laws  which  God  has  written 
in  the  structure  of  ouir  bodies,  bring  with  them  the  curse  of  deranged 
nervous  systems,  broken  health,  irregulirity  of  function,  disease,  pain, 
and  premature  death.  Every  woman  is  an  Eve,  and  forbidden  fruits 
are  all  around  her.  If  she  listen  to  the  voice  of  the  beguiling  serpent, 
hers  is  the  wo.  But,  on  the  other  hand,  fnith  in  God,  obedience  to 
His  laws,  and  living  in  harmony  with  His  works,  assure  to  woman 
health    and  safety,  and  joy,  in  ifulfilUng  alj  her  destiny.     I'hese  ar» 


404  MIDWIFERY. 


truths  i)regnant  \>irh  meaning,  and  incontrovertible  us  the  principles 
of  nature." 

3Irs.  Pendleton  remarl^  (Parent's  Guide):  "It  is  a  well-establish- 
ed tact,  that  women  are  to  be  found  in  almost  every  country  who  suf- 
fer no  pain  in  childbirth.  N'»w,  as  a  natural  law  never  admits  of  an 
exception,  this  exemption  fron  pain  could  not  occur  in  any  individual, 
unle:-s  it  were  fairly  within  the  capabilities  of  the  race." 

Mrs.  Gove — now  Mrs.  Dr.  JNicliolj — testifies  (Lectures  to  Ladies). 
"I  know  many  mothers  who,  wnth  their  husbands,  have  adopted  the 
'  Graham  System,'  or,  in  other  words,  those  correct  habits  recom- 
mended in  these  lectures  (that  is,  attention  to  diet,  exercise,  and  bath- 
ing freely  and  constantly  with  pure,  cold  water),  and  those  mothers 
have  abridged  their  sutlerings  it  parturition  from  forty  hours  to  om 
hour,  nrn\  have  escaped  altogether  iht  ^«»athly  sickness  of  the  three  fir^t 
months  of  gestation." 

George  Combe  observes  (Constitution,  of  Man) :  "The  sufferings 
of  women  in  childbed  have  been  cited  as  evidence  that  the  Creator 
has  not  intended  the  human  being,  under  any  circumstances,  to  exe- 
cute all  its  functions  free  from  pain.  But,  besides  the  obvious  answe^v 
that  the  objection  applies  onlj^  to  one  sex,  and  is  therefore  not  to  be 
too  readily  presumed  to  have  its  origin  in  nature,  there  is  good  reason 
to  deny  the  assertion,  and  to  ascribe  the  sufferings  in  question  to  de- 
partures from  the  natum!  law^s.  in  either  the  structure  or  the  habits  of 
the  individuals  who  experience  it." 

The  late  Dr.  Andrew  Combe  wrote  :  "If  women  in  childbed  could 
be  convinced,  from  previous  knowledge,  that,  as  a  general  rule,  the 
danger  attending  that  state  is  proportioned  to  the  previous  sound  or 
unsound  condition  of  the  system,  and  to  its  good  or  bad  management 
at  the  time,  and  is  not  the  mere  effect  of  chance,  they  would  be 
much  more  anxious  to  find  out,  and  successful  in  observing,  the  laws 
of  health,  both  for  their  o^vn  sakes  and  for  the  sake  of  the  future  in 
tant,  than  they  now  are,  while  ignorar.t  of  the  influence  of  their  own 
conduct." 

Dr.  Eberle's  opinion  {Theory  and  Practice)  is  to  the  same  effect* 
"The  pregnant  female,  who  observes  a  suitable  regimen,  will,  ceeteris 
paribus,  always  enjoy  more  tranquillity  both  of  mind  and  body,  and  in- 
cur much  less  risk  of  injury  to  herself  and  child  than  s])e  who,  givinfia 
free  rein  to  her  appetite,  indulges  to  excess,  or  in  the  use  of  improper 
articles  of  food." 

Dr.  Dewees,  Professor  of  Obstetrics  in  the  Medical  School  of  Penn- 
sylvania, has  argue i   [Tresis  ok   Oullhirth)  that  "  Pain  is  a  morlid 


PARTURITION.  465 


symptom,  the  consequence  of  arfciftcial  modes  of  life  and  treatment,  and 
can  be  avoided  by  appropriate  habits  and  treatment." 

In  corroboration  of  this  ah'eady  conclusive  weight  of  authority,  I  can 
add,  that  I  have  known  females  in  the  city  of  New  York  adopt  a  i-e- 
forra  system  of  living — a  plain,  simple,  vegetable  diet,  with  a  daily  cold 
bath,  and  go  through  the  period  of  gestation  without  losing  an  hour 
from  sickness,  the  ordeal  of  parturition  with  no  assistant  or  attendant 
in  the  room  save  the  husband,  take  the  entire  chiirge  of  the  child  from 
the  moment  of  its  birth — assisted,  of  course,  by  its  other  parent — and 
"  recover"  without  experiencing  a  single  symptom  of  any  one  of  the 
numerous  diseases  so  common  to  the  lying-in  period.  This  shows  that 
nature  can  be  returned  to,  as  well  as  departed  from,  even  among  civ- 
ilized people. 

I  am  aware  that  the  easier  labors  of  the  less  civilized  portions  of  the 
human  family  are  accounted  for  by  some  on  the  supposition  that  the 
children  have  smaller  heads.  There  is  something  in  this  circum- 
stance, no  doubt ;  but  if  the  mother  lives  properly,  and  the  foetus  is 
healthfully  nourished,  the  osseous  structure  will  be  so  elastic  and  pli- 
able that  the  size  of  the  hea  ^..though  larger  among  the  educated  class- 
es, will  constitute  no  serious  obstacle  to  easy  delivery. 

Among  the  improper  habits  which  are  the  sources  of  the  pains  and 
perils  of  childbirth,  improper  food,  unquestionabJy,  ranks  foremost.  The 
immediate  causes  of  the  pains  are  a  rigidity  and  inflexibility  of  the  soft 
structures  on  the  part  of  the  mother,  and  advanced  ossification  of  the 
bones  of  the  cranium  on  the  part  of  the  child.  Acting  upon  this  theo- 
ry, Mr.  Ramsbotham,  of  London,  instituted  an  experiment,  which  was 
published  in  1841  {Essay  on  Human  Parturition),  for  the  purpose  of 
securing  safe  and  easy  delivery.  The  experiment  succeeded  perfect- 
ly ;  and,  although  I  do  not  explain  the  result  as  others  have,  the  facts 
are  just  as  interesting.  Mr.  Ramsbotham  restricted  the  patient  prin- 
cipally to  vegetables  and  fruits ;  farinaceous  articles,  as  wheat,  barley, 
beans,  peas,  rice,  and  especially  fine  wheaten  flour,  being  but  sparingly 
employed  on  account  of  the  phosphates  of  lime  and  magnesia  they  con- 
tain. Mr.  R.'s  idea  was,  by  withholding  some  portion  of  the  natural 
bony  constitutents,  to  de-ossify  the  systems  of  both  mother  and  child  to 
some  extent — to  produce  an  absolute  abnormal  state — trusting  to  a 
more  farinaceous  diet,  after  parturition,  to  supply  tlie  requisite  ele- 
ments of  bone.  The  same  experiment  has  been  repeated  in  this  coun- 
try in  several  cases,  and  always  successfully. 

Now  I  think  the  whole  explanation  is  furnished  by  the  prmciple  of 
a  more  plain,  and  simple,  and  less  concentrated  diet.  Such  a  dietary 
will  alwavs  keop  the  system  open  and  unobstructed,  and  the  excre- 


466  MIDWIFEllY. 


tions  free,  so  that  the  superfluous  particles  of  earthy  matter,  if  any  ex- 
ist in  the  farinaceous  articles,  will  be  readilj'  washed  away.  The  real 
objection  to  urge  against  farinaceous  food  is,  that  being  highly  nutri- 
tious, most  persons,  without  a  large  admixture  of  fruits  and  vegetables, 
are  very  apt  to  eat  too  much.  I  agree  entirely  with  Mr.  R.,  that  the 
diet  is  far  the  most  impoi-tant  of  any  one  of  the  hygienic  considerations 
affecting  the  security  or  happiness  of  the  pregnant  female,  or  the  health 
of  her  offspring. 

Medicating  Labor  Pains. — The  fashion  of  giving  ergot  and  other 
"forcing  medicines"  to  expedite  delivery,  has  prevailed  to  an  alarming 
extent;  happily,  however,  it  is  now  on  the  decline-  But  the  auEES- 
thetic  agents,  ether  and  chloroform,  are  threatening  to  have  "a  run'* 
among  ever-changing  medical  fashions.  Among  the  advantages  alleged 
by  Dr.  Stearns,  who  first  introduced  the  employment  of  ergot  in  1807, 
was  "saving  to  the  accoucher  a  considerable  portion  of  time."  Per- 
haps an  hour  or  two  of  a  doctor's  time  is  more  precious  than  the  health 
of  the  infant — and  perhaps  not.  "The  pains  induced  by  it,"  says  Dr. 
iS'tearns,  "are  peculiarhj  farcin g^  Again  says  the  doctor,  "since  I 
have  adopted  the  use  of  this  article,  I  have  seldom  found  a  case  that  de- 
tained me  more  than  three  hours!''  Dr.  Beck  tells  us  the  profession  is 
divided  on  the  question,  "Whether  the  use  of  ergot  has  an  injurious 
influence  on  the  child — some  maintaining  that  its  common  use  is  the 
principal  cause  of  the  increasing  number  of  still-born  children."  Now 
it  is  perfectly  clear,  that  if  it  forces  the  uterus  to  rapid  and  extraordi- 
nary "forcing"  contractions,  it  must  to  precisely  that  extent  expose  the 
mother  to  tearing  and  laceration  of  the  soft  parts,  and  endanger  an  in- 
jurious and  fotal  compression  of  the  child's  head  in  the  passage  ;  and 
further  than  this,  if  the  child  s  not  soon  born  after  its  administration, 
the  narcotic  properties  of  the  drug — which  are  known  to  be  potent — 
may  narcotize  or  destroy  the  child  through  the  medium  of  the  circula- 
tion. The  only  plausible  argument  which  has  ever  been  advanced  for 
its  use  is,  that  the  strong  uterine  contraction  which  it  induces,  will  tend 
to  the  prevention  of  hemorrhage.  But  when  it  is  considered  that  there 
is  no  danger  of  hemorrhage  under  ordinary  circumstances,  and  that,  in 
those  extraordinary  cases  in  Avhich  it  does  occur,  we  have  a  surer  re- 
source in  simple  cold  water,  the  argument  appears  almost  foolish.  As 
long  ago  as  1812  it  was  noticed  by  many  physicians,  and  recoi  led  in 
the  New  England  Journal  of  Medicine  and  Surgery,  "  that  in  a  large 
proportion  of  cases  where  ergot  was  employed,  the  children  did  not  re- 
spire for  an  unusual  length  of  time  afl  m-  birth,  and  in  several  cases  they 
Were  irrecoverablv  dead."      "Since    hen."  savs  Dr.  Beck,   "a   larg« 


PARTURITION.  W, 


amount  of  testimony  has  been  furnished,  confirmatory  of  the  truth  of 
this  suggestion."  Still  more  pointed  and  direct  evidence  is  found  in 
the  following  statistics,  collected'by  Dr.  Beck.  Dr.  Ward,  of  New  Jer- 
sey, who  used  the  article  extensively,  came  to  the  conclusion,  that 
unless  the  child  was  expelled  in  forty  minutes  after  its  effect  was  ap- 
parent, it  would  be  born  dead.  Dr.  Hosack  gave  it  in  three  cases,  and 
the  result  was  three  still-born  children.  The  late  Dv.  William  Moore, 
"a  veteran  practitioner  of  obstetrics  in  this  city,"  testified,  "  It  appears 
to  be  injurious  to  the  child  at  all  times,  for  in  every  case  in  which  I 
have  seen  it  exhibited,  the  child  was  still-born."  Dr.  Chatard,  of  Bal- 
timore, gave  it  in  thirty-seven  cases,  and  fourteen  oi  them  were  still- 
births. Dr.  Holcombe,  of  New  Jersey,  Dr.  Davies,  of  London,  Mr. 
T.  Chavasse,  of  Birmingham,  Mr.  Paterson,  of  Abei-deen — all  expe- 
rienced obsteti'icians,  coincide  with  the  previous  authors.  Dr.  Per- 
kins, of  this  city,  testifies  :  "  I  have  reasons  satisfactory  to  my  own 
mind  for  believing,  that  it  has  frequently  destroyed  foetuses,  and  pro- 
duced sterility  in  mothers." 

Dr.  Beatty,  of  Dublin,  states  that  he  has  known  infants  which  have 
been  narcotized  by  ergot  before  birth,  to  have  been  affected  with  con- 
vulsions afterward,  terminating  in  idiotcy  ! 

This  is  but  a  small  part  of  the  evidence  extant,  but  T  trust  it  is  suffi- 
cient for  a  proper  understanding  of  the  subject. 

Nor  is  the  employment  of  chloroform,  ether,  or  any  other  unnatural 
agent  free  from  danger.  These  agents  will,  it  is  true,  mitigate  the 
suffering  from  labor  pains  to  a  much  greater  extent  than  they  dimin- 
ish the  contractile  power  of  the  uterus.  But  already  the  attention  of 
practitioners  has  been  called  to  the  injuriously  narcotic  effect  of  these 
articles  on  the  child.  And  even  in  cases  where  it  has  not  stupefied  the 
child,  it  has  produced  a  narcotic  shock  upon  its  nervous  system  which 
proved  a  lasting  and  incurable  injury.  If  mothers  will  take  proper  care 
of  themselves,  there  will  be  rarely  occasion  for  such  treatment ;  and 
if  doctors  would  teach  them  this  lesson,  and  so  avoid  the  necessity  of 
using  those  agents,  they  would  confer  on  suffering  humanity  a  much 
greater  boon  than  in  assuaging  pains  which  might  have  been  avoided. 

Natural  Labor. — All  labors  are  usually  called  natural  in  which  the 
child  is  so  disposed  within  the  uterus  or  pelvis  that  the  h'v'Sa  can  be  ac- 
complished by  the  efforts  of  nature ;  in  contradistinction  to  unnatural 
and  complicated  labors,  which  require  maaual  or  instrumental  assist- 
ance. In  the  most  common,  and  perhaps  the  only  truly  natural  labor, 
the  head  presents  at  the  superior  strait,  with  the  occiput  in  front  or  to- 
ward the  symphisis  pubis,  and  the  Aice  turned  toward  the  sacruno. 


468  MIDWIFERY. 


The  reversed  presentation — the  face  forward — is  mrely  attended  with 
any  other  difficulty  tiian  a  more  tedious  delivery.  Foot  presentations 
aJmost  ahvays  terminate  naturally,  and  the  same  is  true  of  breech  pre- 
sentations. 

Diagnosis  of  Prkse.xt^iions. — The  distinctive  signs  b\'  which  dif- 
erent  parts  of  the  body  can  be  recognized  at  once,  ought  to  be  familiar 
not  only  to  all  mid  wives,  but  to  all  females  who  are  liable  to  be  called 
upon  to  assist  in  emergencies.  The  head  may  be  readily  known  by 
its  hardness  and  by  the  sutures  and  fontanelies ;  the  breech,  by  its  soft- 
ness, the  anus,  os  coccygis,  the  scrotum  or  vulva,  and  the  cleft  between 
the  buttocks;  the  knee,  by  its  rounded  form,  and  by  the  condyles  of 
the  femur  ;  the  foot,  by  its  long  narrow  form,  its  being  at  right  angles 
with  the  leg,  the  narrow  heel,  and  near!}-  equal  length  of  the  toes  :  the 
elbow,  by  the  olecranon  process,  which  renders  the  joint  much  sharper 
than  the  knee  ;  and  the  hand,  by  its  shortness,  the  unequal  length  of 
the  fingers,  and  the  divarication  of  the  thumb. 

Stages  of  Labor. — The  first  stage  is  usually  reckoned  that  period 
in  which  the  first  obstacle  to  delivery  is  overcome,  which  consists  in 
the  dilation  of  the  cervix  uteri.  In  most  cases,  a  pouch  of  the  mem- 
branes, filled  with  liquor  amnii,  called  '-the  bag  of  the  waters."  la 
pressed  forward  of  the  child's  head,  and  serves  as  an  equable  wedge 
to  effect  the  dilation  in  the  easiest  possible  manner ;  but  when  the  wa- 
ters have  been  prematurely  discharged,  the  child's  head  acts  as  a 
wedge,  in  which  case  there  is  considerable  more  suffering.  In  the 
second  stage  the  second  obstacle,  which  is  the  brim  of  the  pelvis,  is 
overcome ;  the  head  of  the  child  is  compressed,  and,  as  it  were,  mold- 
ed into  a  shape  exactly  adapted  to  the  passage.  When  the  due  posi- 
tion of  the  head  is  attained,  it  advances  with  every  pain,  and  recedes 
somcAvhat  during  their  intervals  until  it  arrives  at  the  lower  outlet.  The 
obstacles  here  are  the  ligaments,  muscles,  cellular  tissue,  and  perine- 
um, which  gradually  yield  Jis  the  head  is  repeatedly  pressed  against 
them,  until  the  dilatation  is  sufficient  to  i>ermit  the  head  to  pass,  con- 
stituting the  third  stage,  and  completi^ig  the  birth.  The  duration  of 
natural  labor  varies  from  a  few  hours  to  several  days.  The  average 
lime  is  abou;:  twelve  hours.  In  the  fourth  and  last  stage,  the  placenta 
is  detached  and  ex[)e1!ed.  It  may  occur  in  a  few  minutes  after  the 
delivery  of  the  child,  or  not  till  a  lapse  of  several  hours.  Its  expulsion 
'b  attended  by  comparatively  slight  l;ih-v  pains. 

Position  during  Labor. — Sinco  )nan-midwifery  has  been  i  trade. 


PARTURITION.  j*19 


an  immense  amount  of  ridiculous  parade  and  scientific  barbarity  has  be- 
come fashionable  on  parturient  occasions.  It  is  quite  customary  to  fix 
and  fasten  the  patient  in  some  awkward  position  for  hours  together, 
surrounded  by  some  half  a  dozen  female  helpers,  each  one  having  some 
particular  pushing,  pulling,  holding,  or  lifting  duty  to  perform  in  the 
premises,  while  the  doctor  is  fantastically  and  frightfully  dressed,  as  if 
about  to  perform  some  terrible  surgical  operation.  It  is  not  strange  that 
mothers,  with  a  first  child,  are  so  often  tormented  or  alarmed  into  dis- 
eases and  accidents.  In  the  cities,  labor-chairs  are  common;  but  m 
the  country  the  patient  is  commonly  perched  up  on  four  chairs,  tied 
together  and  covered  by  bedding,  with  four  attendants  supporting  the 
four  extremities — the  husband  bracing  behind — the  doctor  conveniently 
disposed,  and  one  or  two  extra  attendants  making  themselves  "  gen- 
erally useful"  in  preparing  medicinal  slops  for  tiie  woman  in  travail, 
and  tea  for  the  partj^  as  soon  as  the  travail  can  be  urged  to  a  conclu- 
fiion.     All  this  is  wrong. 

The  patient  should  walk,  sit,  or  stand  until  she  feels  inclined,  by  the 
severity  of  the  pains,  or  the  local  disturbance,  to  rest.  She  shoulu  then 
recline  o-n  a  hard  bed  or  mattrass.  She  may  assume  any  position  that 
she  finds  most  comfortable.  She  may  have  the  head  high  or  low  ;  lay  on 
the  right  or  left  side,  or  back ;  or,  for  a  change,  rest  on  the  knees,  sup- 
porting the  breast  with  pillows;  or  she  may  change  from  any  one  of 
these  positions  to  either  of  the  others  as  often  as  she  pleases,  and  even 
get  up  and  walk,  if  the  labor  is  protracted,  whenever  she  feels  able  and 
inclined  to.  There  is  no  necessity  for  her  being  confined  to  a  fixed  po- 
sition, and  constantly  attended  upon,  by  the  man  or  woman-midwife. 
Nay,  such  constant  attention  is  invariably  injurious. 

Management  during  Labor. — So  many  erroneous  notions  are 
aoroad  on  this  subject,  that  I  can  scarcely  write  a  paragraph  without 
crossing  some  professional  error  or  non-professional  whim.  Ii]  a  nat- 
ural labor  there  is  almost  nothing  to  be  done,  and  the  principal  duty  of 
the  physician  is  to  keep  the  attendants  from  meddling.  After  an  ex- 
amination, to  ascertain  if  the  presentation  is  favorable  or  otherwise,  the 
duty  of  the  midwife  and  attendants  is  resolved  into  keoi)ing  the  patient 
in  a  comfortable  position  on  the  bed,  supporting  her  during  the  pain 
by  making  firm  pressure  with  the  hand  upon  the  lower  part  of  the 
back,  whenever  she  desires  it — assisting  her  to  change  position,  and 
giving  her  a  swallow  of  water  occasionally,  which  should  be  the  only 
food,  drink,  or  medicine  allowed. 

Many  abominable  customs  of  "hastening  the  delivery,"  have  had 
their  day ;  and  many  doctors  have  acquired  great  celebrity  for  "  deliv- 
40 


470  MIDWIFERY. 


ering  womeu"  quickly  ;  but  iil.  people  ought  to  be  taught  that  all  these 
thini^s  pertain  either  to  rash  measures  or  false  pretences.  It  is  a 
cunnnon,  and,  I  believe,  universal  dogma  among  professional  men- 
midwives,  that  the  perineum  must  be  supported  by  pressing  against  it 
externally,  while  the  child's  head  presses  against  it  internally.  I  know 
of  no  standard  author  who  does  not  recommend  this  practice.  Pro  - 
feasor  White,  of  Buffalo,  not  long  since  testified  in  a  court  of  justice, 
that  the  principal  use  of  the  physician  was  to  support  the  perineum 
during  the  passage  of  the  child's  head.  Now,  in  opposition  to  all  this 
high  authority,  I  protest  against  this  practice  as  not  merely  useless,  but 
actually  injurious.  And  against  the  science  urged  in  favor  of  the  prac- 
tice, and  the  affidavit  of  Dr.  White,  I  oppose  the  common  sense,  that 
the  distended  part  is  more  likely  to  be  injured  or  ruptured  when 
pressed  between  two  resisting  bodies  than  w4ien  only  pressed  on  one 
side.  The  practice  I  am  controverting  can  only  be  predicated  on  the 
notion  that  nature  has  not  constructed  the  parts  on  correct  principles, 
or  has  not  provided  the  necessary  means  to  accomplish  her  o\vn  pur- 
poses. 

Some  authors  recommend  the  nurse  to  press  upon  the  uterus  ex- 
ternally as  the  child  is  being  born,  with  a  view  of  loosening  the  after- 
birth. This,  too,  had  better  be  let  alone.  The  umbilical  cord  is  some- 
times coiled  around  the  child's  neck;  and,  although  it  can  be  easily 
slipped  off,  it  seldom  does  any  harm. 

When  the  head  is  very  strongly  pressed  in  the  cavity  of  the  pelvis, 
the  integument  of  the  scalp  often  forms  a  i-ather  firm,  circumscribed 
swelling ;  and  probably  no  occurrence  so  trifling  has  ever  occasioned 
80  manj'  serious  alarms  and  accidents.  It  has  been  mistaken  for  an  ab- 
normal tumor,  and  cut  open ;  and,  for  a  presentation  of  some  other 
portion  of  the  body.  No  one,  not  even  the  most  inexperienced,  need 
make  any  mistake  here  if  he  or  she  will  only  employ  the  thinking  facul- 
ties, for  the  hair  of  the  scalp  will  in  all  cases  determine  its  character; 
and  all  the  treatment  it  requires  is  to  be  left  to  itself. 

As  soon  as  the  child  is  born  it  will  cry  lustily,  if  healthy  and  vigor- 
ous, soon  after  which  the  umbilical  cord  may  be  tied  and  cut ;  but  if  the 
child  does  not  ciy,  or  appears  apoplectic  or  feeble,  the  cord  should  not 
be  cut  until  the  pulsation  in  it  ceases.  Some  authors  have  recommended 
pla|)ping  the  child  on  the  back  to  excite  circulation  and  respiration ;  but 
a  more  merciful  and  more  efficacious  practice  is  to  dash  a  little  cold 
water  on  its  chest,  abdomen,  and  spine. 

The  cord  maj  be  tied  about  two  inches  from  the  navel,  and  again  an 
inch  farther  oflT,  and  then  cut  through  near  the  first  hgature  with  a  pair 
of  scissors.      Dr.  Burke  {Acccurhers   Vade-mecum)  tells  us  with  b»- 


P  A  r.  T  U  E I T 1 0  N  i:  1 


coming  gravity,  that  "  a  piece  of  narrow,  flat  tape  makes  the  best  liga- 
ture ;"  but  I  cannot  conceive  any  reason  for  selecting  one  kind  of  a 
string  in  preference  to  another ;  and,  in  fact,  if  the  cord  is  not  severed 
too  soon,  there  is  no  rea\  necessity  for  a  ligature  at  all,  as  we  may  learn 
from  the  examples  of  the  animals  around  us. 

The  Aftkr-Birth. — The  contractions  of  the  uterus,  which  expel  the 
child,  also  detach  the  placenta;  and  in  most  cases  it  lies  loose  in  the 
vagina  after  delivery  of  the  child.  Sometimes,  however,  it  is  not  en- 
tirely detached,  or  is  still  attached  to  some  portions  of  the  uterus  by 
morbid  adhesions.  If  no  expulsive  efforts  are  made  in  an  hour  or  two 
—^evinced  by  a  recuiTence  of  bearing-down  pains — the  cord  may  be 
gently  pulled  upon — never  forcibly  ;  and  if  the  after-birth  Joes  not  read- 
ily follow,  gentle  pressure  may  be  made  on  the  lower  part  of  the  abdo- 
men with  the  hand  :  or  the  abdomen  manipulated  from  above  down- 
ward. Should  the  placenta  be  retained  several  hours  without  expul- 
sive pains,  the  hand  may  be  dipped  in  cold  water  and  applied  as  above, 
to  excite  uterine  contraction.  The  sudden  application  of  a  cold  wet 
cloth  to  the  abdomen  is  often  effectual.  After  the  removal  of  the  pla- 
centa, a  free  vaginal  injection  of  cold  water  is  always  harmless,  and 
generally  remarkably  soothiP-g  and  strengtlieoiDg. 

After-Management. — Professors  of  midwifery  instruct  theh-  pu- 
pils to  conclude  their  duties  in  this  matter  by  placing  a  bandage  around 
the  abdomen  of  the  mother  to  prevent  a  "pendulous  belly  ;"  and  anoth- 
er around  the  child  to  secure  it  against  being  "  pot-bellied."  All  wrong 
again.  They  do  not  prevent  such  results.  The  most  unshapely  abdo- 
mens I  have  ever  known  occurred  after  severe  bandaging.  To  the 
infant  such  an  application  is  particularly  cruel  and  barbarous.  Its  ten- 
der, flexible  muscles  cannot  have  too  much  freedom ;  and  those  men- 
midwife  philosophers  who  imagine  one  portion  of  the  body  wants  re- 
forming by  artificial  supports,  while  all  the  rest  is  pretty  well  put  to- 
gether by  Dame  Nature,  must  have  a  veiy  mean  opinion  of  her  handi- 
work, as  well  as  an  exalted  estimation  of  their  own  superior  skill  and 
taste. 

The  wet  and  soiled  clothing  should  be  removed  from  the  bed  as 
Boon  as  convenient,  and  the  patient  supplied  Avith  clean  linen  ;  after 
which  she  should  be  allowed  to  rest  as  long  as  she  feels  so  inclined. 
A  tepid  sitz-bath  or  ablution  may  be  advantageously  taken  after  resting 
awhile.  It  is  a  great  mistake  that  lying-in  women  should  keep  their 
rooms  or  beds  any  prescribed  length  of  time.  But,  on  the  other  hand, 
there  is  nothing  gained  in  being  too  heroic.     I  have  known  females  i»» 


472  MIDWIFERY. 


this  citv  take  the  entire  charge  of  their  infouts  from  the  moment  of 
oirtli,  and  li^nve  their  rooms  comfortably  on  the  vlay  after  delivery  ;  but 
if  all  sliould  attempt  to  do  so  some  of  them  would  most  certainly  have 
the  experiment  to  regret.  Whenever  the  patient  feels  faint  or  ex- 
hausted, she  should  be  allowed  the  most  perfect  repose,  until  her  sen- 
sations indicate  exertion.  If  she  has  been  subject  to  prolapsus,  or  se- 
vere leucorrhoea,  she  should  be  guarded  against  exerting  herself  too 
soon.  The  rule  for  her  to  be  governed  by  is,  to  sit  and  walk  as  soon  or 
as  much  as  she  can  without  inducing  pain,  distress,  lameness,  or  bear- 
ing-down sensations — but  not  to  transcend  those  limits — with  no  regard 
whatever  to  time. 

Convalescence  of  Lying  in  Women. — There  is  no  place  where 
more  mischievous  meddling  with  the  harmonious  operations  of  nature 
is  found  than  in  the  chamber  of  the  hing-in  woman ;  nor  is  any  place 
more  abounding  in  mal-practice  on  the  part  of  the  physician  ;  nor  more 
infested  with  the  conceits,  whims,  miseducation,  prejudices,  and  su- 
perstitions of  nurses.  When  the  usual  stimulating  and  slopping  of  the 
mother,  and  the  stuffing  and  dosing  of  the  child  is  taken  into  the  ac- 
count, we  have  no  occasion  to  wonder  that  so  many  mothers  have  a 
'•  bad  getting  up,"  nor  that  so  many  children  decline  and  die.  The 
mother  is  gorged  with  catnip  teas,  panada,  wine-whey,  soups,  broths, 
and  medicated  slops  innumerable  to  promote  the  lochia]  discharge,  or 
increase  the  secretion  of  milk  ;  and  the  child  is  made  to  swallow  cas- 
tor-oil, sweetened  urine,  and  other  nauseous  and  disgusting  trash,  to 
"  clear  out  the  meconium,"  and  afterwai'd  fed  on  magnesia,  prepared 
chalk,  and  dosed  with  aromatic  seeds  and  pungent  essences  to  "keep 
out  the  wind,"  and  paregoric  or  laudanum,  or  opiate  cordials,  to  quiet 
the  pain  and  irritation  which  the  doctoring  has  produced.  These  doings, 
which  are  almost  universal  in  civilized  society,  indicate  a  stupid  ignor- 
ance or  gross  perversion  of  the  simple  and  efficient  operations  of  na- 
ture, destroy  thousands  uj)on  thousands  of  infants  in  their  cradles,  and 
lay  the  foundation  for  debility,  imperfect  development,  and  '-nnumera- 
ble  diseases  in  those  who  are  so  fortunate  or  unfortunate  as  to  survive 
them. 

The  food  of  the  mother  should  be  essentially  of  the  same  nature  as 
usual,  having  reference,  of  course,  to  the  state  of  the  sj'stem,  amount 
of  exercise,  etc.  The  mother  does  indeed,  to  some  extent,  "eat  for 
two,"  but  the  appetite  will  always  demand  food  enough;  and  it  may  be 
satisfied  short  of  overloading  or  oppressing  the  stomach.  Bread  and 
milk,  or  gruel  with  toasted  bread,  cracked  wheat,  boiled  rice,  etc., 
with  a  moderate  supply  of  ordinary  fruits  and  vegetables,  are  suffi* 


PARTURITION.  47i 


L-iently  watery  for  all  needful  purposes  if  the  milk  be  deficient,  while 
dry  toast,  crackers,  good  bread,  potatoes,  etc.,  are  amply  corrective 
whe-d  the  breasts  are  overburdened  with  this  secretion. 

Accidents  during  the  Lying-in  Period. — The  majority  of  acci- 
dents and  diseases  which  follow  ordinary  labors,  are  artificially  jjro- 
duced,  the  result  of  meddlesome  doctoring  or  bad  nursing.  The  r.ia- 
joriiy  of  medical  wi'iters  on  midwifery  give  directions  for  mannging 
the  pcitient,  which,  if  strictly  followed,  could  hardly  fiil  to  induce  ac- 
tual diseases.  It  is  a  common  practice  to  stimulate  with  wine  or  bran- 
dy, or  camplior  and  carbonate  of  ammonia,  if  the  patient  seems  ex- 
hausted and  chilly  after  parturition  ;  give  opium  if  she  is  restless,  and 
bleed  or  leech  if  she  is  feverish,  aiid  take  blood  even  if  she  is  cold  and 
shivering,  if  the  practitioner  susjyccls  the  siiivering  to  be  the  cold  stage 
of  an  approaching  puerperal  fever.  Thus  is  the  whole  organism 
thrown  into  confusion  and  disorder,  and  called  upon  to  waste  its  pros- 
trated energies  in  resisting  the  effects  of  poisons  at  the  precise  mo- 
ment when  it  needs  the  most  profound  and  undisturbed  repose,  both 
as  regards  external  disturbances  and  internal  irritations.  A  single  ex- 
tract from  a  standard  text-book  will  show  that  I  neither  misrepresent 
nor  exaggerate  in  this  matter. 

Dr.  Huston,  as  quoted  by  Dr.  Condie,  in  Churchill's  Midv/ifery, 
says  :  ''  I  have  seen  more  than  one  instance  in  which  there  v/as  reason 
to  believe  the  life  of  the  patient  was  sacrificed  from  ignorance  of  the 
true  character  of  tlie  condition  here  referred  to  [nervous  shock  or 
exhaustion  after  delivery].  If  the  attention  of  the  practitioner  be  at 
the  time  particularly  directed  to  puerperal  fever,  he  is  liable  to  con- 
found the  exhaustion  in  which  he  finds  the  patient  with  the  early 
stages  of  that  disease.  The  cold  extremities  constitute  the  chill,  while 
the  haggard  countenance,  hurried  respiration,  and  frequent  pulse  are 
regarded  as  conclusive  evidence  of  a  rapid  peritonitis.  Bleeding  iVom 
the  arm  or  by  leeches,  is  the  instant  resort,  und  a  few  short  hours  con- 
firm the  worst  anticipations,  by  the  fatal  lei  .nination,  a  result  which 
the  efforts  of  the  attendant  have  but  too  successfully  aided  in  pro- 
ducing." 

Who  can  fail  to  see  the  "lesson  of  wisdom"  taught  b}'  tl  ese  fata' 
mistakes  ?  Lancets  and  leeches  have  no  business  in  the  lying-in  cham- 
ber ;  and  if  they  were  always  wliere  they  should  be  no  woman  would 
be  kiUed  by  them;  the  doctor  might  err  in  opinion  without  causing  the 
di'iith  of  his  patient.  And  here  I  may  pertinently  state  a  rule  of  uni- 
versal application,  which  doctors,  midwives,  and  nurses  might  often 
revert  to    advantageously  '    Whenever  there   is  serious   doubt  us   to 


1"  I  M  I D  W  I  F  E  R  Y. 


\v!i;it  uuglii  to  be  done  fur  the  patient — du  nolhing — ten  cbnnces  to 
o:ie  lliiit  while  the  doubts  ai'e  being  solved,  nature  will  solve  the  dif- 
(iculty. 

Floo-^ing  sometiraes,  though  rarely,  occurs  several  hours  afier  de- 
livery. It  is  to  be  treated  precisely  as  when  occuiTing  at  any  other 
time. 

The  lochiai  discharge,  or  jioivins,  sometimes  ceases  suddenly,  or  is 
suppressed  by  tiiking  cold,  Dr  by  inflammatory  excitement,  followed  bj 
di^tress  or  swelling  in  the  abdomen,  or  pain  in  the  head,  sense  of  numb- 
ness, coldness,  etc.  The  warm  hip-bath  or  hot  fomentations  are  to  be 
occasionally  employed  untL  the  action  is  re-established. 

Puerperul  fever,  or  periionilis,  is  one  of  the  most  frequent  and  fatal 
diseases  under  old  school  practice  ;  but  I  have  never  known  nor  ireard 
of  it  among  several  hundreds  of  cases  treated  hydropathically.  In 
fact,  I  consider  this  frightful  form  of  fever  an  impossibility  under  judi- 
cious water-treatment.  Medical  authors  distinguish  several  varieties 
or  forms  of  this  disease,  as  acute  puerperal  peritonitis,  adynamic  or 
malignant  puerperal  fever,  puerperal  intestinal  irritation,  false  periton- 
itis, etc. ;  but  they  are  all  merel}'  accidental  modifications  or  difierent 
degrees  of  severity  of  the  same  disease,  which  consists  essentially  in  an 
infiammation  of  the  peritoneal  membrane,  sometimes,  however,  com- 
plicated with  infiammation  of  the  bowels  or  uterus,  and  attended  al- 
ways with  a  violent  but  low  prostrating  fever  of  the  typhoid  tj'pe. 
Among  the  more  prominent  symptoms  are  swelled,  hard,  and  painful 
abdomen,  and  obstinately  constipated  bowels. 

There  is  no  disease  the  pathology  of  which  physicians  confess  them- 
selves more  ignorant  of;  and  certainly  there  is  none  which  has  been 
more  unfortunately  treated  by  the  medical  faculty,  the  deaths  averag- 
ing about  one  in  three  cases. 

The  treatment  is  the  same  as  for  ordinary  inflammation  of  the  bow- 
els :  cold  wet  cloths  to  the  abdomen,  the  pack  or  general  ablution, 
warm  foot-baths,  cold  applications  to  the  head,  and  tepid  injections. 
There  is  no  danger  whatever  in  appl3'ing  cold  wet  cloths  to  the  abdo- 
men in  these  cases:  the  danger  is  in  withholding  them.  I  have 
known  too  many  to  sink  rapidly  under  the  hot  mustard  plaster  and 
tur|)etit!ne  ti-eatment,  not  to  speak  advisedly  on  this  point. 

IiijUnnrnation  of  the  breast,  resulting  in  abscess  or  "broken  breast," 
is  iiniuiig  the  frequent  results  of  the  system  of  living  and  doctoring  we 
oi>pose,  and  among  the  things  unknown  in  hj'dropathic  practice.  Cold 
wet  cloths,  well  covered  with  dry  ones,  and  very  often  renewed,  con- 
stitute the  local  treatment.  When  the  breast  has  a  surplus  quantity 
of  milk   it  may  lie  d^awn  off  with  the  breast-pump,  or  b}'  that  ever- 


INFANT    NURSING.  475 


convenient  suction-pump,  the  human  mouth.  When  the  nipple  is 
malformed  or  deficient,  the  breast-pump  will  often  succeed  in  drav/ing 
it  out. 

It  is  no  uncommon  circumstance  for  a  young  mother,  especially 
with  her  first  child,  to  suffer  horribly  for  three  or  six  months,  or  even 
a  year,  with  this  loathsome  complaint ;  and  yet  it  cfin  never  occur  if 
the  system  is  kept  free  from  obstruction  by  proper  diet  atjd  bathing, 
and  is  not  drugged. 

Sore  nipples  require  nothing  more  th;in  a  little  cream,  olive  oil,  or 
simple  cerate,  with  the  occasional  application  of  cold  wet  cloths  when 
they  are  hot  or  painful,  and  occasional  fomentations  when  they  are 
cracked  and  sore. 

Milk  fever,  which  is  owing  to  an  overheated  or  unventilated  apart- 
ment, oi-  to  heating  food,  drinks,  or  medicines,  usually  appears  about 
the  third  day  after  delivery.  It  is  attended  with  the  ordinary  symp- 
toms of  general  fever,  great  pain  and  throbbing  in  the  head,  and,  un- 
less speedily  relieved,  a  suppression  of  the  secretion  of  milk.  If  the 
patient  is  not  very  weak  or  exhausted,  the  wet-sheet  pack  should  bo 
promptly  resorted  to,  and  repeated  as  often  as  the  general  heat  de- 
mands ;  otherwise,  tepid  ablutions  are  to  be  very  frequently  employed. 

Puerperal  swelled  leg — phlegmasia  clolens — is  yet  another  frequent 
occurrence  in  ordinary  practice,  but  unknown  in  the  Water-Cure  sys- 
tem. This  malady  has  already  been  considered  in  the  chapter  on 
Dropsical  Diseases ;  and  I  need  only  add  in  this  place,  that  the  man- 
agement is  the  same  as  for  local  inflammations  generally:  cold  wet 
cloths,  according  to  the  local  heat,  and  cold  or  tepid  sponging  or  wash- 
ing of  the  whole  body,  according  to  the  degree  of  general  heat. 


CHAPTER  VII. 

INFANT  NURSING. 


Dress  of  IxFANih. — The  first  provision  to  make  for  the  new-born 
infant  is  suitable  clothing.  All  the  usual  bandaging  and  swathing  is  to 
be  rejected,  with  every  other  article  of  apparel  that  in  the  least  con- 
strains its  motions.  After  a  washing  in  tepid  water,  a  soft  rag  should 
be  tied  around  the  remnant  of  the  cord,  and  the  child  dressed  with  the 
diaper,  a  loose  shirt,  a  soft  flannel  petticoat,  and  an  easy  frock.     Od  up 


476  MIDWIFERY. 


account  should  any  thing  be  pinned  or  tied  around  the  abdomen,  of 
any  part  of  the  body,  like  a  belt  or  bandage,  unless  for  some  surgical 
purpose.  J 

Bathing  Infants. — Every  child  should  be  washed  over  the  whole 
surface  daily;  always,  too,  immediately  after  waking  from  sleep,  and 
never  soon  after  eating.  The  water  should  be  of  a  mild  temperature 
at  first — 85°  to  SO^ — and  gradually  reduced  to  70°  or  65°. 

Food  of  Infants. — Greater  errors  are  committed  in  this  depart- 
ment of  infantile  nursing  than  in  any  other,  unless  it  be  in  that  of 
drugging.  Indeed,  I  know  of  no  subject  in  relation  to  which  our 
American  women  are  so  ignorant,  or,  rather,  so  full  of  errors  as  this. 
The  women  of  England  are  far  more  intelligent  in  the  method  of 
rearing  children  healthfully ;  and  the  animadversions  of  some  of  them 
upon  the  foolish  habits  which  prevail  in  this  country,  of  stuffing  and 
gorging  young  children  on  complicated  dishes,  sweet  cakes,  candies, 
and  the  like,  though  very  severe,  are  perfectly  just.  No  American 
mother  could  be  induced  to  feed  her  child  in  the  way  children  are 
generally  fed  in  this  country,  if  she  knew  the  consequences. 

Not  long  since  a  gentleman  and  his  wife,  from  a  neighboring  state, 
were  under  treatment  at  one  of  my  establishments.  A  child  happened 
to  be  present  which  liad  been  thus  far  reared  hydropathically,  and  was 
a  perfect  picture  of  health  and  happiness.  During  a  conversation 
about  this  child,  she  went  to  her  trunk,  and  then  exhibited  the  da- 
guerreotypes of  three  beautiful  children  she  had  lost.  They  were  all 
fine,  healthy  children,  and  grew  hopefully ;  but  alas !  at  two,  three, 
and  four  years  of  age  they  suddenly  died  of  convulsions !  After  in- 
quiring into  her  habits  of  feeding  them,  I  could  only  wonder  how  they 
lived  so  long.  Poor,  childless  mother !  she  still  weeps  for  the  lost 
ones ;  but  I  fear  if  others  are  born  unto  her,  they  will  be  lost  in  the 
same  way,  so  difficult  is  it  to  teach  a  mother  that  her  artificial  appetite 
is  no  guide  to  the  natural  diet  of  a  child. 

The  mother's  milk,  it  is  known,  is  the  appropriate  food  during  the 
first  few  months  ;  but  in  cases  where  the  breast  does  not  yield  a  sup- 
pi}^  at  first,  a  little  sweetened  milk  and  water  is  the  best  substitute. 
It  must  be  remembered  that,  in  the  great  majority  of  cases,  the  breast 
will  yield  the  food  as  soon  as  there  is  any  real  necessity  for  it  on  the 
part  of  the  child.  Nurses  generally  commence  giving  solid  food  too 
soon — as  early  as  the  third  or  fourth  month.  The  first  appea-ance  of 
the  teeth,  about  the  seventh  month,  seems  to  indicate  that  as  the  nat- 
ural period  for  commencing  the  employment  of  solid  food.     It  b  a 


NFANT    N  I'll  SIN  a. 


great  mistake  to  suppose  that  all  the  food  taken  into  the  ten-^er  and 
delicate  stomach  of  the  infont  shoula  be  fine,  concentrated,  divested 
of  all  innutritions  matter,  and  very  nutritious.  It  is,  on  the  contrary, 
even  more  important  for  children  thau  for  adults,  that  the  food  should 
be  unconcentrated  and  unobstructing,  as  well  as  simple  and  uncompli- 
cated. Farina,  corn  starch,  fine  flour,  and  refined  sugar,  are  the  fash- 
ionable materials  for  the  infant  dietary ;  but  a  worse  selection  could 
hardly  be  made.  Graham  flour,  mush,  cracked  wheat,  coarse  Indian 
meal,  hominy,  boiled  j-ice,  brown  bread  soaked  in  milk,  boiled  potatoes, 
stewed  squash  or  pumpkin,  roasted,  baked,  stewed,  or  boiled  apples, 
etc.,  are  the  proper  solid  food  for  infants  from  the  first  moment  that 
tliey  are  able  to  take  any  kind.  This  plan  of  dieting  will  secure  the 
ciiiid  against  dysentery,  cholera  infant nrm,  colics,  gripes,  spasms,  con- 
vulsions, scrofulous  swellings,  skin  diseases,  painful  teething,  etc.,  etc., 
which  annually  sweep  oft'  so  many  thousands  to  their  graves. 

Improper  diet  has  a  vast  deal  to  do  with  making  children  cross,  fi-et- 
ful,  and  ugly-tempered,  as  well  as  dull,  sickly,  and  stupid.  The  most 
healthy  children  may  be  stuffed  so  outrageously  as  to  suffer  continu- 
ally from  cramps,  colics,  and  all  sorts  of  aches  and  pains ;  and  so  feeling 
bad,  will  act  bad,  in  spite  of  good  counsel,  parental  authorit}^  the  nurse's 
lullaby,  or  the  barbarian's  rod. 

The  practice  of  learning  or  forcing  children  to  swallow  flesh-meat, 
before  they  can  properly  masticate  it,  is  deserving  the  severest  repre- 
hension. Scarcely  any  thing,  in  my  humble  judgment,  has  a  more 
injurious  efl'ect  upon  its  body  or  mind  than  this  miserably  foolish  f>»°h- 
ion.  Two  or  three  years  is  early  enough,  and  several  years  later  is 
si  ill  better,  for  any  child  to  first  taste  of  flesh.  But  many  mothers, 
perhaps  the  majority,  stuft'  fet,  grease,  and  flesh  into  their  mouths  be- 
fore they  are  even  weaned.  Such  children  are  always  full  of  foul 
humors,  or  liable  to  severe  inflammatory  or  febrile  diseases  every  time 
they  take  a  little  cold ;  all  of  which  may  be  avoided  by  feeding  the 
child  on  such  plain,  simple,  vegetable  food  as  it  always  relishes,  and 
will  always  be  satisfied  with,  until  its  parents  or  nurses,  in  their  deep, 
dark,  and  pitiable  ignorance,  pervert  and  deprave  its  natural  appetite. 

After  being  weaned,  the  usual  time  of  which  is  at  the  end  of  nine 
or  ten  months,  the  child  should  be  trained  to  regularity  in  the  habit  of 
eating;  never  allowed  to  eat  between  meals,  nor  after  going  to  bed  at 
night,  until  the  next  morning's  breakfast-time. 

The  practice  of  feeding  children  simply  to  amuse  them  or  keep 
them  quiet,  is  also  deserving  severe  reprobation;  yet  it  is  one  of 
the  fashions  of  these  days.  Those  who  travel  much  on  our  raili-oads 
or  steamboats  will,  it  they  are  of  observing  habits,  notice  that  a  large 


478  MIDWIFERY. 

proportion  of  all  the  children  aboard,  from  one  year  old  upward,  have 
their  hands  full  of  candies,  sweet  cakes,  or  some  other  eatable  ;  and 
if  their  observing  habits  are  close,  they  will  also  notice  that  those  same 
children  are  crying,  kicking,  and  yelling  with  teethache,  headache, 
stomachache,  and  bellyache,  a  good  portion  of  the  time.  If  the  moth- 
ers of  those  children  understood  the  connection  between  these  causes 
and  effects,  they  certainly  never  would  be  the  instruments  of  inflicting 
so  much  misery  on  their  little  ones. 

Drink  of  Infants. — Few  words  are  required  here.  Those  chil- 
dren who  are  fed  properly  know  very  little  of  thirst,  unless  it  is  de- 
rived from  the  bad  dietetic  habits  of  the  mother.  Still,  if  thirst  exists 
water  should  be  allowed  ad  libitum  ;  but  the  greatest  care  should  be 
taken  to  provide  perfectly  pure  and  soft  water.  Children  are  more 
injuriously  affected  than  adults  by  impure  or  hard  water.  Salted  or 
greasy  food  provokes  excessive  thirst  in  young  children.  Common 
bakers'  bread  induces  gi-eat  thirst  in  all  children  who  are  principally 
fed  upon  it — a  conclusive  evidence  that  it  is  not  fit  for  them.  Warm 
drinks,  with  which  some  nurses  are  so  fond  of  slopping  children,  after 
provoking  unnatural  thirst  by  unnatural  food  or  seasonings,  tend  to  pro- 
duce diseases  and  debility  of  the  kidneys  and  urinary  organs.  It  is  an 
excellent  practice  to  give  the  child  a  tea-spoonful  of  cold  water  two  or 
three  times  a  day,  independent  of  its  desire  to  drink.  It  soothes  the 
irritability  of  the  gums,  and  lessens  the  inflammation  and  tenderness 
during  dentition. 

Sleep  of  Infants. — Young  infants  are  naturally  disposed  to  sleep  a 
large  proportion  of  the  time — an  instinct  which  may  be  indulged  to  its 
full  extent.  It  is  essential,  however,  to  the  health  and  perfect  develop- 
ment of  the  young  child  that  it  does  not  sleep  with  a  sickly  or  aged 
person ;  and  it  is  preferable  to  have  it  sleep  in  a  crib  or  trundle-bed  by 
itself,  in  all  cases  after  weaning.  The  thorough  ventilation  of  a  child's 
sleeping  apartment  is  even  more  important  than  that  of  the  adult. 
Children  do  not  often  take  cold  from  excess  of  air  while  asleep,  but 
very  frequently  in  consequence  of  sleeping  in  a  hot  or  close  room. 

Exercise  of  Children. — Young  children,  if  healthy,  are  always 
in  motion,  except  when  asleep ;  and  those  mothers  do  them  wTong 
who  try  to  keep  them  still  and  out  of  mischief.  The  true  philosophy 
of  hahyism  is  to  keep  mischief  out  of  their  way,  and  then  let  them 
run.  They  must  exercise  in  play  constantly,  or  be  sick.  A  lazy  or  a 
quiet  child  i^  a  sick  one. 


INFANT    NURSING.  473 


ExcRETiojNS  OF  Lnf^ats. — Notlifiig  caii  exceed  the  absurdity  of 
the  common  practice  of  dosing  a  young  child,  on  every  occasion  of  a 
little  irregularity  of  the  stomach  and  bowels.  In  most  instances  those 
disturbances  are  salutary  efforts  of  nature  to  get  rid  of  surplus,  crude, 
or  irritatmg  matters.  The  conical  shape  of  the  infant's  stomach  ena- 
bles it  to  vomit  with  great  facility ;  and  in  most  cases  the  vomiting  is 
the  result  of  overfeeding,  or  offending  material.  «  In  either  case  it  will 
take  care  of  itself  if  left  to  itself,  and  nothing  put  into  it  but  proper 
food  and  drink  in  proper  quantities. 

The  bowels  are  necessarily  subject  to  some  degi'ee  of  irregularity. 
For  a  few  days  after  birth  the  discharge-s  will  be  dark  and  watery, 
consisting  of  the  fa3cal  matters,  or  meconium,  which  accumulate  in  the 
bowels  during  the  latter  part  of  the  foetal  life,  mixed  with  the  ordinary 
fcecal  excrement  and  secretion  ;  gradually  they  become  more  yellow 
and  of  firmer  consistence.  When  the  teeth  are  pressing  through  the 
gums,  the  bowels  are  always  naturally  prone  to  laxness ;  and  if  the 
irritation  from  teething  is  considerable,  the  looseness  will  amount  to 
diarrhea.  Here  again,  if  w^e  are  not  too  blind,  we  may  see  the  benef- 
icent provision  of  nature  to  remedy  what  seems  to  us  to  be  abnormi 
ties.  If  the  child  is  properly  fed,  no  trouble  need  be  apprehended 
from  this  source — the  bowels  will  take  care  of  themselves.  In  ex- 
treme cases  of  irregularity,  either  of  diarrhea  or  constipatim'i,  no  other 
medication  is  necessary  than  cool  injections,  with  the  wet  abdominal 
bandage  in  the  former  case,  and  tepid  injections,  and  perliaps  a  greater 
proportion  of  fruit,  in  the  latter  ditlficulty.  The  ideas  of  curing  diar- 
rhea in  young  persons  by  astringent  medicines  and  constipating  food, 
and  constipation  by  purgatives,  are  both  exceedingly  mischievous  in 
practice.  Both  complaints  arise  from  irritation  or  debility,  and  health- 
ful action  is  the  proximate  ren.edy  for  both. 

Teething. — The  lax  state  of  the  bowels  lessens,  to  a  considerable 
extent,  the  inflammatory  state  of  the  gums  during  the  protrusion  of 
the  teeth.  The  irritation  can  be  further  allayed  by  occasionally  put- 
ting a  tea-spoonful  of  cold  water  into  the  mouth.  When  the  teeth  are 
about  coming  through,  rubbing  the  swelled  gum  with  the  finger  is  ex- 
tremely soothing;  when  there  is  great  heat  and  tenderness,  a  piece  of 
ice  inclosed  in  a  rag  and  rubbed  on  the  gums  will  alleviate  the  pain. 
Children  often  manifest,  for  a  few  hours,  a  high  constitutional  fever, 
the  result  of  the  local  irritation.  Beware  of  meddling  with  this  fever 
in  the  way  of  drug-medicines,  as  an  inflammation  of  the  bowels  may 
be  the  consequence.  I  protest  also  against  the  common  practice  of 
cutting  or  lancing  the  gums  ci  children.     Serious  evils  oftfc:i  result 


480  MIDWIFERY'. 


from  it,  and  all  the  good  it  promises  can  be  assured  by  the  otht^r  riieaus 
I  have  mentioned. 

Drugging  Im'ANTS. — From  a  little  book  {Essays  on  Infant  Thera- 
peutics), by  the  late  John  B.  Beck,  M.D.,  Professor  of  Materia  Med- 
;ca  and  Medical  Jurisprudence  in  the  College  of  Phj-sicians  and  Sur- 
j^eons  of  the  University  of  the  State  of  New  York ;  Corresponding 
Member  of  the  Royal  Academy  of  Medicine  of  Paris:  Corresponding 
Member  of  the  Medical  Society  of  liondon;  one  of  the  Vice-presi- 
tents  of  the  Academy  of  Medicine  of  New  York,  etc. — these  titles 
f-how  that  this  book  is  one  of  autlu/rity — I  copy  the  following  state- 
ments : 

'^  With  regard  to  the  effects  of  opium  on  young  subjects,  there  are 
•"WO  facts  which  seem  to  be  well  established.  Th.^  first  is,  that  it  acts 
with  much  greater  energy  on  the  infant  than  it  does  on  the  adult ;  the 
fiecond  is,  that  it  is  more  uncertain  in  its  action  on  the  infant  than  the 
«idult.  It  is  in  consequence  of  these  peculiarities  attending  its  opera- 
tion on  the  infant,  that  even  the  smallest  quantities  have  not  unfre- 
quently  produced  the  most  unexpected  and  even  fatal  results."  Of  this, 
almost  every  physician  must  have  seen  some  melancholy  examples. 
Dr.  John  Clarke  states  that  half  a  drachm  of  sirup  of  white  poppies, 
and  also  a  few  drops  of  Dalby's  carminative,  have  proved  fatal  in  a  few 
hours.  Mr.  Marley  knew  a  case  in  which  half  a  small  tea-spoonful  of 
sirup  of  poppies  proved  nearly  fatal,  and  one  case  in  which  thirty-five 
drops  of  Dalby's  carminative  proved  quickly  fatal  to  a  young  child.  Dr. 
Bard  knew  an  infant  of  several  months  old  killed  by  ten  drops  of  laud- 
anum, and  another  nearly  killed  by  less  than  two  diops.  Dr.  Christi- 
Bon  states  that  three  drops  of  laudanum  in  a  chalk  mixture  for  diar- 
rhea, killed  a  stout  child,  fourteen  mouths  old,  in  six  hours.  Dr.  Ry- 
an has  known  one  drop  of  the  "sedative  liquor  of  opium"  narcotize 
an  infant.  Pereira  has  seen  a  powerful  effect  produced  on  an  in- 
fant by  one  drop  of  laudanum.  The  London  Medical  Gazette  states 
that  two  drops  of  laudanum,  and  in  one  case  one  drop,  resulted  in  the 
death  of  the  infant. 

In  the  Southern  Medical  and  Surgical  Journal  for  July,  1849,  the 
following  case  was  reported  by  Di  N.  V.  Woolen,  Loundesboro', 
Alabama:  "A  fine,  healthy  female  child,  in  the  fifth  day  of  its  age,  suf- 
fered from  '  griping,'  as  its  mother  supposed,  for  which  she  adminis- 
tered to  it  one  drop  of  laudanum.  Thirty  minutes  afterward  its  breath- 
ing became  slow  and  stertorous,  and  other  symptoms  of  narcosis  came 
on.  Notwithstanding  every  eflfort  made,  the  child  died  in  eleven  hours 
after." 


INFANT   NU  USING.  431 


If  so  nmuy  children  die  from  the  e fleets  of  buch  small  doses,  how 
ruinous  must  be  its  common  administration  by  ihe  hands  of  nnrsos  on 
any  occasion  when  the  child  is  uneasy,  or  refuses  to  keep  as  still  as 
suits  their  comfort  and  convenience.  It  is  an  ingredient  in  most  of  our 
medicated  candies  and  lozenges^  cough-drops,  sootlfmg  sirups,  cordials, 
carminatives,  nervines,  etc.  Dr.  Beck  says;  "The  effect  is  to  stunt 
the  growth  of  the  child;  it  is  emaciated  and  puny;  the  skin  is  flabb}'- 
and  shriveled  ;  the  lips  are  bloated,  and  the  countenance  sallow  and 
wrinkled.  There  is  an  absence  of  all  intelligence,  and  the  whole  ai)pear- 
ance  is  haggard  and  aged,  presenting  a  sort  of'  miniature  of  old  age.'" 

Now,  as  antimonial  preparations  are  among  the  medicines  which  are 
freely  given  to  children,  and  which  enter  into  a  great  variety  of  fever, 
cough,  emetic,  and  cathartic  mixtures,  and  are  even  one  of  the  med- 
icating ingredients  of  candies,  lozenges,  and  sirups,  it  behooves  the  peo- 
ple to  know  something  about  them.  In  the  work  above  quoted.  Dr. 
Beck  tells  us  that  he  has  known  one  thirtieth  of  a  grain  of  tartar  emet- 
ic endanger  the  life  of  a  child  one  year  old;  and  in  another  case  a  child 
was  killed  by  small  doses  of  the  article.  Dr.  Clarke,  of  London,  states 
that  a  quarter  of  a  grain  of  tartrate  of  antimony  in  solution  has  pro- 
duced the  death  of  a  young  child.  Dr.  Hamilton  testifies  that  alarm- 
ing convulsions  have  followed  its  use.  Mr.  Noble,  of  Manchester,  En- 
gland, and  Mr.  Wilton,  surgeon  to  the  Gloucester  Infirmar}^  re})ort 
sevei'al  cases  of  children  of  one  to  four  years  of  age,  dying  from  taking 
the  common  antimonial  wme  for  ordinary  cojigh  and  cold.  Dr.  Arm- 
strong has  many  times  seen  delirium  produced  in  young  children  by 
very  small  doses  of  antimonial  preparations.  Professor  Schjepf  Merei, 
of  the  Children's  Hospital  in  Pesth,  Germany,  certifies  that  he  has 
known  several  ch:l(h-en  vomited  and  purged  to  death  by  very  small 
doses  of  tartar  emetic.  Dr.  M'Cready,  of  this  city,  reports  a  death 
from  the  article  administered  in  tJie  form  of  Coxe's  hive  sirup. 

Dr.  Beck  says:  "The  vomiting  induced  by  the  preparations  of  anti- 
mony ought  to  be  resorted  to  with  great  caution  in  very  young  chil- 
dren, and  should  never  be  used  except  in  those  cases  where  a  sedative 
effect  is  required,  and  can  be  borne  with  safety."  The  rule  stands 
self-stultified,  for  the  frequent  deaths  resulting  from  its  use  in  the 
hands  of  the  experienced  physician,  show  that  no  medical  man  on 
earth  can  ever  know  that  it  can  be  "  borne  with  safety." 

Mercurial  medicines,  in  a  variety  of  disguised  forms,  are  more  fre- 
quently taken  into  infants'  stomachs  than  most  people  are  aware  of. 
Dr.  Beck  tells  us  that  their  action  is  more  energetic  in  the  infant  than 
the  adult,  and  that  when  salivation  takes  place  its  effects  are  most  dis- 
aslTous.  "Sloughing  of  the  gums  and  cheek,"  says  Dr.  Beck  "gen- 
ii—41 


i82  M  1 1>  •'»'  11"  2  R  r. 

era)  prostratioa  and  death,  are  by  no  maans  unconimou  occurrences." 
Dr.  West  [Diseases  of  Infancy  and  Childhood)  has  known  fatal  g<ni- 
grene  of  the  cheek,  and  necrosis  of  the  jaw,  to  result.  31.  Beding- 
tielJ  states  ( Conipend  of  Practice),  that  he  has  known  the  parotid  glands 
ooih  ulcerated  and  entirely  destroyed  bj  mercurial  action  in  young 
cliildren.  Dr.  Beck  expresses  the  opinion  that  the  practice  of  giving 
calomel  as  an  ordinary  purge  to  children,  because  of  the  facility  with 
which  it  can  be  taken  and  retained,  has  laid  the  foundatian  fo?-  the  ruin 
of  the  constitutions  of  thousands. 

I  could  extend  these  quotations  iudefiniteiy ;  but  my  purpose  is  to 
exhibit  a  reason  why  the  whole  trade  of  drugs  should  be  rejected  from 
the  nursery  at  once  and  forever  ;  and  if  the  testimony  already  presented, 
which  the  reader  will  bear  in  mind  is  all  taken  from  standard  authori- 
ties of  the  school  which,  advocates  the  practice  I  am  opposing,  is  not 
conclusive,  neither  would  people  believe  though  all  their  children 
should  die  under  their  own  eyes.  The  little  good  that  these  oxecrable 
poisons  seent  to  do  in  some  cases,  is  counterbalanced  a  thousand  fold  by 
the  certain  injury.  Besides,  and  more  than  all,  there  is  never — I  say 
emphatically  never — any  necessity  for  their  employment.  There  is  no 
conceivable  disease,  state,  condition,  or  ailment  for  which  there  is  not 
a  surer,  safer,  better  way. 

liSFANTiLE  Diseases. — A  multitude  of  small  books  have  been  WTit- 
ten  on  diseases  of  small  children,  in  most  of  which  the  matter  is  treat- 
ed as  though  it  was  as  natural  for  babies  to  be  sick  as  it  was  to  breatlie. 
Gum  rashes,  gripings,  spasms,  tits,  running  at  the  ears,  thrush,  aprha 
or  canker,  inilamed  gums,  etc.,  are  usually  regarded  by  this  class  of 
writers  as  things  to  be  expected,  and  provided  for  by  keeping  a  due  as- 
sortment of  medicines  on  hand.  I  need  not  waste  time  in  exposing 
the  absurdity  of  all  this,  which  is  self-evident  to  all  who  will  take  the 
trouble  to  think  for  themselves.  The  mother  who  chooses  to  reai*  her 
children  according  to  the  principles  advocated  in  this  work,  will  have 
little  to  do  with  "infantile  diseases."  And  'f  she  chooses  to  ihrow  the 
responsibility  of  the  health  and  well-t^ing  v  f  her  offspring  upon  the 
doctor,  I  can  only  pity  Ih^m,  and  pray  for  her  enlightenment. 


COMPLICATED    LABORS.  483 


CHAPTER  VIII. 

COMPLICATED  LABORS. 

Tedioi  3  OR  Protractld  Labors. — These  result  from  a  variety 
of  causes,  the  principal  of  which  are  debility  of  the  nmscular  fibers  of 
the  uterus;  obliquity  of  the  uterus;  premature  escape  of  the  liquor 
amnii ;  excess  of  the  waters  of  the  amnion  ;  unusual  toughness  of  the 
membranes;  and  rigidity  of  the  os  uteri.  In  nearly  ail  these  cases, 
however,  nature  is  competent  to  accomplish  her  work  without  our  in- 
terference ;  and  our  main  duty  is  therefore  to  exercise  patience,  and 
encourage  the  patient  to  do  the  same.  In  some  few  instances  manual 
and  medical  assistance  may  be  rendered.  When  the  membranes  pro- 
ti-ude  externally  during  several  pains,  they  may  be  ruptured  with  the 
finger,  and  the  waters  discharged,  after  which  the  labor  will  be  rapidly 
finished.  Females  who  have  suffered  nuich  from  leucorrhoea  or  pro- 
lapsus, are  liable  to  a  thickening  of  the  mouth  of  the  w'omb,  rendei-ing 
it  undilatable,  or,  rather,  causing  its  dilatation  to  be  unusually  slow^  and 
painful.  An  occasional  warm  hip-batli  will  materially  add  to  the  com- 
fort of  the  patient. 

Preternatural  Presentations. — The  statistics  of  over  300,000 
cases,  collected  by  various  European  practitioners,  show  that  breech 
presentations  occur  once  in  about  53  cases,  and  footlings  once  in 
about  90  cases.  In  78,027  cases,  1,277  were  breech  presentations; 
1,019  presentfitions  of  the  infei'ior  extremities;  and  in  293  cases  the 
superior  exti'emities  presented.  From  these  data  we  may  see  how 
rarely  is  there  occasion  for  instrumental  or  manual  interference,  even 
under  the  present  disease-producing  habits  of  the  civilized  world. 

In  the  great  majority  of  these  pi-eternatural  presentation?,  the  labor 
can  be  accomplished  by  the  efforts  of  nature  alone.  Those  which 
most  frequently  require  assistance  are  presentations  of  the  superior 
extremities.  The  general  remedy  in  all  these  cases  is  version,  or 
turning,  except  in  cases  of' badly-deformed  pelvis,  or  enlargement,  of 
some  other  deformity  of  the  child,  when  evisceration  may  have  to  he 
resorted  to,  or,  as  a  preventive  rieasure,  premature  labor  induced. 

Operations  in  Midwife ri  — The  operations  in  cc\nplicated  casea 


484  M 1 1>  ^V  1  ^  1^  1'^  '^■ 


o(  midwifery  wliicli  are  considered  as  regalar,  are  turning,  the  induc- 
tion of  premature  labor,  the  lever,  the  forceps,  craniotomj,  and  hy- 
sterotomy. 

Turning,  or  version,  consists,  whatever  may  be  the  part  presenting, 
in  bringing  forward  the  feet,  this  converting  the  case  into  a  footling. 
The  stati:^tics  of  English,  French,  and  German  practice  together  show 
that  the  operation  has  been  performed  once  in  about  120  cases.  In 
English  jiractice  alone  it  was  performed  but  once  in  over  250  cases.  It 
is  sometimes  resorted  to  in  cases  of  convulsions,  flooding,  prolapsed  cord, 
etc.,  in  order  to  terminate  the  labor  sooner.  It  is  generally  proper 
and  often  indispensable  in  presentations  of  the  superior  extremities  or 
trunk,  and  in  presentations  of  the  placenta,  which  are  attended  with 
alaruiing  flooding. 

In  performing  this  operation,  the  hand  is  inti'oduced  very  gradu- 
ally during  the  intervals  of  the  pains,  the  Angers  being  kept  in  a  con- 
ical form,  following  the  curve  of  the  pelvic  passage,  until  the  fingers 
and  hand  are  gently  insinuated  through  the  os  uteri,  and  through  the 
membranes,  if  they  have  not  been  ruptured.  If  the  shoulder  ])reseut, 
it  can  then  be  pushed  upward,  and  the  head  brought  down  to  the 
oblique  diameter  of  the  brim  of  the  peivis,  and  the  labor  thus  left  to 
the  eiForts  of  nature.  If  the  case  is  an  arm  presenfcition,  the  hand  is 
to  be  passed  along  the  arm  until  it  reaches  the  body,  then  passed  over 
the  front  of  the  chest  and  abdomen  to  the  feet.  After  one  or  both 
lower  extremities  are  reached,  the  feet  are  to  be  brought,  with  a  gen- 
tle, Waving  motion,  to  the  pelvis,  during  the  intervals  of  the  pains,  which 
accomplishes  the  turning;  after  which  the  labor  is  finished  as  an  orig- 
inal footling  presentation.  The  feet,  in  turning,  are  to  be  brought  over 
ihe  front  of  tlie  child,  and  as  the  feet  are  drawm  down,  the  misplaced 
hand  or  arm  will  ascend.  The  labor  will  then  be  concluded  without 
further  assistance  in  most  cases;  but  if  the  patient  be  in  a  state  of  ex- 
treme exhaustion,  it  is  proper  to  exert  a  moderate  extracting  force  upon 
the  feet  during  the  jmins. 

The  proper  time  for  commencing  the  process  is  as  soon  after  a  suf- 
ficient dilatation  of  the  os  uteri  as  possible.  As  preparatory  measures, 
the  bladder  and  rectum  should  ahvays  be  emptied.  Madame  Bouvin 
performed  this  operation  218  times,  with  a  loss  of  48  children. 

Premature  labor  may  be  justifiably  induced  in  such  known  deformi- 
ties of  the  pelvis  as  will  not  admit  of  the  delivery  of  the  child  at  the 
full  period.  The  operation  has  been  very  rarely  underfciken  by  regu- 
lar physicians  in  any  country;  and  the  results,  as  ffir  as  statistics  have 
been  gatliered,  show  that  about  half  the  children  survive,  while  the 
mortality  of  the  mothers  is  about  one   death  in  ten  cases.     No  less 


• 
COMPLICATED    LAB  OKS.  4fej 


Oian  six  different  methods  of  exciting  prematurely  tke  uterine  co!i- 
tnictions  have  been  advocated,  the  most  effective  of  which  are  punc- 
turing the  membranes,  or  niechanica!  dilatation  of  the  os  uteri.  Uter- 
ine action  usually  cc  nes  on  in  one,  two,  tln-ee,  or  four  days,  and  the 
patient  requires  the  same  management  as  in  ordinary  labors. 

The  lever,  or  vecLis,  is  not  frequently  employed  in  midwifery,  yet, 
more  frequently  than  it  should  be.  Its  first  introduction  into  practice 
was  "ha'led  as  a  discovery  calculated  to  confer  immense  benefit  upon 
the  human  race ;"  but,  like  many  other  pretentious  afi\iirs,  its  reputa- 
tion soon  began  to  wane.  Its  use  is  said  to  be,  "  to  correct  malposi- 
tions, or  aid  the  natural  motions  of  the  head  at  the  brim  or  in  the  cavity 
of  the  pelvis."  My  own  opinion  of  the  insti'ument  is,  tliat  it  ought  to 
be.  excluded  from  midwifery  practice  altogether. 

The  forceps  is  employed  rather  frequently,  and  has  been  in  use 
about  two  centuries.  It  is  undoubtedly  a  valuable  contrivance  for  cer- 
tain morbid  conditions  and  abnormities.  Its  object  is  to  grasp  and  coju- 
press  the  head  of  the  child,  and  it  can  be  then  used  as  a  lever  or  ex- 
tractor. Authors  specify  a  great  variety  of  conditions  and  circumstances 
to  which  they  are  applicable;  but  in  my  judgment  their  proper  em- 
ployment is  Umited  to  cases  in  which  uterine  contractions  fail  from  ab- 
solute exhaustion  of  the  patient;  in  cases  of  convulsions,  hemorrhage, 
or  rupture  of  the  uterus,  demanding  an  immediate  conclusion  of  the 
.abor,  in  order  to  save  the  life  of  the  patient;  and  in  cases  of  breech 
presentation,  when  the  head  is  retained  a  long  time  from  incompressi- 
biiity  of  the  base  of  the  skull.  In  Dublin,  Dr.  Clarke  used  the  forceps 
once  in  728  labors ;  in  Paris,  Madame  Lachapeile  once  in  293  labors ; 
in  Berlin,  Dr.  Kluge  once  in  16  labors  ;  and  Dr.  Siebold,  of  Berlin, 
used  them  once  in  7  labors.  These  figures  show  that  they  are  em- 
ployed more  according  to  the  fancy  of  the  practitioners,  than  from  the 
real  necessities  of  the  cases. 

Craniotomy,  which  consists  in  opening  the  head  of  the  child,  and 
evacuating  the  contents  of  the  cranium,  is  employed  when  there  is  too 
great  disproportion  between  the  size  of  the  foetal  head  and  the  pelvis 
to  permit  the  passage  of  the  former,  as  in  the  case  of  deformed  pelvis  or 
dropsy  of  the  head;  also,  when  the  child  has  been  dead  for  some  time 
without  the  labor  progressing;  also,  when,  from  disease  or  accident, 
the  head  has  been  separated  from  the  body ;  and,  finally,  when  the 
passage  is  obstructed  by  immovable  tumors. 

There  is  another  complication  which  requires  this  operation  as  tho 
only  chance  for  the  mother;  and  although  I  do  not  find  a  similar  case 
mentioned  in  any  of  the  books,  an  instance  occurred  a  few  years  ago  in 
my  own  practice.     T'  was  a  case  of  twins,  one  of  which  was  a  foot, 


48C  MlDWIFEllY 


and  tlio  other  a  head  presenration.  The  difficulty  consisted  in  the 
lieads,  both  of  which  were  small,  being  locked  in  .he  pelvic  cavity;  the 
head  of  the  footling  remaining  fastened  hack  ofxhe  head  of  the  other 
I  ilid  not  see  the  patient  until  the  lalx^r  was  too  far  advanced  to  remedy 
the  malpositions,  and  hence  was  obliged  to  eviscerate  both  heads  belore 
cither  could  advance. 

From  the  statistics  of  over  three  hundred  tnousand  cases,  it  appears 
that  this  operation  has  been  resorted  to  once  in  about  eight  hundred  la- 
bors. Of  course,  in  those  cases  where  the  child  is  not  dead,  the  opera- 
tion contemplates  a  sacritice  of  its  life  to  save  that  of  the  mother ;  as, 
othenvise,  both  would  inevitably  perish 

A  great  variety  of  instruments  have  been  invented  for  this  operation 
^\\&  perfurator  is  commonly  employed  to  open  the  cranium,  and  then 
the  crotchety  or  cranial  hook,  to  extract  the  foetus.  A  pair  of  long-point- 
ed scissors,  or  a  scalpel  with  the  edge  wound  to  very  near  the  point, 
will  answer.  The  principal  point  of  skill  consists  in  keeping  the  point 
of  the  instrument  exactly  in  position  during  the  operation,  and  avoiding 
injury  to  the  surrounding  parts.  When  the  os  uteri  is  well  dilated,  the 
fingers  may  be  employed  as  tractors  more  advantageously  than  any 
other  instrument. 

Embryotomy  is  a  modification  of  craniotom}' ;  it  consists  in  dissecting 
the  trunk  and  limbs,  and  bringing  the  foetus  away  in  fragments,  in  those 
cases  of  cross  presentations  of  the  trunk  or  superioi-  extremities  in  which 
the  body  is  immovably  fixed  in  the  cavity  of  the  pelvis,  and  in  cases  of 
deformities  or  monstrosities  of  the  foetus. 

Hysterotomy,  or  the  Ccesu-  sa7i  section — as  it  is  called  after  Claudius 
Ca3sar,  who  lias  the  rej)utation  of  being  the  first  who  came  into  the 
world  in  this  way — consists  in  making  an  incision  through  the  abdom- 
inal walls  and  the  utei'us,  renjoving  the  foetus  and  placenta,  and  then 
dressing  the  external  wound  by  sutures  and  adhesive  plaster.  It  is  the 
dernier  resort,  and  only  justifiable  \vhen  distortion  or  obstructions  ren- 
der all  other  methods  unavailable.  In  British  and  American  practice 
nither  more  than  ha.f  ■:he  mothers  operated  upon  have  been  lost. 

Symphyseotomy,  or  a  division  of  the  bones  at  the  symphisis  pubis, 
was  proposed  as  a  substitute  for  the  Caesarean  operation  by  Sigault, 
who  evperimented  in  this  way  at  Paris  in  1777;  and  notwithstanding 
lie  was  voted  a  medal  and  a  pension,  the  operation  soon  fell  into  disre- 
pute, for  the  very  good  reason  assigned  by  Dr.  Hull,  •'  every  operation 
had  its  victim."  I  am  not  aware  that  any  among  the  living  authors 
justify  the  operation  under  any  circumstances. 

Face  Puesentatios  —The  face  may  present  in  either  of  two  po« 


COMPLIC  ATED    LABORS.  48; 


Bitrons,  as  the  forehead  is  toward  the  riglit  or  loft  acetabulum.  Tim 
presenting  part  is  known  by  the  general  inequalities  of  the  surfoce,  or 
by  the  recognition  of  distinctive  parts,  as  the  eyes,  nose,  mouth,  or  chin. 
After  the  labor  is  somewhat  advanced,  a  swelling  of  the  face  may  make 
it  liable  to  oe  mistaken  for  a  breech  presentation.  The  bridge  of  the 
nose  is  here  the  best  guide,  presenting,  as  it  does,  a  firm,  sharp  promi- 
nence unlike  any  other  part. 

These  cases  do  not  necessarily  require  assistance.  The  labor  is 
more  prolonged  and  tedious,  and  the  child's  head  is  often  considerably 
bruised  and  tumefied,  but  seldom  dangeroush'  so.  Patience  is  here  the 
best  doctor.  The  tables  collected  in  the  books  show  that  this  form  of 
presentation  occurs  once  in  two  or  three  hundred  cases. 

Breech  Presentations. — In  all  these  cases,  as  the  child  enters  the 
cavity  of  the  pelvis,  its  back  is  turned  either  anterioi-ly  or  posteriorly 
toward  the  symphisis  pubis  or  sacrum.  They  occur,  on  an  average,  as 
appears  from  the  statistical  data,  once  in  fifty  or  sixty  cases.  They 
may  be  distinguished  from  shoulder  presentations  by  the  movable  coc- 
cyx. The  labor  is  not  as  tedious  as  in  the  preceding  presentation,  and 
IS  rarely  dangerous  to  the  mother,  although  it  is  hazardous  to  the  child, 
more  than  one  fourth  of  those  born  in  this  way  having  been  lost.  The 
duty  of  the  midwife  or  attendant  in  these  cases  is  well  stated  by  Dr. 
Churchill:  "As  to  the  actual  management,  the  less  interference  the 
better  for  the  patient."  Dr.  Collins,  another  experienced  practitioner, 
remarks  to  the  sanie  effect:  "The  most  common  and  djingerous  error 
committed  by  the  medical  attendant  arises  from  ofificious  and  injudi 
cious  attempts  to  hasten  or  assist  during  the  early  stages  of  labor,  thar. 
which  we  could  not  well  adopt  a  more  hazardous  course." 

Foot  and  Knee  Presentations. — Experience  shows  that  the  in- 
ferior extremities  present  but  once  in  about  a  hundred  cases.  The 
mortality  among  children  has  been  somewhat  greater  than  in  bi-eech 
presentations,  akliough  the  danger  to  the  mother  is  no  more.  When 
the  feet  present,  the  toes  may  point  forward  or  backward,  and  one  or 
both  feet  may  be  advanced.  In  knee  presentations,  this  i)Hi-t  is  lial)lc  to 
be  mistaken  for  the  elbow;  it  may  be  distinguished  by  ifs  two  promi- 
nences, with  a  depression  between  them. 

In  these  cases,  according  to  the  admissions  of  the  most  experienced 
writers,  it  is  even  more  important  that  the  labor  be  let  alone  or  left  to 
Uselt  than  in  either  of  the  preceding  varieties  of  malposition. 

Presentation  oi  the  Suferiok  Extremities.— In  near'y -ili 'jf 


488  MIDWIFE  K  Y. 


these  cases  the  shoulder  is  the  part  primarily  presenting,  but  afterward 
the  arm  prolapses  ;  the  back  of  the  child  may  be  turned  toward  the  ab- 
domen or  spine  of  the  uiother.  the  former  being  the  most  common  oc- 
currence. In  some  of  the  instances  of  this  presentation  the  kbor  lias 
been  accomplished  without  assistance,  but  in  others  this  is  impractica- 
ble. Its  frequency  has  been  one  Ciise  in  two  or  three  hundred.  Irs 
danger  may  be  judged  of  by  the  facts  that,  of  the  cases  recorded, 
i-ather  more  than  one  half  of  the  children  were  lojt.  and  one  in  nine  of 
the  mothers.  The  diagnosis  is  difficult  or  impossible  iu  the  early  stiges. 
When  the  bag  of  the  membranes  proti'udes  in  a  conical  or  elongated 
form  without  inclosing  the  head,  a  suspicion  may  be  justly  entertained  ; 
and  after  the  labor  has  progiessed  somewhat  the  axilla  may  be  found, 
which,  with  the  round  prorainence  of  the  shoulder,  will  convert  the 
suspicion  into  certainty. 

Turning  is  the  proper  resort  in  all  these  cases,  and  the  best  time  to 
commence  tiie  operation  is,  as  soon  as  the  os  uteri  is  as  fully  dilated  us 
possible.  There  is  no  danger  in  waiting  so  long  as  the  liquor  amnii 
has  not  escaped ;  nor  is  there  much  difficulty  in  turning  in  this  case  ; 
but  the  difficulty  is  greatly  increased  afterward  by  the  firm  and  more 
constant  contractions  of  the  uterus.  If  the  conti-actioiis  aie  intense, 
turning  will  be  impossible,  and  the  attempt  tlien  would  endanger  the 
rupture  of  the  uterus.  In  this  case  the  whole  abdomen  should  be  Ib- 
meuted  with  warm  wet  clothes  to  relax  the  muscular  system  and 
lessen  the  contractions;  and  the  patient  should  drink  warm  water  to 
the  extent  of  nausea  to  aid  iu  suspending  the  pains,  after  which  the 
operation  may  be  undertaken.  Should  all  these  measures  fail,  an*.^ 
turning  prove  impracticable,  the  only  remedy  is  evisceration  of  the 
thorax. 

CoMPOU-ND  Presentations. — In  some  rare  cases,  the  liand  or 
arm  presents  with  the  head,  rendering  the  labor  more  difficult,  rut  not 
necessarily  dangerous.  If  discovered  early,  the  arm  may  be  leplaced 
above  the  head ;  but  great  care  must  be  taken  not  to  draw  down  the 
arm,  as  this  procedure  would  convert  the  case  into  an  arm  j^resenta- 
tion.  If  the  replacement  is  notpracticnble  it  must  be  treated  as  an  or- 
dinary labor. 

The  feet  and  hands  may  present  together,  or  one  of  each,  attended 
usually  with  prohijisus  of  the  cord.  As  the  labor  progresses,  one  or 
the  other  extremity  will  descend,  converting  it  into  a  footling  or  an  arm 
presentation.  Bj  dniwing  down  the  feet,  the  most  favorable  position 
b  secured:  and  this,  if  done  gently  and  skillfully,  can  always  be  done 
safely ;  the  attendant  should  bo  especially  careful  not  to  mistake  a  hand 


COMPLICATED    LABORS  48t 

for  a  foot,  nor  in  any  way  maneuver  so  as  to  fiivor  the  descent  of  the 
hand  or  arm. 

Plural  Births. — The  signs  which  denote  twin  pregnancy  are  ex- 
tremely dubious.  Each  child  has  a  separate  placenta,  and  its  special 
envelopes,  and  both  are  almost  always  .'smaller  than  usual.  The  labor 
may  be  in  all  respects  natural  in  relation  to  both,  or  preternatural:  or 
one  may  present  a  natural  and  the  other  an  abnormal  labor.  Hence 
all  the  directions  mentioned  for  single  labors  are  applicable  to  twins. 
triplets,  etc.  As  many  as  five  children  have  been  born  at  one  time, 
and  four  have  been  born  alive.  Statistics  make  the  proportion  of  twins 
lis  rather  above  one  in  a  hundred;  and  of  triplets,  one  case  in  five  or 
six  thousand. 

After  the  birth  of  the  tirst  child  there  is  an  interval  of  rest,  vai-yiug 
from  a  few  minutes  to  sevenil  hours ;  in  some  instances,  several  weeks 
have  intervened  between  the  birth  of  the  first  and  second  child.  In 
the  majority  of  cases,  however,  the  expulsive  efforts  of  the  uterus  are 
resumed  in  less  than  half  an  hour.  If  the  placenta  of  the  first  child  is 
not  easily  removable,  it  should  be  lett  until  after  tlie  delivery  of  the 
second  one :  and  the  same  rule  applies  to  triplet  and  quadruplet  cases. 

MoxsTERS. — In  all  of  these  cases  there  is  excessive  or  defective  de- 
velopment of  some  part  or  parts  of  the  foetus,  or  two  foetuses  are  con- 
joined. The  only  practical  point  relates  to  the  obstacle  which  their 
bulk  furnishes  to  the  accomplishment  of  the  labor;  and  here,  when  the 
deformity  or  monstrosity  is  too  great  to  allow  its  passage,  embryotomy 
is  the  necessary  and  only  resort.  In  some  cases  of  double  monsters, 
as  the  Siamese  twins,  both  have  been  born  alive.  The  principal  dis- 
eases which  produce  such  morbid  enlargements  as  to  render  the  child 
disjjroportionate  to  the  natural  passages  are,  dropsy  of  the  belly,  and 
dropsy  of  the  head — ascites  and  hj/drocejyhalus.  In  the  former  cases, 
after  the  expulsion  of  the  head,  it  will  readily  bo  discovered  that  the 
distention  of  the  abdomen  prevents  the  delivery  of  the  body:  and  in  the 
latter  case  the  head  is  presented  at  the  brim  of  the  pelvis  of  unusual 
size  and  nearly  incompressible ;  and,  notwithstanding  strong  uterine 
contractions,  or  "good  pains,"  the  head  does  not  descend  into  the  pel- 
vic cavity.  In  either  case  the  child  is  either  dead  or  in  a  dying  condi- 
tion ;  there  need  be  no  hesitancy  in  eviscerating  or  puncturing  the  ab- 
domen or  the  head.  In  footling  cases  of  hydrocephalus,  the  head  is  to 
be  perforated  behind  the  ears. 

Prolapsed  Corp. — The  umb'^-'^al  cord  may  protrude  alone,  or  with 


490  MIDWIFERY. 


the  presenring  part,  either  at  the  commeucement  or  during  the  course 
of  labor.  This  accident  has  no  influence  on  the  labor,  but  endangers 
the  child,  by  obstructing  the  circulation  of  the  cord.  Statistics  indicate 
its  occurrence  once  in  about  two  hundred  and  fifty  cases,  with  the  loss 
of  about  half  the  children.  A  gi-eat  variety  of  plans  have  been  suggest- 
ed, and  many  of  them  tried  to  remedy  this  difficulty ;  but  some  of  them 
are  hazardous  to  both  inother  and  child,  and  all  uncertain  ;  my  own 
opimon  is  decidedly  in  favor  of  the  let-alone  practice  in  preference  to 
any  thing  yet  proposed.  In  this  way  the  mother's  life  will  never  be 
endangered,  whily  the  chances  for  the  child  are  scarcely  lessened. 

Retained  Placenta. — Obstetricians  differ  as  to  the  time  a  re- 
rained  placenta  should  be  left  to  the  efforts  of  nature  before  proceeding 
to  exti-act  it  by  force.  Some  are  for  waiting  onl}' an  hour;  others 
several  hours ;  and  others  still  oppose  its  forcible  extraction  at  any 
time  except  when  hemorrhage  attends.  It  is  certain  that  it  will  slough 
off  and  be  expelled  sooner  or  later,  but  practitioners  have  generally  ap- 
prehended dangerous  inflammation.  Under  the  ordinary  practice, 
there  is  very  great  danger  in  this  respect ;  but  with  a  more  rational 
philosophy,  and  more  efficient  appliances  to  keep  down  inflammation, 
the  hydropath  can  justly  exercise  greater  hope  in  his  own  resources, 
as  well  as  greater  faith  in  nature. 

The  irregular  contraction,  or  "hour-glass  contraction"  of  the  uterus, 
by  which  the  placenta  is  retained,  has  been  noticed  frequently  to  follow 
the  use  of  ergot,  and  sometimes  the  employment  of  instruments. 

Hemorrhage. — Flooding,  accompanying  labor  abortion,  has  already 
been  considered.  During  the  last  month  of  gestation,  at  the  com- 
mencement of  labor,  two  forms  of  hemorrhage  are  liable  to  occur  ;  one 
is  called  accidental  because  it  arises  from  an  accidental  and  partial  sep 
aration  of  the  placenta  while  occupying  its  usual  situation;  tlie  other  it 
termed  unavoidable^  because  the  placenta  is  placed  over  the  os  uteri 
and  unavoidably  separated  as  the  dilatation  progresses.  Hemorrhage 
from  these  sources,  according  to  the  statistics,  occurs  once  in  about  one 
hundred  and  fifty  cases.  In  the  first  variety,  the  discharge  occurs  only 
between  the  pains ;  whereas,  in  the  second  variety,  it  is  increased 
durin<i  the  fains,  yet  continues  also  during  their  intervals. 

When  the  hemorrhage  occurs  before  expulsive  contraction  takes 
place  in  the  uterus,  the  ordinary  measures  to  correct  it  should  be  re- 
sorted to,  as  the  liorizontal  posture,  a  cool  room,  hard  bed,  cold  water- 
drinking,  and  cold  enemata,  to  which  may  be  added,  in  severe  cases, 
the  tampon  of  two  silk  handkerchiefs.     When  the  full  term  of  gesta- 


COMPLICATED    LABOIIS.  401 


tion  has  arrived,  and  actual  labor  pains  have  coinir.enced,  the  operation 
of  turning  should  be  resorted  to  as  soon  as  the  os  uteri  is  sufficiently 
dilated,  providing  the  hemorrhage  continues  dangerously  alarming. 

Convulsions, — Convulsions  of  the  hysteric,  epilejHk,  or  apojnedic 
character,  are  among  the  incidents  of  complex  labors  noticed  by  au- 
thors. They  may  occur  previous  to,  during,  or  after  parturition. 
Epileptic  convulsions  are  much  more  frequent  than  either  of  the  other 
kinds;  and  among  all  the  cases  recorded,  only  one  in  about  six  hun- 
dred have  been  affected  with  either  kind.  When  the  fits  occur  during 
labor,  the  uterine  contractions  are  seldom  interrupted  by  them. 

Writers  on  midwifery  are  very  contradictory  as  to  the  proper  treat- 
ment to  be  pursued  in  these  cases.  The  majority  insist  on  large  and 
repeated  bleedings  and  strong  purgatives ;  others  add  to  this  leeches, 
cupping,  and  blisters;  and  others  add  to  them  all  opium  and  tartar 
emetic.  Dr.  Huston  testifies  that  he  tried  the  bleeding  practice  in 
one  case,  and  the  patient  had  a  tedious  recovery.  In  the  next  case, 
he  tried  an  exactly  opposite  method — gentle  stimulants — and  the  pa- 
tient did  much  better.  His  experience  strikingly  illustrates  the  benefit 
of  "  choosing  the  least  of  two  evils." 

The  general  plan  of  treatment  for  these  fits  is  precisely  the  same 
as  when  they  occur  at  other  times :  warm  hip  and  foot  baths,  cold  ap- 
plications to  the  head,  etc. 

Puerperal  Mania. — Temporary  delirium,  or  mania,  often  accom- 
panies the  latter  stage  of  labor.  It  is  manifested  by  incoherence  of 
language,  and  appears  to  be  occasioned  by  the  extreme  suffering  ex- 
perienced at  that  time  by  very  irritable  and  nervous  females.  It  gen- 
erally passes  off  as  soon  as  the  labor  is  finished,  and  the  patient  has 
become  partially  composed.  In  some  cases  it  results  from  an  accidental 
suppression  of  the  lochial  discharge ;  and  occasionally  it  seems  to  re- 
sult from  the  irritation  attending  the  lacteal  secretion.  As  it  is  always 
pymptomatic,  attention  is  only  required  to  the  primary  difficulty. 

Lacerations. — Rupture  of  the  uterus,  or  vagina,  and  lacerations 
of  the  perineum,  are  fortunately  among  the  extremely  rare  complica- 
tions. They  may  result  from  disease  of  the  parts,  producing  a  soften- 
ing of  the  structures  or  obstruction  of  the  j;assages,  from  the  inju- 
dicious use  of  instruments,  or  improper  interference  with  natural 
labors.  It  is  only  necessary  to  say,  in  relation  to  all  these  accidents, 
tliat  they  require  the  attention  of  the  experienced  surgeon. 


492  MIDWIFERY 


LwERSior?. — An  inversion  of  the  uterus  may  result  from  a  forced 
or  too  quick  delivery,  pulling  upon  the  umbilical  cord,  preternatural  at- 
tachment of  the  placenta  to  its  fundus,  ov  a  tumor  adherent  to  its  fun- 
dus. It  is  denoted  by  the  external  protrusion,  and  the  absence  of  the 
contracted  uterus  in  the  lower  part  of  the  abdomen.  There  is  gene- 
rally considerable  hemorrhage,  and  the  patient  always  becomes  sud- 
denly deadly  pale,  faint,  and  sick  at  the  stomach ;  the  voice  is  weak, 
the  pulse  rapid  and  fluttering,  and  immediate  dissolution  som.etimes 
takes  place. 

In  all  cases,  whether  the  inversion  be  partial  or  comj)lete,  its  reduc- 
tion should  be  attempted  at  once,  by  pressing  the  proti'uded  portion 
gently,  but  firmly,  up  through  the  vaginal  passage.  Its  complete  re- 
placement will  be  known  by  its  suddenly  springing  from  the  hand, 
after  it  has  been  nearly  restored  to  its  position. 

When  the  placenta  is  still  attached  to  the  uterus,  authors  are  divided 
in  opinion  whether  it  should  be  removed  prior  or  subsequent  to  the 
replacement.  The  best  rule  appears  to  me  to  be  this  :  if  the  attempt 
can  be  made  immediately  after  the  accident,  not  to  wait  to  remove  the 
placenta;  but  if  a  considerable  time  has  elapsed,  the  contraction  will 
probably  make  its  removal  indispensable  to  success,  so  that  the  safer 
c»y  is  then  to  remore  it  before  any  attempt  at  reduction. 


APPENDIX.  49g 


APPENDIX 


Thr  following  paragraph,  having  been  accidentally  omitted  in  it8  proper  place,  must 
forra  an  appendix  to,  and  the  conclusion  of  this  work : 

Theory  of  Cokception.— The  researches  of  naturalists  and  physiologists  during  the 
last  hundred  years,  together  with  extensive  observations  and  experiments  which  have 
recently  been  made,  in  relation  to  the  reproductive  function,  have  established  a  fact  of 
immense  importance  to  physiological  improvement  and  human  happiness.     It  has  beea 
demonsU-ated  that  procreation  in  the  human  animal  is  effected — as  in  all  roaramifers,  as 
well  as  with  birds  and  reptiles — by  the  development  of  germs,  ovules,  or  eggs  in  the 
female,  and  their  fecundation  by  the  male.    These  ovules  are  formed  in  the  ovaries,  and 
are  passed  to  the  uterus,  and  thence  expelled  independently  of  fecundation  or  sexual 
intercourse.     During  each  menstrual  period  an  ova  is  transmitted  to  the  uterus,  where 
it  remains  several  days,  varying  in  time  usually  from  one  to  two  weeks,  though,  in  a 
majority  of  cases,  it  is  passed  off  between  seven  and  twelve  days.     But  if,  before  its  ex- 
pulsion, it  become  impregnated  by  sexual  connection,  it  remains  and  becomes  the  em- 
bryon  of  the  future  being.     Now,  a  knowledge  of  this  law  of  conception  places  the 
existence  of  offspring,  and  the  future  population  of  the  earth,  entirely  within  the  con- 
trol of  the  will,  reason,  and  judgment,  instead  of  leaving  them,  as  heretofore,  at  the 
mercy  of  a  blind  impulse  or  merciless  passion.     A  thousand  reasons  will  occur  to  any 
reflecting  mind  why,  in  certain  places  and  under  certain  circumstances,  a  less  numer- 
ous but  better  quality  of  infantile  population  is  desirable.     There  are  also  thousands  of 
married  persons  in  the  world,  whcse  circumstances  of  extreme  indigence  render  many 
children  a  source  of  regret  to  the  parents  and  misery  to  the  offspring ;  and,  again,  there 
are  thousands  of  infirm,  crippled,  deformed,  imbecile,  or  incurably  diseased  persons, 
livhig  in  the  matrimonial  relation,  who  are  capable  of  propagating  an  inferior  race,  but 
who  ought  not  to  be  cursing  and  cursed  with  offspring  at  all;  and,  lastly,  under  the 
forcing,  stimulating,  disorderly  physiological  habits  of  the  vast  majority  of  civilized  peo- 
ple, there  is  a  tendency  to  numerical  increase,  with  corresponding  imperfection  of  off- 
spring.    Against  all  these  accidents  and  incidents,  a  knowledge  of  the   origin   of  liCo 
affords  us  the  remedy.     And  who  shall  say  that  a  knowledge  of  the  origin  of  life  is  not 
as  legitimately  to  be  sought  and  understood  as  a  knowledge  of  the  growth,  development, 
education,  and  preservation  of  it?     It  is  true  that,  in  some  few  instances,  the  ova  is  ex 
palled  in  two  or  three  days  alter  the  cessation  of  menstruation  ;  and  in  seme  rare  case* 
42 


i'M  APFEKDiX. 

It  does  not  pass  off  until  after  the  twelfth  dnv ;  but  these  are  only  exceptions  to  a  gena- 
ral  rule ;  and  as  impregnation  can  only  occur,  as  a  general  rule,  between  the  commence' 
mcnt  of  the  menstrual  excitement  and  twelve  days  after  its  cessation,  those  who  womld 
not  propajrnte  have  only  to  abstain  from  sexual  connection  during  tliis  period.  I  ana 
aware  thut  some  may  object,  as  others  have  objected,  to  enlightening  the  general  mind 
on  this  matter  ;  that  many  persons,  dreading  the  cares,  expenses,  trials,  etc.,  of  a  family 
will  abuse  the  privilege  it  confers,  and  refuse  to  bear  their  share  of  the  burdens  of 
furnishinff  the  world  with  inhabitants,  and  the  state  with  taxable  citizens  and  numbers 
for  the  census.  But  I  have  no  sympathy  with  the  advocate  for  ignorance  in  relation  to 
this  or  any  other  physiological  law  ordained  for  man's  government.  If  God  has  mads 
the  law,  it  is  man's  privilege  to  learn  it,  and  his  duty  to  obey  it ;  and,  further,  if  there 
arc  such  persons  in  existence  as  the  objection  supposes,  the^  are  themselves  the  Btronff- 
e*t  argument  I  can  adduce  in  favor  cf  my  position.     Thcp  s^i.^d  never  be  pju-eniB. 


:n^ex. 


Page 

Abdomen,  vol.  i..   213 

Abdomen,  dropsy  o^  ii..  "256 
Abdominal  wrapper,  ii. .     53 

Ablution,  i 378 

Abortion,  ii 458 

Absence  of  mind,  ii 278 

Absorption,  i 270 

Abstemious  diet,  i 444 

Abstraction,  mental,  ii.  .  278 

Abscesses,  ii 365 

Abyssinian  baths,  i 41 

Accidents,  lying-in,  ii.  . .  473 

Acid  poisons,  ii 312 

Acids,  i 339 

Acidulous  drinks,  i 314 

Acrid  poisons,  ii 323 

Acrotismus,  ii 229 

Adhesive  plaster,  ii 326 

^sculapius,  i 11 

Aetius,  i 18 

Affusion-bath,  ii 41 

After-birth,  ii 471 

A  gue  and  fever,  ii 90 

Ague-cake,  ii 249,  251 

Agu-e,  dumb,  ii 91 

Air,  atmospheric,  i..  267,  296 

Air-bath,  ii 49 

Air-tight  stoves,  i 302 

Albino  skin,  ii 308 

Albucasis,  i 18 

Albumen,  i 332 

Albuminous  aliment,  i.  .  331 

Alchemists,  i.  .' 19 

Alcoholic  diathesis,  ii.  . .  180 

Alcoholic  poisons,  i 310 

Ale,  i 316 

Alexandrian  baths,  i.  . . .  39 
Alexandrian  school,  i.  .  -     14 

Ali  abbas,  i 18 

Aliment,  i 339 

Alimentary  canal,  i 215 

Alimentary  principles,  i.  325 

Almond  oil,  i 330 

Almonds,  i 350 

Allspice,  i 363 

Alum,  poisonous,  ii 321 

Amaurosis,  ii 183 

Ambergris,  ii 145 

Amenorrho3a,  ii 286 

American  race,  i 292 

Amnion,  ii ■_ —  447 

Amnion,  liquor  of,  ii.  -  -  -  452 

Amputation,  ii 433 

Amylaceous  aliment,  i.  -  327 

Anajsthesia,  ii 331 

Anasarca,  ii 253 

Anatomical  argument,  i.  402 
Anatomical  erythema,  ii.  196 
Anatomical  physicians,  i.    82 


Page 
Anatomy,  genei'al,  Vol.  i.  53 
Anatomy,  obstetrical,  ii.  452 

Anchyloblepharon,  ii 425 

Ancient  bathing,  i 36 

Ancient  physicians,  i 10 

Andromachus,  i 17 

Aneurism,  ii 349 

Aneurisrcal  varix,  ii 250 

Angeiology,  i 131, 148, 155 

Angina,  ii 1 13 

Angina  pectoris,  ii 224 

Angina  stridula,  ii 218 

Anglicanus,  i 20 

Anhelation,  ii 216 

Anhaemia,  ii 156 

Animal  food,  i 3.39 

343,421,  444 

Animal  jelly,  i 334 

Animal  heat,  i 282,  364 

Ankle,  fractures,  ii 422 

Ankle-joint,  i 90 

Ankle  luxations,  ii 406 

Anteversion,  ii 294 

Anthrax,  ii 348 

Antimonial  poisons,  ii. . .  315 

Antipathy,  ii 268 

Antiseptic  property,  i.  . .  338 
Antiscorbutic  vegetables, 

i 362 

Anus,  imperforate,  ii.  . .  432 

Anxiety,  ii 268 

Aphonia,  ii 282 

Aponeurology,  i 127 

Apoplexy,  ii 244 

Aposteme,  ii 365 

Apparent  death,  ii 239 

Apples,  i 360,435,439 

Apple-tea,  i 314 

Apricots,  i 350 

Aptha,  ii 201 

Arabian  physicians,  i.  . .     18 

ArsBtius,  i 16 

Arcagathus,  i 15 

Archigenes,  i 16 

Areolar  tissue,  i 237 

Arenation,  i 43 

Aristot.e,  i H 

Arm-bathj  ii 49 

Armstrong  on  epilepsy, 

ii ;     207 

Aromatic  fomentations,  i.  44 
Arrow-root,  i.. .  -  327, 361,4.34 

Arsenical  poisons,  ii 314 

Arteries,  i 131 

Artichokes,  i 350,  437 

Arthritis,  ii 122 

Artificial  drinks,  i 310 

Articulations,  i 78 

Ai'tificial  heat) :. -.  2tl 


Ascites,  vol.  ii 256 

Asclepiadee,  i H 

Asiatic  cholera,  ii 139 

Asparagus,  i 362,  439 

Asphyxia,  ii 239 

Assyrian  priests,  i 10 

Asthenopia,  ii 135 

Asthma,  ii 217 

Astrology,  medical,  i 19 

Atmospheres,  factitious,  i.   45 

Atrimatrics,  i 44 

Atrophy,  ii 166 

Aura  epileptica,  ii 20€ 

Auscultation,  ii. , 161 

Autumnal  fever,  ii 90 

Avenzoar,  i 18 

Averroes,  i 18 

Avicenna,  i 18 

Axunge,  i aiO 

Baby-jumpers,  i 369 

Back-rooms,  i 305 

Bagliva,  i 26 

Bakers'  bread,  i 353 

Baldness,  ii. 310 

Bandages,  medical,  ii.  . .     52 
Bandages,  surgical,  ii.  . .  327 

Barbadoes  leg,  ii 260 

Barbiers,  ii 214 

Barley,  i 356,  430 

Bartholine,  i 23 

Barytes,  poisons  of,  ii.. .  321 

Bastard-pox,  ii 99 

Bathing,  ancient,  i 36 

Batliing.  habits,  i 39 

Bathing,  history  of,  i 36 

Bathing,  hygienic,  i 317 

Bathing,  rules,  ii 56 

Bath,  order  of,  i 39 

Baths,  hydropathic,  ii...     22 

Baths,  medicated,  i 43 

Beans,  i 359,  430,  4.33 

Beatty,  on  ergot,  ii 467 

Beck,  on  infants,  ii 480 

Bed-curtains,  i 302 

Beddoes' gases,  i 44 

Beds  and  bedding,  i 373 

Beech-nuts,  i. 441 

Beef,  cooking  of,  i 421 

Bees'  eggs  bath,  i 43 

Beets,  i 362,437,439 

Bell,  Dr.,  on  diet,  i 399 

Bellini,  i 25 

Beribery,  ii 214 

Bt'zoar,  ii 145 

Bible  Christians,  i 412 

Bible,  on  diet,  i 399 

Bile-ducts,  i 221 

Bile,  nature  of,  i 263 

Bilious  cholera,  ii 139 


106 


INDEX. 


Hilious  diarrhea,  vol.  ii.-  144 

Hi'.ioua  fevpr,  ii 73,  'JO 

IJilitJUS  teioperaineiit,  i..  i.'81) 

i;iicuit8,  i -•--•  4J7 

I'.ioinuth,  poisons  of,  ii.  .  31? 

I'.itU-'r  alaioucls,  i 359 

Hlackbcrries,  i 440 

JJlwck  caut-er,  ii 179 

liiack  curraiiU,  i 360 

hiack  pi'pptT,  i 3(J3 

JJlat-k  pudciing,  i 343.  354 

Hlack  vomit,  li t^S 

Blaiic-mange,  i 335 

Bladder,  inlituned,  ii.  ...  1:21 
Bladder,  structure  ot,  i..  2*29 

Bladdery  lever,  ii 202 

Blaiiis,  ii 305, 

Bleeding,  abnormal,  ii.. .  169 
Bleeding,  surgical,  ii. . . .  338 
Blepbaridoplastice,  ii.  ..  425 
Bl..norrlioea  luodes,  ii. ..  292 
B.ign,  Capt.,  on  rum,  i.  .  283 

Blood,  as  food,  i 342 

Blood,  nature  of,  i 276 

Blood  pudding,  i 354 

Bloody  liux,  ii 152 

Bloody  urine,  ii 170 

Blubber  oil,  i 333 

Blue  disease,  ii 309 

Bodily  positions,  i 301 

Body  linen,  i 377 

Boerhaave,  i 28 

Boiling  flesh,  i 343 

Boils,  ii 357 

Bone  cancer,  ii 348 

Bones,  i 55 

Bones,  diseases  of,  ii.  . . .  262 

Bottle  noses,  ii 342 

Bottoms,  i 354 

Bowels,  function  of,  i.  . .  281 

Bowels,  inflamed,  ii 119 

Brain,  i 164 

Brain  fever,  ii 112 

Brain,  inflamed,  ii 112 

Bramin  baths,  i 41 

Brandy  sores,  ii. 357 

Bread-making,  rules,  i.  .  429 

Breads,  i 352,  423 

Breast,  inflamed,  ii 474 

Breathing,  i 269 

Bright's  beverage,  i 361 

Broccoli,  i 350 

Broiling  flesh,  i 343 

Bromine,  poisons  of,  ii..  321 

Bronchitis,  ii 220 

Bronchlemmitis,  ii 114 

Bronchocele,  ii 345 

Brown  stout,  i 314 

Brown  study,  ii 278 

Bruises,  ii 335 

Brunonian  system,  i.  . . .     30 

Buboe.s,  i 29-2 

lUickwhf^at,  i 356 

Bucneniia  tropica,  ii.  . . .  260 

Bunion,  ii 343 

Buns,  i 3o4 

Burns  and  scalds,  ii 335 

Burst  eye,  ii 185 

Butter,  i 330,  345,  422 

Buttermilk,  L ■>44 


Fage 

Butternut,  vol.  i 441 

Cabbage,  i 362,  439 

Cachexies,  ii 1 54 

Cadaverous  food,  i 346 

Caesarian  section,  ii 486 

Caglivaii  paste,  i 3.54 

(;airo,  baths  in,  i 40 

Cakes,  i 354,  436 

Cakium,  in  food,  i 324 

Calculus,  intestinal,  ii. ..   145 
Calculus,  urinary,  ii.  . . .  299 

Calf's  foot  jelly,  i 334 

Calf 's  head  jelly,  i. 335 

Callipee,  i 347 

Caloiufication,  i 281 

Camel,  diet  of,  i 407 

Camp  fever,  ii 89 

Cancer,  ii 175,  346 

Caudle  smoke,  i 303 

Canine  madness,  ii 225 

Capillary  system,  i 266 

Carbon,  heating,  i 285 

Carbuncle,  ii. . ., 348 

Carditis,  ii 117 

Caries,  ii 358 

Carolina  potato,  i. . .  361,  438 
Carpal  dislocations,  ii...  396 

Carpenter,  on  food,  i 404 

Carpus,  i 73 

Carrigeen,  i 329 

Carrots,  i 362,  437 

Casein,  i 333 

Cashew-nut,  i 350 

Cassava  bread,  i 327 

Catacausis,  ii 179 

Catalepsy,  ii 243 

Cataract,  ii 35,  183 

Cataract-bath,  ii 35 

Catarrh,  acute,  ii 151 

Catarrh,  chronic,  ii 280 

Catarrhal  fever,  ii 107 

Catheterism,  ii 429 

Caucasi;m  race,  i 290 

Cauliflower,  i 350 

Caustics,  ii 328 

Caviare,  i 349 

Cayenne,  i 363 

Celery,  i 350,  439 

Cellars,  unhealthful,  i...  305 
Cells,  development,  i.  . .  236 

Cellulw  dropsy,  ii 253 

Cellular  tissue,  i 237 

Celsus,  i 17 

Cephalaea,  ii 265 

Cephalagia,  ii 265 

Cereal  grains,  i 351 

Cerebral  epilepsy,  li  . . .  206 

Cerebellum,! 167 

Cerebrum,! 164 

Cerumen,  i 278 

Chancres,  ii 292 

Change  of  air.  i 300 

Charlemagne,  bath  of,  i. .     39 
Cliatard,  on  labor  pains,ii.  467 

Cheese,  i 333,  345 

Cheilo-plastice,  il 426 

Chemistry  of  diet,  i 413 

Chemical  physicians,  i. .     20 

Cherries,  i 440 

Chestnuts,  i 431,  441 


Page 
Chest- wrapper,  vol.  ii. . .     53 

Chicken-pox,  ii 99 

C  hickory,  i 314 

Chilblain,  ii 198 

Childbirth,  ii 461 

Childbirth,  pains  of,  ii.  .  462 

Chill  fever,  ii 91 

Chlorine,  in  food,  i 324 

Chloroform,  in  labor,  ii.  467 

Ciilorosis,  ii 287 

Chocolate,  i 313 

Choking,  ii 431 

Cholera,  ii 139 

Cholera  infaiitum,  ii.  ...   140 

Cholera  morbus,  ii 139 

Cholera,  seasons,  i 412 

Chord,  in  music,  i 2.^5 

Chorion,  ii 447 

Chorea,  ii 212 

Chrome,  poisons  of^  ii...  321 

Chrysippus,  i 14 

Churchill,  on  pains,  ii...  462 

Chyle,  i 264 

Chyle-ducts,  i 264 

Chy lincation,  i 264 

Chylous  diarrhea,  ii.  ...  144 

Chyme,  i 262 

Chymification,  i 262 

Circulation,  i 264 

Cinnamon,  i 363 

Circocele,  ii 353 

Citric  acid,  i 329 

Citrons,  i 35C 

Clairvoyance,! 24rJ 

Clams,  i 349 

Clapp,  ii t392 

Clarke,  Dr.  Adam,  i 340 

Clavi,  ii 343 

Clavicle  bandage,  i! 386 

Clavicle,  fractured,  ii.  . .  410 

Clavicle,  luxated,  !i 388 

Climate,  i 365 

Closed  pupil,  ii 183 

Clothing,  i 374 

Cloves,  i 363 

Club-foot,  ii 382 

Cochituate  water,  i 316 

Cockles,  i 349 

Cocoa,  i 314 

Cocoa-nuts,  i 350 

Cod  sounds,  i 335 

Cottee,  i 312 

Cold  in  the  head,  ii 281 

Colds,  common,  i 365 

Colic,  ii 136 

Collins,  on  parturition,  ii.  487 
Combe,  Dr.,  on  pains,  ii.  464 
Combe,  G.,  on  pains,  ii..  464 
Common  compress,  i.  ..  437 

Common  cress,  i 351 

Common  diet,  i 444 

Common  salt,  i 336 

Compress,  surgical,  ii...  :^J6 
Compressing  arteries,  ii.  AJ7 

Compression,  ii 335 

Conception,  theory  of,  li.  493 
Concords,  in  music,  i  .  255 
Concretions,  intestinal,  ii.  145 

Concussions,  ii 334 

Condiments,! ■*63,441 


INDEX. 


497 


Congelation,  vol.  n 330 

Congestive  fever,  ii 73 

Consonants,  i 258 

Constipated  colic,  ii.  ...  137 

Constipation,  ii 128,  459 

Consumption,  ii X54 

Contracted  sinews,  ii.  . .   284 

Contractility,  i 238 

Convulsions,  ii 204 

Cookery,  liydropatliic,  i.  417 
Cooper,  on  fractures,  ii.  418 
Copland,  on  bronchitis,  ii.  149 
Copper,  poisons  ot,  ii.  . .  21(5 

Cords,  vocal,  i 259 

Corn,  i 43U 

Cornea,  diseases  of,  ii...  182 

Corns,  ii 343 

Corn  starch,  i 434 

Corsets,  i 297 

Coryza,  ii 280 

C  oughing,  ii .''. 426 

Cough,  ii 215 

Cows'  heels  jelly,  i 335 

Cow-pox,  ii 98 

Cowshps,  i 350,  439 

Coxalgia,  ii 12G 

Coxarum  morbus,  ii 368 

Crabs,  i 349 

Cracked  wheat,  i 431 

Crackers,  i 354 

Cradle,  i 369 

Cramp,  ii 231,  45C 

Cranberries,  i, 43l« 

Cranium,  i.  60  ;  ii 408 

Craniotomy,  ii 485 

Cravings,in  pregnancy.ii.  459 

Craziness,  ii 273 

Cream,  i 345 

Credulity,  morbid,  ii 279 

Cretinism,  ii 2G3 

Crises,  ii 59 

Crotchet,  the,  ii 486 

Croton  water,  i 316 

Croup,  ii 114 

Crowing  inspiration,  ii..  218 

Crustacean  food,  i 349 

Crusta  lactea,  ii 306 

Cucumbers,! 350 

Culien,  i. 29 

Curd,  i 333,  3  io,  422 

Currants,  i 435,  440 

Curvature,  spinal,  ii.  ...  234 

Custard,  i 434,  436 

Cutaneous  rashes,  ii.  ...  301 
Cutaneous  vermin,  ii,  . .  308 

Cuvier,  on  diet,  i 403 

Cyanosis,  ii 309 

Cynanche,  ii 113 

Cyrtosis,  ii 263 

Cystic  sarcoma,  ii 353 

Cystitis,  ii 121 

Dall's,  Mrs,,  testimony,  ii.  439 

Dandelion  tops,  : 350 

DandruU',  ii 3U3 

Darwin's  Zoonoraia,  i...  30 
Davies,  Dr.,  on  ergot,  ii.  46'' 

Daymare,  ii 2l9 

Deafness,  ii 196 

Death,  apparent,  ii 239 

Deatii,  natural,  i 386 


Decay  of  nature,  vol.  ii.  167 

Decidua,  ii 447 

Decline,  ii 167 

Deformities,  ii 377 

Deglutition,! 261 

Delirium  tremens,  ii. . . .  209 

Democritus,  i 12 

Dentition,  periods  of,  i..     69 

Derivative  baths,  ii 28 

Despondency,  ii 275 

Devonshire  colic,  ii 136 

Dewees,  on  pains,  ii 464 

Diabetis,  ii 297 

Diapliragm,  i 270 

Diarrhea,  ii 139 

Dicks  )n,  controverted,  i.  404 

Dietaries,  i 441 

Diet,  divisions  of,  i 444 

Dietetic  rules,  i 441 

Dietetics,  i 397 

Dilhcult  bi-eathiijg,  ii. . . .  216 

Digby,  Kenelm,  i 23 

Digestion,  i 261 

Dioscorilles,  i 17 

Diplomas,  first  granted,  i.     19 

Diphthongs,  i 258 

Discords,  in  music,  i.. ..  255 

Disease,  nature  of,  ii 4 

i  )islocations,  ii 385 

Displacements,  ii 293 

Dissoiiant  speech,  ii 284 

Dissonant  voice,  ii 283 

Dizziness,  ii 269 

Doane,  on  asphyxia,  ii.  .  243 
Dogmatic  physicians,  i..  11 
Donne's  experiment,  i.. .  335 

Dotage,  ii 279 

Douche-bath,  ii 25 

Dreams,  i 371 

Dress,  female,  i 298 

Drink,  i .307 

Drinks,  acidulous,  i 314 

Drinks,  artificial,  i 3 10 

Drinks,  intoxicating,  i.  .  314 

Drinks,  warm,  i 312 

Dripping-sheet,  ii 27 

Di'op-bath,  ii 49 

Drop  serene,  ii 183 

Dropsical  diseases,  ii.  . .  252 

Drug  fever,  ii 73 

Drug-treatment,  ii 9, 15 

Drunkard's  delirium,  ii.  209 

Dry-cupping,  ii 327 

Dry  pack-batli,  ii 35 

Dry  scall,  ii 304 

Dumbness,  ii 282 

Dumplings,  i , . .  355 

Dung-baths,  i 43 

Dunglison,  conti'o verted, 
i.  300, 331, 333,  336, 342, 

358,  372,  404 

Duodenitis,  ii Y3Z 

Duration  of  life,  i 383 

Duration  of  pregnancy,  i.  455 

Dysmenorrhoaa,  ii 286 

Dysentery,  ii 152 

Dyspepsia,  ii 129 

Dyspeptic  phthisis,  ii.  . .   158 

Dyspnoea,  ii 216 

Dysuria,  ii 297 


Png« 

Earache,  vol.  ii i!j4 

Ear,  anatomy  ol",  i 195 

Ear-bath,  ii 47 

Ear,  diseases  of,  ii 187 

Eai-,  substances  in,  ii 194 

Ear-wax,  i 278 

Earth-bath,  i 43 

Eberle,  on  pains,  ii 464 

Ecchymosis,  ii 186,  338 

Eclectic  physicians,  i   . .     15 

Ecstasy,  ii 243 

Ecthyma,  ii 306 

Ectropium,  ii 184,  425 

Eczema,  ii 305 

Efiervescing  mixtures,  i.  314 

Eggs,  i 347,  422 

Egyptian  baths,  i 37,  40 

Egyptian  ophtiialana,  ii.  184 

Egyptian  priests,  i 10 

Elasticity,  i 2.17 

Elbow,  Iractured,  ii 414 

Elbov/,  luxated,  ii 393 

Elbow-joint,  i 85 

Elderberries,  i 350 

Elements  of  food,  i 325 

Elements,  organic,  i.  . . .     54 

Elephantiasis,  ii 168 

Elephant  leg,  ii 260 

Elephant  skin,  ii 168 

l^^lUotson,  on  I'aL-y,  ii.  ..   -^xi 

Embryotomy,  ii 418 

Emetics,  surgical,  ii.  ...  3.i:j 
Emissions,  nocturnal,  ii.  291 

Emollient  herbs,  i 44 

Empirical  physicians,  i.     11 

Emphysema,  ii 259 

Empyema,  ii 3fi5 

Encephalitis,  ii 2i:J 

Endine,  i 3.'il 

Endocarditis,  ii il7 

Endosmose,  i.  286,  287 ;  ii.      7 

Enearesis,  ii. 298 

English  bath.s,  i 42 

Enlargements,  ii 248 

Enteritis,  ii 119 

Entropium,  ii 184,  4 J5 

Ephemeral  lever,  ii b6 

Epicures,  i 341 

Epilepsy,  ii 2o6 

Epithems,  i 43 

Epistaxis,  ii 170 

Episynthetics,  i A    Hi 

Epulis,  ii 344 

Erasistratus,  i 14 

Ergot,  in  labor,  ii 466 

El  uptive  fevers,  ii 93 

Eruptions,  heat,  ii 3u5 

Eruptions,  scaly,  ii 303 

Erysipelas,  ii 103 

Erysipelatous  rasli,  ii.  . .    196 

Erythemas,  ii 195 

Escpiimaux  voracity,  i.  .  ;J.")l 
Essenes,  vegetarians,  i   .   414 

Kthiopic  race,  i 291 

EtioiatiMi  vegetables,  1.  .   iJilj 

Eustachius,  i 23 

Evacuations,  i . .   379 

Exatnpli's  ot  iiingevity.  1.  384 

Excitability,  i 238 

Excreliona,  i 37S} 


498 


INDEX. 


rage 

Kxcreraentitious    secre- 

tuins,  vol.  i 277 

i:xcTctoiy  organs,  i 279 

Kxcrfsc»;nee,  genital,  ii. .  294 

Excrfeceiii  gums,  ii 135  i 

Kxt-nise,  i 367 

Kxtuliation,  ii 358 

Kxlinhition,  i 277 

i;xatmuhe,  i.  286 ;  ii.  . . .       7 

t.xperieiice  in  diet,  i 411 

Extaiiguiuity,  ii lot) 

LxteriKil  absorption,  i...  271 

Kxti'rual  senses,  i 189 

ICye-batl'.,  ii 47 

Eye,  diseases  of,  ii 180 

Eye,  excrescences  of,  ii.  184 

Eye,  structure  of,  i 190 

P3ye,  substances  in,  ii 186 

Fabriculi  lever,  ii 73 

Factitious  atmospheres,  i.   45 

Factitious  gases,  i 44 

Faculties,  i 245 

Faeces,  i 262 

Fainting-fit,  ii 27U 

Falling  sickness,  ii 206 

Fallopian  dropsy,  ii 258 

Fallopian  tubes,  i 231 

Fanaticism,  ii 276 

Farina,  i 354,  4.32 

Fasciae,  i 127 

Fat,  i 330 

Fattening  poultry,  i 347 

Fatty  livers,  i 347 

Fatuity,  ii 279 

Feculent  diarrhea,  ii.  ...  144 

Feculoid,  i 327 

Felon,  ii 345 

Female  authors,  ii 440 

Female  dress,  i 298 

Ferment,  i 426 

Fermentationists.  i 24 

Fermented  breads,  i.  353, 425 

Fi^rmentation,  i 427 

Ferxi-tree,  i 350 

Fever  and  ague,  ii 90 

Fever  diet,  i 444,  447 

Fever  sores,  ii 357 

Fevers,  classified,  ii 72 

Fevers,  ephemeral,  ii.  . .     86 

Fevers,  eruptive,  ii 93 

Fevers,  inflammatory,  ii.  87 
Fevers,  intermittent,  ii..  90 
Fevers,  remittent,  ii.  ...  90 
Fevers,  symptomatic,  ii.     92 

Fevers,  typhoid,  ii 72 

Fevers,  typhus,  ii 88,  89 

Fibrin,  i 331 

Fidgets,  ii 268 

Figs,  i 440 

Filberts,  i 350 

Finger-bath,  ii 48 

Fingers,  dislocated,  ii.  . .  397 

Fingers,  fractured,  ii 416 

Fingers,  superfluous,  ii..  379 

Finlanders'  baths,  i 40 

Fireplaces,  i 3(J2 

Fish  aliment,  i 348 

Fishes,  as  food,  i 339  348 

Fishes,  poisonous,  ii.  . . .  323 
Fieh  »kin,  ii 304 


Page 

Fissures,  vol.  ii 363 

Fistula    lachrymalis,   ii. 

185,364,424 

Fistula  in  ano,  ii 360 

Fistula  in  perenio,  ii.  ...  362 

Fistula,  salivary,  ii 364 

Fixed  oils,  i 330 

Flatulence,  ii.  129 

Flatulent  cholera,  ii 139 

Flatulent  colic,  ii 137 

Flesh-meat,  i 339, 343 

Flooding — Flowing,  ii.. .  474 

Fluor  tifbus,,  ii 239 

Fluorine,  in  food,  i 325 

Fluxes,  ii 151 

Foetal  anatomy,  i 233 

Foetal  development,  ii...  447 

Foetal  pathology,  ii 456 

Follicles,  gastric,  i 278 

Fomentations,  ii 50 

Fomentations,  medical,  i.  43 
Fomentations,  surgic,  ii.  330 

Food,  i 320 

Food,  animal,  i 339 

Food,  vegetable,  i 350 

Foot-bath,  ii 31 

Foot,  dislocated,  ii 407 

Foot,  fractured,  ii 423 

Fore-arm,  fractured,  ii.  .  415 
Forceps,  in  labor,  ii..  ..  48^) 
Forsyth,  Dr.,  on  diet,  i..  4G0 

Fountain-bath,  ii 40 

Fowl,  i 422 

Fractures,  ii 407 

Fragillitas  ossium,  ii 26:3 

Framb'jesia,  ii 203 

Freckles,  ii 30d 

French  baths,  i 41 

Kret,  ii 198 

Friction,  ii 54 

Fritters,  i. 354 

Frogs,  as  food,  i 339 

Fruit-cake,  i 354 

Fruits,  i 439 

Frying  food,  i 330 

Full  diet,  i 444 

Fumigations,  i 44 

Functions,  divisions  of,  i.  235 
Functions,  individual,  i..  260 
Fungus  hematodes,  ii...  347 

Funis,  ii 449 

Furunculus,  ii 357 

Galen,  i 17 

Gall-bladder,  i 221 

Gall-stones,  ii 133 

Ganglia,  i 183 

Ganglion,  ii 344 

Ganglionic  system,  i.  . . .  186 
Gangrenous  erythema,  ii.  U>6 

Gaping,  i 238 

Garlics,  i 3.50 

Garments,  i 376 

Gas-burners,  i 302 

Gases,  facti  ious,  i 44 

Gastric  fever,  ii 107 

Gastiic-juice,  i 262 

Gastric  remitt.  fever,  ii.    166 

Gastritis,  ii 118 

Gastroenteritis,  ii 119 

Ganla,  bathing  Labits»    .    38. 


Gelatin,  vol.  i 334 

Gelatin  commission,  i.. .  335 

Genio  plastice,  ii 426 

Genital  displacements,  ii.  293 

Generation  of  heat,  i 364 

German  baths,  i 39 

Ginger,  i 363 

Ginger  beer,  i 314 

Ginger-bread,  i 354,  437 

Gin-liver,  ii 249 

Glandular  secretions,  i. .  278 
Glandules,  odoriferous,  i.  279 

Gleet,  ii 292 

Globus  hystericus,  ii 208 

Glue,  i 335 

Gluten,  i 333 

Goitre,  ii 345 

Gold,  poisons  of,  ii 318 

Good,  criticised,  ii.  122, 
156,  198,  213,  228,  270,  302 

Gooseberries,  i 435,  440 

Gonorrhoea,  ii 292 

Gout,  ii 122 

Graham  crackers,  i 354 

Graham  flour,  i 432 

Graham,  on  diet,  i 403 

Grain,  constituents  of,  i.  3.52 

Grtmular  eyelids,  ii 182 

Grapes,  i 360,  439 

Gravel,  ii 299 

Gravel  doctors,  ii 300 

Gravies,  i 430 

Gray  hair,  ii 310 

Greatrix,  Valentine,  i.  . .  23 

Grease,  i 330 

Grecian  physicians,  i.  . .  10 

Greek  baths,  i 38 

Green  corn,  i 430 

Green-sickness,  ii 287 

Green  vegetables,  i 439 

Griddle-cakes,  i 354,  437 

Groats,  i 355 

Grog-roses,  ii 342 

Ground-nuts,  i 437 

Gruels,  i 432 

Gully,  Dr.,  on  crisis,  ii.  .  63 

Gully,  on  dyspepsia,  ii.  .  129 

Gum,  i 326 

Gum-rash,  ii 302 

Gums,  i 216 

Gums,  excrescent,  ii 135 

Gutta  rosea,  ii 341 

Guy,  Dr.,  on  hysteria,  ii.  208 

Ha^mastasis,  ii 331 

Hajmatamesis,  ii 170 

Ha^maturia,  ii 170 

Haemoptosis,  ii 170 

Hair,  morbid,  ii 310 

Ilalf-bath,  ii 29 

Half  pack-bath,  ii 25 

Haller,  i 28 

Hallucination,  ii 27f 

Hand-bath,  ii 48 

Hand,  fractured,  ii 416 

Happiness,  i 245 

Hare-lip,  ii 377 

Hartshorn,  i 335 

Harvey,  i 23 

Hash.i 430 

Hazel-nuts.i 350 


INDEX. 


499 


Headache,  vol.  ii 2(55 

Head-biith,  ii 32 

Head,  dropsy  oi,  ii 255 

Hearing,  morbid,  ii 271 

Hearing,  organ  of,  i 195 

Hearing,  sense  of,  i 252 

Heart,  anatomy  of,  i.  . . .  204 

Heartburn,  ii 129,  459 

Heart,  inflamed,  ii 117 

Hf^at,  animal,  i 2F1 

Heat  eruption,  ii 305 

Heated  rooms,  i 365 

Hematocele,  ii 353 

Hem«ralupia,  ii 185 

IL^miplegia,  ii 247 

Hemorrhage,  ii 169 

Hemorrhage,  in  labor,  ii.  490 

Hemorrhoids,  ii 148 

Henner,  on  nodes,  ii.  . . .  355 

Hepatitis,  ii 118,  132 

Hernia  humoralis,  ii.  ...  353 

Heruiifi,  ii 369 

Hernial  anatomy,  i..  128,  131 

Heroic  physician,  i 15 

Herophilus,  i 14 

Herpes,  ii 305 

Hiccough — hiccup,  ii.  ..  236 

Hill,  Dr.,  on  hernisB,  ii..  375 

Hip-bath,  ii 27 

Hip-disease,  ii .368 

Hip,  dislocated,  ii 397 

Hip  joint,  i 88 

Hippocrates  i 13 

Hirse,  i 359 

History  of  bathing,  i 36 

History  of  medicine,  i.  .  10 

History  of  midwifery,  ii.  439 

Hoe-cake,  i 424 

Hoiiman,  i 26 

Hog,  diet  of,  i 407 

Holcombe,  on  ergot,  ii.  .  469 

Holy  tire,  ii 196 

Home,  on  diet,  i 403 

Hominy,  i 358,  432 

Hooper,  criticised,  ii.  74,  118 

Hooping-cough,  ii 215 

Hop-yeast,  i 42<j 

Horse,  diet  of,  i 408 

Horse-radishes,  i 363 

Hosack,  on  ergot,  ii 469 

Hose-bath,  ii. 26 

Hospital  fever,  ii 89 

Hot-bath,  ii 41 

Hot  rolls,  i. 354 

Human  diet,  i 409 

Humerus,  fractured,  ii. .  412 

Humid  scalls,  ii 306 

Humoral  pathology,  ii.  .  6 

Humors  of  the  eye,  i.  . .  193 

Hunger,  i 264 

Huston,  on  bleeding,  ii. .  473 

Hydrarthrus,  ii 351 

Hydrocele,  ii 258 

Hydrocephalus,  ii 255 

Hydrophobia,  li 225 

Hydrometra,  ii 258 

Hydrops  articular,  ii 352 

Hydrops  capitis,  ii 254 

Hydrops  thoracis,  ii. 256 

Hydro-rachitis*  ii 380 


Page 

Hydrothoras,  vol.  ii.  ...  253 

Hygiene,  i i>95 

Hygiene,  mental,  i 381 

Hj  yienic  agencies,  i 295 

Hypochondi-iacism,  i 276 

Hysteria,  ii 207 

Hysterics,  ii 207 

Hystcritis,  ii 121 

Hysterotomy,  ii 486 

Iced-watcr,  i 309 

Iceland  moss,  i 351 

Ichthyophagists,  i 348 

Icterus,  ii 132 

Icthj'iasis,  ii 304 

Idiotism,  ii 279 

Ignis  sacer,  ii. 196 

IH%2  passion,  ii 136 

Illusion,  mental,  ii 276 

lilutation-bath,  i 43 

Imbecility,  ii 279 

Imbibition,  i 287 

Immelodious  voice,  ii...  283 

Imperforate  anus,  ii.  ...  432 

Imperforate  urethra,  ii..  432 

Impetigo,  ii 30i) 

Imposthume,  ii 3()5 

Incantations,  i 10 

Incubus,  ii 219 

Incurvation,  spinal,  ii. . .  232 

Indian  baths,  i 40 

Indian  corn,  i 358 

Indian  meal,  i 432,  437 

Indian  puddings,  i 358 

Indigestion,  ii 128 

Individual  functions,  i.. .  160 

Infant-drugging,  ii 480 

Infantile  diseases,  ii 484 

Infantile  hectic  fever,  ii.  166 

Infantile  ophthalmia,  ii. .  182 

Infant  nursing,  ii 475 

Infant  teething,  ii 479 

Infection,  sources  of,  i.  .  299 

Inilammation,  ii 1U8 

Inflammatory  dropsy,  ii.  260 

Inflammatory  fever,  ii.  .  87 

Inflation,  pulmonary,  ii.  242 

Influenza,  ii 151 

Inhalations,  medicated,  i.  45 

Injections,  ii 58 

Injuries,  ii 334 

Innervation,  i 260 

Inordinate  lust,  ii 293 

Inosculation,  ii 4.30 

Insalivation,  i 261 

Insanity,  ii 273 

Insects,  as  food,  i 350 

Insects,  poisonous,  ii 234 

Insects,  wounding,  ii 198 

Insolation-bath,  i. 43 

Insurttation,  i 44 

Intermittent  fever,  ii.  . .  90 

Internal  absorption,  i.  . .  271 

Intertrigo,  ii i.':iti 

Intestinal  concretions,  ii.  145 

Intestinal  enlargem't,  ii.  251 

Intestines,  i 217 

Intoxicating  beverages,  i.  314 

Invalids,  rules  for,  i 44 1 

Invermination,  ii 145 

Inversion,  uterine,  ii.  294,  492 


Pag« 

Involuntary  evacuations, 

vol.  i 379 

Iodine  fumigation,  i 45 

Iodine,  poisons  ot,  ii.  . . .  320 

1 1'ish  moss,  i 35  L 

Iritis,  ii igi 

Iron,  in  food,  i 324 

Iron,  poi^^ons  of,  ii 318 

Irrationality,  ii 279 

Irritability,  i 238 

I.?churia,  ii 297 

Isinglass,  i 3;j,5 

Italian  baths,  i 39 

Itch,  bakers,  etc.,  ii 304 

Itch,  common,  ii 307 

Jail  fever,  ii 89 

Jams,  i 329 

Jarrold,  on  curvatures,  ii.  235 

Jaundice,  ii 1.32 

Jaw,  dislocated,  ii 387 

Jaw,  fractured,  ii 408 

Jelly,  i 328 

Jelly,  animal,  i 334 

Jelly,  preparations  of,  i.  33o 

Jewish  pi-iests,  i 10 

Johnson,  Dr.  E.,  opposed, 

h 103,  105,211 

Johnson,  Dr.  J.,  contro- 
verted, i 396 

Johnny-cake,  i 358 

Joints,  structu'v  -A',  i.  . .     79 

Juints,  dropsy  •..,  ii 352 

Keratoplastice,  ii 425 

Kernels,  i 359 

Kidneys,  structure  of,  i.  223 
Kidneys,  function  of,  i. .  280 

Kidneys,  inflamed,  ii IgO 

Killing  animals,  i 341 

Kine-pox,  ii 98 

Kin-cough,  ii 215 

King's  evil,  ii 173 

Knee,  dislocated,  ii 404 

Knee-joint,  i 189 

Labium  leporinum,  ii. . .  377 

Labor,  ii 461 

Labor,  complicated,  ii...  483 
Labor,  management  of,  ii.  469 

Labor,  natural,  ii 467 

Labor,  pains  of,  ii 462 

Labor,  premature,  ii 484 

Labor,  protracted,  ii. ...  483 
Labor,  rationale  of,  ii.  . .  461 

Labor,  stages  of,  ii 463 

Lacerations,  ii 491 

Lachrymal  fistula,  ii. . . .   185 

364,  424 

Lacteal  absorption,  i 272 

Lactic  acid,  i 329 

Lactometer,  i 344 

Lagcphthalmus,  ii 42.5 

Lainbe,  on  diet,  i.  . .  403,  413 

Lamps,  i 302 

Langhaus,  criticised,  ii..   195 

Lard,  i 330 

Laiyngismus  stridulus,  ii.  218 

Laryngitis,  ii H3 

Laryngotomy,  ii 431 

Larynx,  i 207 

Larynx,  inflamed,  ii 113 

Lavemeuts,  ii,  ^ 


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INDEX. 


501 


Page 

Neck-joint,  vol.  i 80 

Necrosis,  ii .'J58 

Nectarines,  i 350 

Neijhritia,  ii 120 

Nerve-acbe,  ii 266 

Nf  rve«,  i 161 

Nervous  fever,  ii 88 

Nervous  influtnce,  i.  ...  246 

Nervous  ay  stems,  i 240 

Nervous  temperament,  i.  288 

Nervous  tissue,  i 329 

Nettle-rash,  ii 201 

Nrmralgia,  ii 266 

Neurology,  i 161 

Neutral  salts,  poisons,  ii.  313 
Nevvr  York  nuisances,  i. .  299 
N.  York  temperature,  i. .  362 
Nichols,  Dr.,  on  labor,  ii.  4fi2 
Nichols,  Mrs.,  on  labor,  ii.  464 

Nictitati'jn,  ii 2.'i8 

Nightmare,  li 219 

Nipples,  deficient,  ii 474 

Nipples,  sore,  ii 475 

Nitrogenized  tood,  i.. . . .  322 

Nodes,  ii 355 

Noli-metangere,  ii 349 

N'jn-nitrogenized  food,  i.  3^2 

Nose,  i ■-...  189 

Nose-bleeding,  ii 170 

N(jse,  fracture  of,  ii 408 

Nutmegs,  i 363 

Nutrition,  i 274 

Nutritive  nerv's  syst'm,  i.  211 

Nuts,  i 359,441 

Nyctalopia,  ii 185 

Nymphomania,  ii 293 

Oritmeal — oats,  i 355,  432 

Obesity,  a  disease,  i 274 

Obstetrical  anatomy,  ii..     45 

Occupation,  i 393 

Ocular  specters,  ii 271 

Odoriferous  glandules,  i.  279 

(Edema,  ii 253 

(Edematous  erythema,  ii  195 

CEsophagotomy,  ii 430 

(Esophagus,  i 217 

Oil,  as  food,  i 285 

Oils,  fixed,  i 330 

Oleaginous  aliments,  i.  .  330 

0:ive  oil,  1 330,  437 

Omelettes,  i 4j2 

Omentum,  i. 2[5 

Omentum,  enlarged,  ii.  .  2-'J2 

Onions,  i 4;J9 

Onychogryphosis,  ii.  ...  313 

Oiiyx,  ii 367 

Oijyxis,  ii. 343 

Opacity  of  cornea,  ii 182 

Ophthalmia,  ii 181 

Oranges,  i 3.30 

Orange  akin,  ii 308 

Oral-bath,  ii 48 

Orbits  of  the  eye,  i 66 

Orang-outan-g,  diet  of,  i.  411 

Orchitis,  ii 122 

Order  of  development,  1  249 
Order  of  the  Bath,  i.  . . .  39 
Organic  elements,  i...  ,  53 
(Jiganic  transmission,  444 
Orient!).' baths,  i 40 


Page 
Origin  of  races,  vol.  i. . .  293 

Orthopnoea,  ii 216 

Osmazome,  i 344 

Ossification,  i 56 

Osteology,  i 55 

Osteo-sarcoma,  ii. 34ft 

Osthexy,  ii 263 

Otalgia,  ii 194 

Otitis,  ii 187 

Otoplastice,  ii 426 

Otorrhoea,  ii 189 

Ovaries,  i 231 

Ovary,  dropsy  of,  ii 257 

Oxalic  acid,  i 3-..9 

Oysters,  i 349 

Ozajna,  ii 281 

I'acking-sheet,  ii 22,  35 

I'ain,  nature  of,  i  ' 11 

Pains  of  labor,  ii    462 

Painter's  colic,  ii 136 

Palate,  i 215,  216 

i'alpitation,  ii 237 

Palsy — paresis,  ii 246 

I'anary  fermentation,  i..  427 

i*ancake3,  i 354 

rancrea.%  i 263 

Pancreatic  juice,  i 263 

Pandiculation,  ii 2^)9 

Panther,  diet  of,  i 406 

J'apuloua  scall,  ii 306 

Paracelsus,  i 21 

Paracentesis,  ii..424,  431,  432 

i'araly.sis  agitans,  ii 215 

Paraplegia,  ii 247 

Parched  corn,  i 431 

Pari.-iian  fashions,  i 297 

Parker,  controverted,  ii.  275 
Parkinson,  criticised,  ii.  212 

Pi.ronchia,  ii 345 

Pai-otid  glands,  i 216 

Parotitis,  ii 115 

Paranep,  i 362,  437,  438 

Parturition,  ii 461 

Parulis,  ii 3.57 

Pa-isions,  hygiene  of,  i.  .  381 
Passions,  ungovemab.,  ii.  275 

Pastry,  i 434 

Patella,  fractured,  ii.  ...  420 

Pathology,  ii 72 

Pathol  of  the  foetus,  ii.  .  4.56 

Peaches,  i 435,  439 

Peach-li;atuer,  i 44u 

i'eanuts,  i 4-il 

Pearl  barley 

Pearl  wheat,  i 354 

Pears,  i ^559,  4;J5 

Peas,  i 359,  430,  432,  433 

Pectin — pectid  acid,  i.  . .  323 
Pnctinaceous  aliment,  i..  326 

P(;lvis,  cavity  of,  ii 4.52 

Pelvis,  fracture  of,  ii.  ...  412 

Pelvi.H,  viscera  (ji\  i 22i 

Pemphigus,  ii 202 

Pendleton,  on  paiiis,  ii.  .  46*1 

Pepper,  i 363 

Pepsin,  i ij62 

Percussion,  ii 161 

Pereira  controverted,  i.  2!i3 

285,  313.  314,  321,  324,  336 

Perforator,  obstetrical,  ii.  486 


Pericarditis,  vol.  ii U? 

Peripneumony,  ii U8 

Peritoneum,  i 213 

Peritonitis,  ii 120,  474 

Perkins,  on  ergot,  ii 46 

Pernicioua  fever.  iL .     73 

Pernio,  ii 198 

Persian  baths,  i 40 

Perspiration,  i 278 

Pertussis,  ii 215 

Peruvian  hatha,  i 41 

Pessaries,  ii 295 

Petechial  fever,  ii fj.) 

Pettit-Loes'  jelly,  i 3;j5 

Pharynx,  i 21 6 

Phenomena,  mesmeric,  i.  249 
Phenomena  of  sleep,  i.  .  371 
I'hilosophy  of  mind,  i...  244 
Philos.  of  water-/:ure,  ii.      3 

Phlebitis,  ii 338 

phlei)otomy,  ii 3^38 

Phle-gmasia  dolcns,  ii.  2(W,  475 
I'iionographic  reform,  i.  259 
Phosphorus,  in  food,  i.. .  323 
I'iiosphoru.'?,  poisons, ii..  320 
i'hrensy — phrcnitis,  ii...  112 
Phthisis,  pulmonalia,  ii..  152 

Pliysiology,  i 235 

Phy.'iiology  of  diet,  i.  . . .  410 

Piebald  skin,  ii 308 

Pica,  i 434 

Piles,  ii 148,  4.59 

I'ine-apple,  i 3.jO 

Placrnta,  iu 451,  490 

Plague — pestis,  ii 107 

Plantain,  i 350 

Platina,  puiaona  o^  ii.  ..  321 

Plato,  i 14 

l'l,;dgets,  surgical,  ii.  ...  327 

Plethora,  ii 173 

Pleura,  i 212 

Pleuralgia,  ii 126,  2j4 

lleurisy,  ii 116 

Pleurodyne,  ii 126,  224 

Plica  polonica,  ii 310 

Pluin-cakCji •i54 

Plum  pudding,  i 'iTA 

i'l-ums,  i 440 

i'lungf;-bath,  ii 30 

I'lural  births,  ii 489 

Pneumatic  physicians,  L    16 

I'lieumatology,  i 16 

Pneumonia,  ii 116 

Podagra,  ii 122 

Poisons,  ii 31 1 

I'olypua,  ii 2al,  :j.>l 

Pompholy.x,  ii 3i)5 

Population,! 21i4 

Pork,  i 3.!9 

I'orrigo,  ii 3ij6 

Portabh;  shower-bath,  ii.  41 
Portal,  .M.,  criticised,  ii..  243 

I'ortal  systf-m,  i 15-1 

Positions  aSeet'g  brcata- 

ing.  i 300 

PiLiition,"*,  bodily,  i 301 

Positions  during  sleep,  i.  372 

positions  in  labor,  ii 468 

Potassium,  in  fof>d,  i.  ...  325 
Potatory  i 361.  136,  l:«7 


602 


INDEX. 


Paje 

Poiato-tops,  vol.  i 439 

Potato-starch,  i 361 

^ot-cln>ese,  i 44:2 

"^otherbs,  i 362 

."'oultices,  i 43 

.^oultry,  benighted,  i 305 

Poultrj',  fattened,  i 347 

Pox,  venereal,  ii 292 

Pravvna,  i 349 

Pregnancy,  ii 455 

Prejniancy,  accidents,  ii.  457 
PregnHncy,  diseases,  ii. .  459 

Preparing  iood.  i 421.  423 

Presbyopja,  ii 186 

Presentations  in  labor,  ii  468 
Presentations,  unnat.,  ii.  483 

Prickly  heat,  ii 302 

Prince  of  empirics,  i. 21 

Priests,  a7Mient,  i 10 

Prolapsed  cord,  ii 4S9 

Prolapsed  uteius,  ii 293 

Propensities,  i 245 

Prostatic  abscess,  ii 368 

Prostatic  enlargement,  ii.  355 

Protein,  i 331 

Proteinaceous  aliment,  i.  331 
Prout,  controverted,  i...  327 
Proximate  elements,  i.  .     54 

Prunes,  i. 440 

Pruriginous  rash,  ii 302 

Pruritis,  ii 4.59 

Pseudarthrosis,  ii 382 

Psoas  abscess,  ii 367 

Psoriasis,  ii 304 

Psorophthalmia,  ii 184 

Pterygium,  ii 183 

Ptosis,  ii 185,  425 

Puddings,  i 433 

Puerperal  convulsions,  ii.  491 

Puerperal  fever,  ii 474 

Puerperal  mania,  ii 491 

Puerperal  swelled  leg,  ii. 

260,475 

Pu  monary  consump.,  ii.  1.52 

Pulse,  nature  of,  ii..* 67 

Pulselessness,  ii 229 

Pumping  the  stomach,  ii.  429 

Pumpkins,  i 361,  440 

Pupil,  closed,  ii 183 

Purificati  ;n  of  air,  i 302 

Purification  of  vcater,  i..  319 

Pythagoras,  i 12,  414 

Quadrupeds  as  food,  i.. .  339 
Quicksilver,  poison  of,  ii.  313 
Quicksilver  quack,  i.  . . .     22 

Quinces,  i 350 

Quinsy,  ii 113 

Rabies,  ii 225 

Races  of  men,  i 290 

Radishes,  i 439 

Rain-bath,  ii 40 

Rainbow-worm,  ii 305 

Rain  water,  i 316 

Raised  bread,  i 428 

Pcaisins,  i 360 

Ramolissement,  ii 234 

Ramsbotham  on  labor,  ii.  465 

Ranula,  ii 344 

Raphania,  ii 213 

Raspberries,  i 440 


Rationale  of  crisis,  vol.  ii. 

Rationale  of  drugs,  Ii.  . . 

Rationale  ot  fever,  ii.  . . . 

Rationale  of  iuflamma.  ii. 

Rationale  of  parturi.  ii.  . 

Rationale  of  water-cu.,  ii. 

Rattling  m  I  he  throat,  ii. 

Riiyer,  criticised,  ii 

Rau-se,  Dr.,  on  crisis,  ii. 

Rear  buildings,  i 

Recrementitious    secre- 
tions, i 

Reflex  nervous  system,  i. 

Regulars  banished,  i. . . . 

Relapsing  fever,  ii 

Remittent  fever,  ii 

Reproduction,  ii 

Reptiles  as  food,  i 

Respiration,  i 

Respiration,  habits  affect- 
ing, i 

Respiratory  food,  i 

Restlessness,  ii 

Retinitis,  ii 

Retroverted  uterus,  ii. . . 

Revery,  ii 

Rhazes,  i 

Rheumatism,  ii 

Rhinoplastice,  ii 

Rhinorrhape,  ii 

Rhubarb  plant,  i 

Rhypia — rhupia,  ii 

Ribs,  fracture  of,  ii 

Rice,  i 355, 

Rickets — rachitis,  ii 

Ringworm,  ii 

River-bath,  ii 

River  water,  i.  , 

Roasting  flesh,  i 

Roller,  surgical,  ii 

Roman  baths,  i 

Ronchus,  ii 

Root-beer,  i 

Roots,  edible,  i 361, 

liose-rash — roseola,  ii.. 
Ross,  Sir  J.,  on  rum,  i. . 
Rubbing  wet-sheet,  ii.  . . 

Kubeola,  ii 

Rubula,  ii 

Rum-blossoms,  ii 

R:;  nning  scall,  ii 

Ru|>tures,  ii 

Rush  on  alcohol,  i 

Rusks,  i 

Russian  vapor-bath,  L  . . 

Rye— rye  meal,  i 430, 

.Sacchar  ne  urine,  ii 

Sago,  i 327. 

Salads,  i 362, 

Saline  aliment,  i 

Saliva,  i 

Salivary  fistila,  ii 

Salivary  gland.=,  i 

Salt  antiseptic,  i 

Salt,  common,  i 

Samp,  i 

Sand-bath,  i   

Sanguine  temp'ment,  i. . 

Sarcocele,  ii 

Satyrias's,  ii 


Salvages,  vol.  i 

Sax,  on  organic  laws,  ii 

Scabies,  common,  ii 

Scabies,  rough,  ii 

Scalds,  ii 

Scall,  dry,  ii 

Scalled  head,  ii 

Scall,  humid,  ii 

Scallops,  i 

Scaly  eruptions,  ii 

Scapula,  fractured,  ii.  . . 

Scarifying,  ii 

Scarlet  fever,  ii 

Scarlatina,  ii 

Schirrus,  ii 

Schlesekotomy,  ii 

Schuylkill  water,  i 

Sciatica,  ii 

Sclerotitis,  ii 

Scoresby,  on  alcohol,  i.. 
Scorbutus,  ii 


61 

15 

77 
108 
461 
4 
262 
305 

63 
305 

277 
,242 

14 

73 

90 
443 
339 
267 

.301 

322  Scrofula,  ii. 

268 

181 

293 

278 

IS 
126 
425 
425 
436 
305 
411 
430 
262 
305 

39 
316 
345 
328 

38 
2f2 
314 
437 
301 
284 
261 

99 
203 
342 
306 
369 
284 
354 

30 
432 
297 
434 
439 
335 
261 
364 
216 
338 
336 
358 

13 
288 
3.53 


tcurvy,  11 

Scybalum,  ii 

Sea-biscuit,  i 

Seasonings,  i 322,  362. 

Sea  water,  i 

Sebaceous  glands,  i 

Secretion,  i 

Sedative  baths,  ii 

Seed?,  cooked,  i 

Semi-aiiimist  physici.  i.. 

Semolina,  i 

Sensation,  i 

Sensation,  diseases  of,  ii. 
Senses,  external,  i...l89, 

Sensibility,  i 

Sensitive  hair,  ii 

Sentient  nerv's  syst'm,  i. 

Sentimen  alism,  ii 

Sequestrum,  ;i 

Serous  diarrhea,  ii 

Serpents,  bites  of,  ii.  197, 
Serpents,  poisonous,  ii.  . 

Serum,  i 

Sesamoid  bones,  i 

Sexual  diseases,  ii 

Shaddocks,  i 

Shaking  palsy,  ii 

Shallots,  i 

Shallow-bath,  ii 

Shell  fish  as  food,  i 

Sheeps'  trotters  jelly,  i. 
Shew,  Dr.,  on  crisis,  ii.. 

Shingles,  ii 

Ship-bread,  i. 

Ship  fever,  ii 

Shrimps,  i 

Shoulder-joint,  i 

Shoulder,  dislocated,  ii. . 

Shower-bath,  ii 

Sight,  organ  of,  i 

Sight,  morbid,  ii 

Siiiht,  s  nse  of,  i 

Silliness,  ii 

Silver,  poisons  of,  ii 

Sinews,  contracted,  ii. . 

Singultus,  ii 

Sinuses,  i 1.50, 


293  I  Sitz-bath,  ii. 


.  2d 
.  445 
307 
306 
335 
3;J4 
3u6 
306 
349 
303 
410 
338 
lUO 
100 
.346 
425 
316 
126 
181 
281 
173 
173 
172 
145 
354 
441 
317 
278 
277 
28 
430 
28 
354 
250 
264 
250 
239 
309 
242 
276 
359 
144 
200 
324 
277 
77 
285 
350 
211 
3.50 
29 
3:39 
335 
63 
305 
354 
89 
349 
84 
389 
33 
190 
270 
256 
279 
217 
384 
■2'S 
151 
27 


INDEX. 


503 


Page 
Skeleton,  vol  i 57 

Skey,  on  dislocations,  ii.  386 

Skin,  diseases  of,  ii 301 

Skin,  functions  of,  i 279 

Skin,  structure  of.J.-e'^^^Ol 

Sleep,  i ^,^^^^370 

Sleep  disturbanc^ii.  - . 

Sleeplessness,  ii .^ 

Sleeping  apartig^(jMKD^>'-3' 

Sleep-walking,  ii? 27S 

Small-beer,  ^jpr. 314 

Small-pox,  ii 93 

Smee,  on  hysterics,  ii...  209 

Smell,  morbid,  ii 272 

Smell,  organ  of,  i 189 

Smell,  sense  of,  i 2.'i3 

Snail-food — snail-parks,  i  349 

Sneezing,  i 253;  iL  236 

Snoring,  ii 282 

Soda  water,  i 314 

Sodjum,  in  food,  i 334 

Solidist  physicians,  i 26 

Somnambulism,  ii 278 

Sordid  blain,  ii 305 

Sorrel,  meadow,  i 436 

Sound,  philosophy  of,  i.  254 
Sounds,  of  the  heart,  i..  265 

Sounds,  vowel,  i 258 

Spare  diet,  i 446 

Spartan  baths,  i 37 

Spasmodic  diseases,  ii. . .   204 

Special  senses,  i 189,  250 

Specks  in  the  eye,  ii 182 

Speech,  i 257 

Speechlessness,  ii 282 

Spermatic  cord,  i 218 

Spermatocele,  ii 358 

Spermorrhea,  ii 291 

Spina  bifida,  ii 255,  380 

Spinach,  i 362,  439 

Spinal  column,  i 59 

Spinal  cord,  i 169 

Spinal  curvatures,  ii.  232,  380 

Spinal  dropsy,  ii 255 

Spinal  irritation,  ii 290 

Spinal  nei'^'^s,  i. 176 

Spine,  fraclares  of,  ii...  412 

Spitting  of  blood,  ii I7i) 

Splanchnology,  i 204 

Spleen,  enlarged,  ii 250 

Spleen,  inflamed,  ii 118 

Spleen,  mental,  ii 276 

Spleen,  structure  of,  i...  222 

Splints,  surgical,  ii 328 

Sponge-bath,  ii 41 

Sponge,  in  surgory,  ii...  326 
Spontaneous  combus  ,  ii.  179 

Spotted  fever,  ii 89 

Spring  water,  i. 315 

Spray-bath,  ii 40 

Squashes,  i 36!,  440 

Squinting,  ii ,.  .184,  379 

Stahl,i 26 

Stammering — stutter.,  ii.  284 

St.  Anthony's  tire,  ii 103 

Staphyloma,  ii 183 

Starch,  i 327 

Stearns,  on  ergot,  ii 466 

Sternum,  dislocated,  ii.     338 


Page 

Stemal^a,  vol.  ii 224 

Sternuin,  fractured,  ii.. .  411 

Stethescope,  ii 161 

Ste\  ens,  controverted,  ii.  243 

tift'-joint,  ii. 235 

itch  in  the  side,  ii 224 

omach  i 217 

Siomach,  fever  of,  ii 166 

stomach,  inflamed,  ii...  218 
Stomach,  pumping,  ii. . .  429 
Stone  in   the  bladder,  ii.  299 

Stoves,  i 302 

Strabismus,  ii 184,  379 

Strains,  ii 335 

Strangury,  ii 297 

Strawberries,  i 440 

Stretching,  ii 239 

Strict  diet,  i 444 

Strictures,  ii 262 

Struphulous,  ii 302 

Structural  developm't,  i.  249 

Struma  vulgaris,  ii 173 

Studium  inane,  ii 278 

Stunning,  ii 334 

Stupidity,  ii 279 

Sturgeon,  isinglass  of,  i.  335 

St.  Vitus's  dance,  ii 212 

SubmersioQj,  death  by,  ii.  241 

Subsultus,  11 238 

Succotash,  i 431 

Sudoriferous  glands,  i.. .  278 

Suet,  i 330 

SuflbcatioD,  ii 240 

Sugar,  i 336 

Sulphur,  in  food,  i 323 

Sulphur,  poisons  of,  ii. .  320 

Summer  rash,  ii 302 

Sunburn,  ii 3('8 

Superannuation,  ii 279 

SuperfcBtation,  ii 456 

Superstition  in  medici.,  i.     19 

Suppers,  late,  i 312 

Suppressed  urine,  ii 296 

Supra-renal    capsules,  i.  223 

Surfeit,  ii 137 

Surgery,  ii 325 

Surgcal  appliances,  ii.. .  .325 
Suspended  animali(;n.  ii.  239 

Sutures, i.  65 ;  li.  329 

Swathmg  children,  i 376 

Sweat,  morbid,  ii 309 

Sweating-bath,  ii 35 

Sweating-cradle,  ii 39 

Sweet  potatoes,  i  . .  .361,  440 
Sweet,  on  dislocations,  ii.  386 

Swimming-bath,  ii 42 

Swine,  as  food,  i 339 

Swine  pox,  ii 99 

Swooning,  ii 270 

Sycosis,  ii 342 

Sydenham,  i 24 

Sylvius,  i 21 

Symblepharon,  ii 425 

Symptomatic  fevers,  ii..     92 

Syndesmology,  i. 78 

Syncope,  ii 270 

Synocus  fever,  ii 87 

Synovitis,  i 376;  ii.  339 

Syphilis  ii 292 

Tabes,  i: 167 


Pn:?« 

Table  beer,  vol.  i 314 

Talipes,  ii 383 

Tallow,  i 330 

Tamarinds,  i. 350 

Tapioca,  i 327,  434 

Tarsal  joint,  i 91 

Tartaric  acid,  i 3-9 

Tartarous  teeth,  ii 135 

Taste,  morbid,  it 272 

Taste,  organ  of  i 200 

Taste,  sense  oi',  i 252 

Ti'a — tea-drinking,  i.  310,  312 

I'ears,  i 279 

Teeth,  i 67 

Teeth-drawmg,  ii 428 

Teething,  ii L'io 

'l\  inperaments,  i 287 

Temperature,  i 1363 

Tenements,  lighted,  i.  . .  306 

Tents,  surgical,  ii 327 

Testes,  i 228 

Testimony  for  bathing,  i.     46 

Tests  of  waters,  i 318 

Tetanus,  ii 299 

Tetter,  ii -  -  305 

Thames,  water  of  the,  i. .  5i6 

Theobroma  cacao,  i 313 

Theory  and  practice,  ii. .       3 
Theorj'  of  conception,  ii.  493 

Theory  of  fever,  ii 75 

Theory  of  inflamm'n,  ii.  108 
Theory  of  population,  i.  294 

Tnerapeutics,  ii 72 

Thigh,  fractured,  ii 416 

Thirst,  i 264 

Thoracic  duct,  i 158 

Thoracic  viscera,  i 204 

Throat,  inflamed,  ii 113 

Thrush,  ii 201 

Thymus  gland,  ii 451 

Thyroid  gland,  i 311 

Til»ia,  fracture  of,  ii 421 

Tic  Doloreaux,  ii 26u 

Tiger,  diet  of,  i 405 

Tight  dresses,  i 297 

Tinea  capitis,  ii 306 

Tin,  poisons  of,  ii 31 7 

Tissues,  i 54,  235 

Tobacco  inhalations,  i.-  -     45 

Tobacco  smoke,  i 299 

Todd,  on  rabies,  ii 2~'7 

Toe  joints,  i ■  •  -     92 

Toe-nail,  incurvnted,  ii..  343 
Ties,  superfluous,  ii.  . . .  379 

TfJinatoes,  i 440 

Tunes  of  voice,  i 259 

Tongue,  i •  -  200 

Tongue,  mercurializ'd,  ii.  381 

Tongue  tied,  ii 378 

Tonic-baths,  ii 28 

Tonicity  of  muscle,  i 238 

Tonsillitis,  ii H'^ 

Tonsils,  i 216 

Tonsils,  enlarged,  ii  . . . .  378 

Tonsils,  excised,  ii 378 

Toothache,  ii 138 

Toothache  in  pregnan.  ii.  459 

Toothedge,  ii 135 

Toothlessness,  ii j  •'^5 

Tooth  raah,  ii ^03 


504 


INDEX. 


Page 

Tope,  bakers',  vol.  i 354 

Torpitude,  dieeaees  of,  ii.  2.39 

Torsion,  surgical,  ii 329 

Toucli,  morbid,  ii 272 

Touch,  orjrftn  of,  i 201 

Touch,  Bvuse  of,  i 252 

Touriiiqunt,  ii 32^) 

Towel-bath,  ii 41 

Trachea,  structure  of,  i.  210 

Trachea,  inflamed,  ii 114 

Tracheitis,  ii 114 

Tracheotomy,  ii 431 

Trance,  ii 243 

Transfusion,  ii 331 

'Jransudation,  i.   287 

Tremor — trembling,  ii. . .  209 

Trepliining,  ii 423 

Trichiasis — trichosis,  ii. 

184,  310 

Triphthongs,  i 2.38 

Trismus,  ii 2.31 

Tubular  diarrhea,  ii 144 

Tumors,  ii .340 

Turnips,  i 362,  4.37 

Turgescence.  visceral,  ii.  248 

Turkish  baths,  i 40 

Turning  in  childbirth,  ii.  484 

Turn  ot  life,  ii 287 

Turtles,  as  food,  i 347 

Twitchell.  Dr.,  case  of,  i.  413 

Tjphoid  iever,  ii 73 

Typhomania,  ii 244 

Typhus  fever,  ii 88,  89 

Typhus  syncopalis,  ii...  89 
Ulcerated  sore  throat,  ii.  113 

Ulcers,  ii 35fi 

Ulna,  fracture  of,  ii 415 

Umbilical  cord,  ii.  .  .449,  452 
Underground  tenem'ts,  i.  305 
JJnfermented  bread,  i.  . .  355 
Ungovernable  passion,  ii.  275 
United  States,  baths  in,  i,  42 
UnU-avened  bread,  i.  . . .  423 

Urethra,  i 2-.J9 

Urethra,  imperforate,  ii.  43v! 
Urethra,  stricture  of,  ii..  3fi2 

Urinary  calculus,  ii 2P9 

Urinary  diseases,  ii 296 

Urinary  secretion,  i 280 

Urticaria,  ii 201 

Uterine  hcmorrhasre,  ii..  170 
Uterus,  anatortiy  of,  i.  . .  230 

Uterus,  displaced,  ii 292 

Uterus,  dro|-sy  of,  ii.  . . .  2.58 

Uterus,  inflamed,  ii jo] 

Uterus,  inverted  ii..294,  492 
UTiila,  enlarged,  ii 378 


Vaccination,  vol.  ii. .  .96, 
Vaccine   disease — vacci- 
nia, ii 

Vagina,  i 

Vapor-bath,  ii 

Vapors,  ii 

Varicella,  ii 

Varicocele,  ii 

Varicose  aneurism,  ii... 

Variola, 

Varix—varices—varicose 

veias,  ii 351 

Vaults,  i 305 

Veal  skin,  ii 308 

Vectis,  in  parturition,  ii.  485 

V'egetable  diet,  i 444 

Vegetable  food,  i.. .  .350,  423 

Vegetables,  green,  i 4.39 

Vegetarian  dietaries,  i.. .  455 
Vegetarian    societies,   i. 

412,  414,  416 

Veins,  anatomy  of,  i 148 

Venesection,  ii 338 

Venereal  disease,  ii 291 

Venous  absorption,  i.  . .  273 

Ventriloquism,  i 260 

Venus  de  Medicis,  i 299 

Vermicelli,  i....333,  354,  434 
Version,  obstetrical,  ii..  484 

Vertebral  column,  i 58 

Vertigo,  ii 269 

Verucca,  ii 342 

Vesiculae  seminales,  ii..  266 
Vesiciilar  erythema,  ii..  196 

Vesicular  fever,  ii 202 

Vicarious  menstruati.,  ii.  287 
Vicarious  uriitalion.ii.. .  298 
Vicissitudes  of  weath.  i.  36:3 

Vinegar,  i 329 

Vipers,  dried  flesh  of,  i..  25 
Viscera,  anatomy  of,  i. . .  204 
Visceral  inflamm'tion,  ii.  108 
Visceral  turgescence,  ii.  248 
Vismedicat.  natur<p,  i.  25,    .30 

Vitalist  phj-sicians,  i 25 

Vocal  cords,  i 2.59 

Voice,  i 257 

Voice,  imraelodious,  i. . .  283 

Voice,  tones  of,  ii 2-59 

Voice,  vehispering.  ii 283 

Volunt'y  evacuations,  i.  379 

Voluntary  muscles,  i 94 

Vomiting,  action  pf,  i 264 

Vomiting  of  blood,  li 170 

Vowel  sounds,  i 258 

Waists,  female,  i 298 

Walnu;  oil,  i. 330 


Page  Pa^ 

430    Walnuts,  vol.  i 441 

Ward,  on  ergot,  ii 467 

98   Warm-bath,  ii 41 

230   Warts,  ii 342 

37  Wa|hinston'fi  death,  ii..  114 
276 1  'V*Mbr,  acts  on  lead.  i.  . .  320 
^|P    \\~er,  i^duUerat'nsof,  i.  319 

^lajgVater-blebs,  ii 305 

3jT^Vatex-cress,  i 439 


W'at^pirjitae  dietaries,  i..  4.33 
W^ePcure  processes,  ii.  22 
Water-drinking,  i.  308  ;  ii.  57 

Water  in  t^s,  i 308 

Water-melons,  i 440 

Water,  purification  of,  i.  319 
Waters,  medicinal,  i.  ...  317 

Waters,  mineral,  i 317 

Waters,  natural,  i 315 

Waters,  tests  of,  i 318 

Watery  diet,  i 446 

Wave-bath,  ii 39 

Weariness  oi"  life,  ii 276 

Weather,  vicissilxides,  i.  363 

Web  fingers,  ii 379 

Weddin?-chke,  i 354 

Well-wa"ter,  i 316 

Wet  dress-bath,  ii 41 

Wet  wrappers,  ii 53 

Wheat — wheaten  arits,  i. 

352,  353,  431 

Wheezing,  ii 282 

Whelk,  ii 341- 

Whispering  voice,  ii 283 

White  diarrhea,  ii 144 

White  fish,  i 421 

Whites,  ii 289 

White-swelling,  ii 351 

Whitlow,  ii 34.'5 

Whortleberries,  i.  ..436,  440 

Wies:*,  on  crisis,  ii 62 

Wind  cholera,  ii 139 

Wind  colic,  ii. !37 

Wind  dropsy,  ii 25.^ 

Windows,  ventilated,  i..  302 

Worms,  ii 145 

Wounds,  ii 332,  3.38 

Wrist,  anatomy  of,  i.  . . .  86 
Wrist,  fractures  of,  ii.  . .  416 
Wrist,  dislocation  of,  ii..   395 

Wryneck,  ii 2:55,  380 

Yakut's  voracity,  i 3.52 

Yawning,  i 329 

Yaws,  ii 203 

Yeast,  i 425 

Yeast-bread,  i 353,  42.1 

Yellow  fever,  ii 88 

Z .'  oc  poisons,  ii '^Xl 


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